Psychotropic Medication Burden in Older Persons With Dementia
Psychotropic Medication Burden in Older Persons With Dementia
Objectives To estimate the proportion of community-dwelling older adults with dementia being prescribed a psychotropic and to identify patient and caregiver factors associated with antipsychotic use.
Methods Retrospective cohort study of the Aging, Demographics, and Memory Study (ADAMS) from 2002 to 2004 designed to assess dementia severity and service use of community-dwelling older adults. The frequency of psychotropic medication (antipsychotics, antidepressants, anticonvulsants, and benzodiazepines) use was tabulated and weighted to the U.S. population according to dementia diagnosis. Logistic regression analysis identified factors associated with antipsychotic use.
Results The 307 ADAMS participants had the following dementia diagnoses: Alzheimer's disease (69.3%), vascular dementia (17.7%), and other dementia (12.4%). The proportion of participants prescribed a psychotropic medication broken down according to therapeutic class was 19.1% antipsychotics, 29.1% antidepressants, 9.8% benzodiazepines, and 8.8% anticonvulsants. Older adults with dementia were significantly more likely to receive an antipsychotic if they had moderate (odds ratio (OR) = 7.4, P = .002) or severe (OR = 5.80, P = .002) dementia than if they had mild dementia or were diagnosed with Alzheimer's disease (OR = 6.7, P = .04) compared to vascular dementia. Older adults with dementia who lived with a caregiver were significantly less likely to taking an antipsychotic (OR = 0.19, P = .001) than those who lived alone. Also, persons with dementia were significantly less likely to be prescribed an antipsychotic if their caregiver was clinically depressed (OR = 0.03, P = .005) than if their caregiver was not depressed.
Conclusion Psychotropic medication use is common in community-dwelling older adults with dementia. Caregivers appear to have a substantial effect on whether an antipsychotic is prescribed, which adds additional complexity to conversations discussing the risk:benefit ratio of this medication class.
The number of older adults with dementia is expected to triple by 2050. No cure for dementia exists, and currently available therapies only slow progression for a limited period of time. Dementia is characterized by cognitive loss and occupational, social, and physical decline. Neuropsychiatric symptoms such as anxiety and depression, thought and perceptual problems, and activity disturbances also accompany the disease process, with a prevalence of 60% to 80%.
Neuropsychiatric symptoms pose a substantial problem for persons with dementia and their families. People with neuropsychiatric symptoms have greater functional impairment, more-rapid cognitive decline, and overall poorer quality of life than those without. At the same time, caregivers of persons with dementia exhibiting neuropsychiatric symptoms report higher levels of depression and burden than caregivers of persons with dementia without these symptoms. Medications such as antipsychotics, antidepressants, anticonvulsants, and benzodiazepines are frequently used to ameliorate neuropsychiatric symptoms, but the frequency of their use in community-dwelling persons with dementia has not been well established.
Thought and perceptual problems and activity disturbances remain particularly problematic because no Food and Drug Administration (FDA)–approved medication currently exists for treatments, and commonly used off-label therapies have noteworthy shortcomings. Controversy exists over the use of antipsychotics for neuropsychiatric symptoms in this population because of the marginally higher rate of cerebrovascular events and death, even with low-dose, short-term use. Debates surrounding the risk:benefit ratio of antipsychotic use have emphasized patient-related outcomes while overlooking the caregiver's health. Caregiver outcomes are extremely important to consider because poorly controlled neuropsychiatric symptoms are frequently cited as a determinant of nursing home placement of people with dementia.
The current investigation took advantage of the Health and Retirement Study, a probability-based nationally representative longitudinal study, to address some of these current gaps in the literature. The first objective of the study was to quantify psychotropic medication use in community-dwelling persons with dementia. The second was to identify patient and caregiver factors associated with antipsychotic use in this population. Taken together, the study findings detail the overall burden of psychotropic medication use in community-dwelling persons with dementia and serve as a benchmark to compare practice patterns. Patient and caregiver factors associated with antipsychotic use are identified and help to better understand characteristics associated with their use in community-dwelling populations.
