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Prescribing of psychotropic drugs and indicators for use in residential aged care and residents with dementia

Published online by Cambridge University Press:  20 November 2018

R. E. Brimelow Open the ORCID record for R. E. Brimelow [Opens in a new window] ,
J. A. Wollin ,
G. J. Byrne  and
N. N. Dissanayaka
R. E. Brimelow*
Affiliation:
The University of Queensland, UQ Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women’s Hospital Campus, Herston, Queensland, Australia
J. A. Wollin
Affiliation:
Queensland University of Technology, School of Nursing, Kelvin Grove, Queensland, Australia
G. J. Byrne
Affiliation:
The University of Queensland, UQ Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women’s Hospital Campus, Herston, Queensland, Australia Royal Brisbane and Women’s Hospital, Royal Brisbane Clinical Unit, Herston, Queensland, Australia
N. N. Dissanayaka
Affiliation:
The University of Queensland, UQ Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women’s Hospital Campus, Herston, Queensland, Australia Royal Brisbane and Women’s Hospital, Royal Brisbane Clinical Unit, Herston, Queensland, Australia
*
Correspondence should be addressed to: Rachel E. Brimelow, The University of Queensland, UQ Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women’s Hospital Campus, Herston, Queensland 4029, Australia. Phone: +0419 627 382. Email: r.brimelow@wmq.org.au.
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Abstract

Introduction:

It is well established that there is a high prescribing rate of psychotropic agents in residential aged care (RAC). The appropriateness of these medications has become controversial, given the limited data on efficacy and growing evidence of associated adverse outcomes.

Objective:

To assess psychotropic prescribing in RAC including identification of potentially inappropriate prescriptions (PIPs) and common psychological and behavioral symptoms indicated for prescribing. These were viewed in context of dementia and different RAC facilities.

Methods:

Electronic care plans of 779 RAC residents across 12 facilities were examined to elucidate psychotropic prescribing rates, PIPs, and indications for use.

Results:

One in two residents (48.1%) were prescribed a psychotropic drug. The primary reasons for prescribing were depression (61.5%), anxiety (26.7%), sleep problems (25.4%), agitation (13.7%), psychosis (11.0%), and other behaviors (7.2%). Residents with dementia (56.6%) were more likely to be prescribed a drug for agitation and psychosis, and had a significantly increased prescription rate for antidepressants (OR = 1.50, 95% CI = 1.08–2.08, p = 0.01) and antipsychotics (OR = 1.88, 95% CI = 1.23–2.88, p < 0.01). Conversely, residents with dementia were less likely to receive medication to combat sleeping difficulties, with significantly lower benzodiazepine prescribing (OR = 0.63, 95% CI = 0.44–0.91, p = 0.01). Over half of all psychotropic prescriptions (54.0%) were potentially inappropriate based on the Beers Criteria. There was high variability of prescribing rates between homes.

Conclusion:

There is a high prescribing rate of potentially inappropriate medications. Residents with dementia are more likely to receive medication for agitation and psychosis, and are less likely to receive medication to combat sleeping difficulties.

Keywords

aged carenursing homedementiabehavioral and psychological symptoms of dementia (BPSD)psychogeriatrics
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 6: Issue Theme: Frailty, Cognition, and Mental Health , June 2019 , pp. 837 - 847
Copyright
© International Psychogeriatric Association 2018 

