Deprescribing antihypertensive medications may help reduce cognitive decline in nursing home residents, particularly those with dementia, and long-term care providers should weigh the risks when prescribing these drugs to reduce the potential for resident harm, according to new research.
In a study published Monday in JAMA Internal Medicine, researchers from the University of California, San Francisco, and Stanford University used a target trial emulation approach to study the effects of deprescribing on cognitive function of more than 12,000 long-term care residents in Veterans Administration nursing homes between 2006 and 2019. The average age of the residents was nearly 78 years old.
“Our study suggests that deprescribing antihypertensives may protect nursing home residents from future cognitive losses, especially for those living with dementia,” study authors wrote. “This work highlights the need for patient-centered approaches to deprescribing, ensuring that medication regimens for older adults are optimized to preserve cognitive function and minimize potential harms.”
Nursing home residents were studied in two groups: those with stable blood pressure medication usage and those in the deprescribing group. Deprescribing was defined as a 30% decrease in antihypertensive medication use, sustained for a minimum of two weeks.
Investigators used the Cognitive Function Scale (CFS) to measure the residents’ cognitive function and impairment for a period of 12 weeks. Over that span, residents who were in the deprescribing group had a 12% decrease in their odds of progressing to a worse CFS category and a 16% reduction in the odds of further cognitive decline among residents with dementia, the researchers found.
The study further pointed to the need for more research on the potential benefits and harms of antihypertensive deprescribing to better inform medication management in nursing homes.
Other recent research has found other potentially negative impacts of antihypertensive medications for older adults, including one recent study which found an association between the use of antihypertensive medications, particularly diuretics, and increased risks of fractures and falls.
Describing medications has become a topic of increased interest in the long-term care industry in recent years. A 2023 study by the University of Michigan found that 80% of older adults between the ages of 50 and 80 would be willing to stop taking one of their long-term prescription medications and 82% if approved by their clinician, and 82% of people in that group take at least one prescription medicine regularly.
However, that study’s authors noted that clinicians and patients must carefully weigh the risks as well as the potential benefits when considering deprescribing medications.