Abstract and Introduction
Abstract
Objectives To estimate the proportion of community-dwelling older adults with dementia being prescribed a psychotropic and to identify patient and caregiver factors associated with antipsychotic use.
Methods Retrospective cohort study of the Aging, Demographics, and Memory Study (ADAMS) from 2002 to 2004 designed to assess dementia severity and service use of community-dwelling older adults. The frequency of psychotropic medication (antipsychotics, antidepressants, anticonvulsants, and benzodiazepines) use was tabulated and weighted to the U.S. population according to dementia diagnosis. Logistic regression analysis identified factors associated with antipsychotic use.
Results The 307 ADAMS participants had the following dementia diagnoses: Alzheimer's disease (69.3%), vascular dementia (17.7%), and other dementia (12.4%). The proportion of participants prescribed a psychotropic medication broken down according to therapeutic class was 19.1% antipsychotics, 29.1% antidepressants, 9.8% benzodiazepines, and 8.8% anticonvulsants. Older adults with dementia were significantly more likely to receive an antipsychotic if they had moderate (odds ratio (OR) = 7.4, P = .002) or severe (OR = 5.80, P = .002) dementia than if they had mild dementia or were diagnosed with Alzheimer's disease (OR = 6.7, P = .04) compared to vascular dementia. Older adults with dementia who lived with a caregiver were significantly less likely to taking an antipsychotic (OR = 0.19, P = .001) than those who lived alone. Also, persons with dementia were significantly less likely to be prescribed an antipsychotic if their caregiver was clinically depressed (OR = 0.03, P = .005) than if their caregiver was not depressed.
Conclusion Psychotropic medication use is common in community-dwelling older adults with dementia. Caregivers appear to have a substantial effect on whether an antipsychotic is prescribed, which adds additional complexity to conversations discussing the risk:benefit ratio of this medication class.
Introduction
The number of older adults with dementia is expected to triple by 2050. No cure for dementia exists, and currently available therapies only slow progression for a limited period of time. Dementia is characterized by cognitive loss and occupational, social, and physical decline. Neuropsychiatric symptoms such as anxiety and depression, thought and perceptual problems, and activity disturbances also accompany the disease process, with a prevalence of 60% to 80%.
Neuropsychiatric symptoms pose a substantial problem for persons with dementia and their families. People with neuropsychiatric symptoms have greater functional impairment, more-rapid cognitive decline, and overall poorer quality of life than those without. At the same time, caregivers of persons with dementia exhibiting neuropsychiatric symptoms report higher levels of depression and burden than caregivers of persons with dementia without these symptoms. Medications such as antipsychotics, antidepressants, anticonvulsants, and benzodiazepines are frequently used to ameliorate neuropsychiatric symptoms, but the frequency of their use in community-dwelling persons with dementia has not been well established.
Thought and perceptual problems and activity disturbances remain particularly problematic because no Food and Drug Administration (FDA)–approved medication currently exists for treatments, and commonly used off-label therapies have noteworthy shortcomings. Controversy exists over the use of antipsychotics for neuropsychiatric symptoms in this population because of the marginally higher rate of cerebrovascular events and death, even with low-dose, short-term use. Debates surrounding the risk:benefit ratio of antipsychotic use have emphasized patient-related outcomes while overlooking the caregiver's health. Caregiver outcomes are extremely important to consider because poorly controlled neuropsychiatric symptoms are frequently cited as a determinant of nursing home placement of people with dementia.
The current investigation took advantage of the Health and Retirement Study, a probability-based nationally representative longitudinal study, to address some of these current gaps in the literature. The first objective of the study was to quantify psychotropic medication use in community-dwelling persons with dementia. The second was to identify patient and caregiver factors associated with antipsychotic use in this population. Taken together, the study findings detail the overall burden of psychotropic medication use in community-dwelling persons with dementia and serve as a benchmark to compare practice patterns. Patient and caregiver factors associated with antipsychotic use are identified and help to better understand characteristics associated with their use in community-dwelling populations.
Source...