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References

Álamo, C., López-Muñoz, F., García-García, P. and García-Ramos, S. (2014). Risk-benefit analysis of antidepressant drug treatment in the elderly. Psychogeriatrics, 14, 261–268. doi: 10.1111/psyg.12057.CrossRefGoogle ScholarPubMed
Australian Institute of Health and Welfare (2013). Depression in Residential Aged Care 2008–2012. Aged Care Statistics Series No. 39. Canberra, ACT: AIWH.Google Scholar
Australian Institute of Health and Welfare (2016). Australia’s Health 2016. Dementia. Australia’s Health Series No. 15. Cat. No. AUS 199. Canberra: AIHW.Google Scholar
Azermai, M., Elseviers, M., Petrovic, M., Van Bortel, L. and Stichele, R. V. (2011). Geriatric drug utilisation of psychotropics in Belgian nursing homes. Human Psychopharmacology: Clinical and Experimental, 26, 12–20. doi: 10.1002/hup.1160.CrossRefGoogle ScholarPubMed
Ballard, C. G., Waite, J. and Birks, J. (2006). Atypical antipsychotics for aggression and psychosis in Alzheimer’s disease. Cochrane Database of Systematic Reviews, Art. No.: CD003476. doi: 10.1002/14651858.CD003476.pub2.Google Scholar
Banerjee, S. et al. (2011). Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. The Lancet, 378, 403–411. doi: 10.1016/S0140-6736(11)60830-1.CrossRefGoogle ScholarPubMed
Bathena, S. P. R., Leppik, I. E., Kanner, A. M. and Birnbaum, A. K. (2017). Antiseizure, antidepressant, and antipsychotic medication prescribing in elderly nursing home residents. Epilepsy & Behavior, 69, 116–120. doi: 10.1016/j.yebeh.2017.01.027.CrossRefGoogle ScholarPubMed
Bloch, F., Thibaud, M., Dugué, B., Brèque, C., Rigaud, A.-S. and Kemoun, G. (2011). Psychotropic drugs and falls in the elderly people: updated literature review and meta-analysis. Journal of Aging and Health, 23, 329–346. doi: 10.1177/0898264310381277.CrossRefGoogle ScholarPubMed
Bourgeois, J., Elseviers, M. M., Azermai, M., Van Bortel, L., Petrovic, M. and Vander Stichele, R. R. (2012). Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages. European Journal of Clinical Pharmacology, 68, 833–844. doi: 10.1007/s00228-011-1188-z.CrossRefGoogle ScholarPubMed
Cabrera, E. et al. (2015). Non-pharmacological interventions as a best practice strategy in people with dementia living in nursing homes. A systematic review. European Geriatric Medicine, 6, 134–150. doi: 10.1016/j.eurger.2014.06.003.CrossRefGoogle Scholar
Campanellie, C. M. (2012). American geriatrics society updated Beers Criteria for potentially inappropriate medication use in older adults: the American geriatrics society 2012 Beers Criteria update expert panel. Journal of the American Geriatrics Society, 60, 616–631. doi: 10.1111/j.1532-5415.2012.03923.x.Google Scholar
Cerejeira, J., Lagarto, L. and Mukaetova-Ladinska, E. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, 73. doi: 10.3389/fneur.2012.00073.CrossRefGoogle ScholarPubMed
Chen, Y., Briesacher, B. A., Field, T. S., Tjia, J., Lau, D. T. and Gurwitz, J. H. (2010). Unexplained variation across US nursing homes in antipsychotic prescribing rates. Archives of Internal Medicine, 170, 89–95. doi: 10.1001/archinternmed.2009.469.CrossRefGoogle ScholarPubMed
Creighton, A. S., Davison, T. E. and Kissane, D. W. (2016). The prevalence of anxiety among older adults in nursing homes and other residential aged care facilities: a systematic review. International Journal of Geriatric Psychiatry, 31, 555–566. doi: 10.1002/gps.4378.CrossRefGoogle ScholarPubMed
Cool, C. et al. (2014). Potentially inappropriate drug prescribing and associated factors in nursing homes. Journal of the American Medical Directors Association, 15, 850.e1–850.e9. doi: 10.1016/j.jamda.2014.08.003.CrossRefGoogle ScholarPubMed
de Maat, S. M., Dekker, J., Schoevers, R. A. and de Jonghe, F. (2007). Relative efficacy of psychotherapy and combined therapy in the treatment of depression: a meta-analysis. European Psychiatry, 22, 1–8. doi: 10.1016/j.eurpsy.2006.10.008.CrossRefGoogle ScholarPubMed
