(SLB-016) A Scoping Review of the Benefits and Risks of Prescription Stimulant Medications in Older Adults

Background: Previous reviews have studied prescription stimulant use among older adults for specific disease states, but none have comprehensively examined the full scope of potential benefits and risks of these medications for any therapeutic use.

Objectives: To explore the potential benefits and risks of prescription stimulant use for any therapeutic purpose among older adults.

Methods: We adhered to PRISMA-ScR guidance for the reporting of scoping reviews in this study. We reviewed electronically available literature published between 1/1/1929 through 3/1/2024 that assessed the efficacy and/or safety of prescription stimulants (amphetamine and methylphenidate products), in individuals aged 65 years and older. The associated documentation for search strategy, databases queried, article screening procedures, and inclusion/exclusion criteria can be found in the published Open Science Foundation protocol for this study.

Results: Of 29,843 articles identified, 166 were included (from databases [N=160] vs. from manual grey literature/citation search [N=6]). Prescription stimulants were studied for indications including attention deficit/hyperactivity disorder, Alzheimer’s disease and other dementias, apathy, cancer, chronic illnesses, depression, fatigue, narcolepsy, Parkinson’s disease, stroke rehabilitation, and/or other uses. Methylphenidate was studied in 74% of articles (N=123), amphetamines in 19% (N=31), and any prescription stimulant in 7% (N=12). Immediate-release formulations were most frequently used, and dosing varied by indication(s) studied. Benefits were discussed in 90% of the articles (N=149), and included improved cognitive function, mood, gait/mobility, attention/energy, daily functioning, and social interaction/communication. Risks were discussed in 119 of the articles (72%), most frequently involving neuropsychiatric (e.g., insomnia, agitation/irritability, nervousness, hypomania, psychoses, anorexia), cardiovascular (primarily tachycardia and hypertension), and gastrointestinal adverse effects. The risk of misuse/abuse or dependence was documented in only two case reports. In 66% of articles (N=110), authors reported a favorable opinion towards prescription stimulant use in this population, while 13% were mixed (N=21), 13% unfavorable (N=21), and 8% neutral or unclear (N=14).

Conclusions: Most studies showed that therapeutic benefits of prescription stimulants outweighed their risks in older adult patients. However, a small number of studies highlighted serious risks that outweighed benefits, sometimes requiring medication discontinuation and/or other interventions. Further research is needed to establish comprehensive guidelines for safe prescribing practices in this population.