Making Medication Therapy Management a Cornerstone of Community-Based Care for People with Alzheimer's Disease and Other Forms of Dementia

Article excerpt

Editor's Note. The following document reports on research conducted in 2006 and is reprinted and adapted for the Care Management Journals format with permission from the Medicare Rights Center (www.medicarerights.org).

People with Alzheimer's disease and other forms of dementia have a particular need for medication therapy management (MTM) services that improve compliance with drug regimens and address inappropriate prescribing. All Medicare Part D plans are required to establish MTM programs, but plans have generally favored eligibility criteria, modes of delivery, and enrollment models that are ill suited to people with dementia. The Centers for Medicare and Medicaid Services (CMS) should take a proactive stance to encourage the development of MTM programs that meet the needs of people with Alzheimer's disease and other forms of dementia, particularly those who reside in the community.

Every year the United States spends over $200 billion to correct medication-related problems. 1 Some patients do not take their medicine as prescribed; some are treated with too much, too little, or the wrong medicine; and some are prescribed medicines that interact dangerously with each other (Table 1). As a result, as many as 200,000 people in the United States may die from medication-related problems each year 2 and 16% of all hospital admissions are due to medication-related problems.3

The burden of advancing age and increasing incidence of chronic illness makes older adults particularly vulnerable to these medication-related problems. On average, they are taking more medications and many are becoming less able to manage them. The Office of Inspector General of the Health and Human Services Department reports that 55% of older adults fail to comply in some way with their medication regimen.4 Nearly 28% of hospital admissions for people age 65 and older are due to medication-related problems.5 Moreover, medication-related problems are estimated to be one of the top five causes of death in that age group.6 One quarter of all nursing home admissions result from older people being unable to take their medications properly.7

These challenges are amplified for people with diminished capacity to make sound health care decisions, such as those with Alzheimer's disease or dementia. Alzheimer's disease, a progressive brain disorder that results in a gradual and steady deterioration of mental ability, can make it impossible for a person to manage his or her medication. Dementia was identified by the Office of Inspector General as one of the dominant reasons older adults fail to comply with their medication regimens.8 Similarly, a survey commissioned by the Mental Health Foundation of the United Kingdom found that over 90% of people with dementia who were living in the community suffered from medicationrelated problems.9 The financial and social implications of this are devastating.

In the United States, at least $100 billion is spent each year on Alzheimer's disease, with the average lifetime cost of care for an individual with Alzheimer's disease estimated at $174,000 in 1991.10 The average annual direct cost of care in 1998 was $19,000 per individual still in the community and $64,000 per institutionalized individual. 11 Further, most individuals with Alzheimer's disease eventually spend part of their lives in a nursing home or assisted living facility.

The comprehensive approach of MTM could play a crucial role in optimizing therapeutic outcomes for people with dementia and lead to reduced overall health care expenditures. The provision of MTM services for this population could optimize the use of medicines that slow the rate of mental decline, minimize the use of drugs that worsen dementia, as well as the inappropriate use of drug therapy to address behavioral symptoms of Alzheimer's disease. The application of MTM can also help with compliance with drug regimens, potentially delaying the need for long-term care services. …