Department of Health (2016). Aged Care Funding Instrument (ACFI). User guide 2016. Australian Government. Canberra, ACT: DoH.Google Scholar
Eggermont, L. H., De Vries, K. and Scherder, E. J. (2009). Psychotropic medication use and cognition in institutionalized older adults with mild to moderate dementia. International Psychogeriatrics, 21, 286–294. doi: 10.1017/S1041610209008552.CrossRefGoogle ScholarPubMed
Farina, N., Morrell, L. and Banerjee, S. (2017). What is the therapeutic value of antidepressants in dementia? A narrative review. International Journal of Geriatric Psychiatry, 32, 32–49. doi: 10.1002/gps.4566.CrossRefGoogle ScholarPubMed
Flick, U., Garms-Homolová, V. and Röhnsch, G. (2012). “And mostly they have a need for sleeping pills”: Physicians’ views on treatment of sleep disorders with drugs in nursing homes. Journal of Aging Studies, 26, 484–494. doi: 10.1016/j.jaging.2012.07.001.CrossRefGoogle ScholarPubMed
Fournier, J. C. et al. (2010). Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA, 303, 47–53. doi: 10.1001/jama.2009.1943.CrossRefGoogle ScholarPubMed
Galik, E. and Resnick, B. (2013). Psychotropic medication use and association with physical and psychosocial outcomes in nursing home residents. Journal of Psychiatric and Mental Health Nursing, 20, 244–252. doi: 10.1111/j.1365-2850.2012.01911.x.CrossRefGoogle ScholarPubMed
Gerardin, M., Victorri-Vigneau, C., Guerlais, M., Guillou-Landreat, M., Grall-Bronnec, M. and Jolliet, P. (2014). Benzodiazepines consumption: does dependence vary with age? Substance Use & Misuse, 49, 1417–1425. doi: 10.3109/10826084.2014.912226.CrossRefGoogle ScholarPubMed
Glass, J., Lanctôt, K. L., Herrmann, N., Sproule, B. A. and Busto, U. E. (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ, 331, 1169. doi: 10.1136/bmj.38623.768588.47.CrossRefGoogle ScholarPubMed
Gustafsson, M., Isaksson, U., Karlsson, S., Sandman, P.-O. and Lövheim, H. (2016). Behavioral and psychological symptoms and psychotropic drugs among people with cognitive impairment in nursing homes in 2007 and 2013. European Journal of Clinical Pharmacology, 72, 987–994. doi: 10.1007/s00228-016-2058-5.CrossRefGoogle ScholarPubMed
Hanlon, J. T., Handler, S. M. and Castle, N. G. (2010). Antidepressant prescribing in US nursing homes between 1996 and 2006 and its relationship to staffing patterns and use of other psychotropic medications. Journal of the American Medical Directors Association, 11, 320–324. doi: 10.1016/j.jamda.2010.01.007.CrossRefGoogle ScholarPubMed
Khouzam, H. (2009). The diagnosis and treatment of depression in the geriatric population. Comprehensive Therapy, 35, 103.Google ScholarPubMed
Kleijer, B. C. et al. (2014). Variability between nursing homes in prevalence of antipsychotic use in patients with dementia. International Psychogeriatrics, 26, 363–371. doi: 10.1017/S1041610213002019.CrossRefGoogle ScholarPubMed
Landi, F. et al. (2005). Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 60, 622–626. doi: 10.1093/gerona/60.5.622.CrossRefGoogle ScholarPubMed
Lustenberger, I., Schüpbach, B., Von Gunten, A. and Mosimann, U. (2011). Psychotropic medication use in Swiss nursing homes. Swiss Medical Weekly, 141, w13254. doi: 10.4414/smw.2011.13254.Google ScholarPubMed
Nelson, J. C., Delucchi, K. L. and Schneider, L. S. (2013). Moderators of outcome in late-life depression: a patient-level meta-analysis. American Journal of Psychiatry, 170, 651–659. doi: 10.1176/appi.ajp.2012.12070927.CrossRefGoogle ScholarPubMed
Olsson, J. et al. (2010). Quality of drug prescribing in elderly people in nursing homes and special care units for dementia: a cross-sectional computerized pharmacy register analysis. Clinical Drug Investigation, 30, 289–300. doi: 10.2165/11534320-000000000-00000.CrossRefGoogle ScholarPubMed
Paterniti, S., Dufouil, C. and Alpérovitch, A. (2002). Long-term benzodiazepine use and cognitive decline in the elderly: the epidemiology of vascular aging study. Journal of Clinical Psychopharmacology, 22, 285–293. doi: 10.1097/00004714-200206000-00009.CrossRefGoogle ScholarPubMed
Peisah, C. and Skladzien, E. (2014). The Use of Restraints and Psychotropic Medications in People With Dementia (Vol. 38) A Report for Alzheimer’s Australia. Alzheimer’s Australia.Google Scholar
Pitkala, K. H. et al. (2012). Reducing inappropriate, anticholinergic and psychotropic drugs among older residents in assisted living facilities: study protocol for a randomized controlled trial. Trials, 13, 85. doi: 10.1186/1745-6215-13-85.CrossRefGoogle ScholarPubMed
Riese, F. (2015). An update on current treatment strategies for behavioural and psychological symptoms of dementia. European Psychiatry, 30, 26. doi: 10.1016/S0924-9338(15)30020-1.CrossRefGoogle Scholar
Richter, T., Mann, E., Meyer, G., Haastert, B. and Köpke, S. (2012). Prevalence of psychotropic medication use among German and Austrian nursing home residents: a comparison of 3 cohorts. Journal of the American Medical Directors Association, 13, 187e7–187.e13. doi: 10.1016/j.jamda.2011.03.007.CrossRefGoogle ScholarPubMed
Rosenberg, P. B. et al. (2012). The association of psychotropic medication use with the cognitive, functional, and neuropsychiatric trajectory of Alzheimer’s disease. International Journal of Geriatric Psychiatry, 27, 1248–1257. doi: 10.1002/gps.3769.CrossRefGoogle ScholarPubMed
Ruths, S. et al. (2013). Trends in psychotropic drug prescribing in Norwegian nursing homes from 1997 to 2009: a comparison of six cohorts. International Journal of Geriatric Psychiatry, 28, 868–876. doi: 10.1002/gps.3902.CrossRefGoogle ScholarPubMed
Seitz, D., Purandare, N. and Conn, D. (2010). Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. International Psychogeriatrics, 22, 1025–1039. doi: 10.1017/S1041610210000608.CrossRefGoogle ScholarPubMed
Skottheim, A., Lövheim, H., Isaksson, U., Sandman, P.-O. and Gustafsson, M. (2017). Insomnia symptoms among old people in nursing homes. International Psychogeriatrics, 30, 77–85. doi: 10.1017/s1041610217001703.CrossRefGoogle ScholarPubMed
Snowdon, J., Galanos, D. and Vaswani, D. (2011). A 2009 survey of psychotropic medication use in Sydney nursing homes. The Medical Journal of Australia, 194, 270–271.Google ScholarPubMed
Stephenson, C. P., Karanges, E. and Mcgregor, I. S. (2012). Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011. Australian and New Zealand Journal of Psychiatry, 47, 74–87. doi: 10.1177/0004867412466595.CrossRefGoogle ScholarPubMed
Takkouche, B., Montes-Martinez, A., Gill, S. S. and Etminan, M. (2007). Psychotropic medications and the risk of fracture. Drug Safety, 30, 171–184. doi: 10.2165/00002018-200730020-00006.CrossRefGoogle ScholarPubMed
Tampi, R. R., Tampi, D. J., Balachandran, S. and Srinivasan, S. (2016). Antipsychotic use in dementia: a systematic review of benefits and risks from meta-analyses. Therapeutic Advances in Chronic Disease, 7, 229–245. doi: 10.1177/2040622316658463.CrossRefGoogle ScholarPubMed
van Der Spek, K. et al. (2016). Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-study. International Psychogeriatrics, 28, 1589–1595. doi: 10.1017/S104161021600082X.CrossRefGoogle ScholarPubMed
Vasudev, A. et al. (2015). Trends in psychotropic dispensing among older adults with dementia living in long-term care facilities: 2004-2013. The American Journal of Geriatric Psychiatry, 23, 1259–1269. doi: 10.1016/j.jagp.2015.07.001.CrossRefGoogle ScholarPubMed
Volicer, L. (2012). Antipsychotics do not have to be used “off label” in dementia. Journal of the American Medical Directors Association, 13, 495–496. doi: 10.1016/j.jamda.2012.04.006.CrossRefGoogle Scholar
Weitz, E., Hollon, S. D., Twisk, J., van Straten, A., David, D. and Cuijpers, P. (2015). Does baseline depression severity moderate outcomes between CBT and pharmacotherapy? An individual participant data meta-analysis. JAMA Psychiatry, 72, 1102–1109. doi: 10.1001/jamapsychiatry.2015.1516.CrossRefGoogle Scholar
Zuidema, S. U. et al. (2015). A consensus guideline for antipsychotic drug use for dementia in care homes. Bridging the gap between scientific evidence and clinical practice. International Psychogeriatrics, 27, 1849–1859. doi: 10.1017/S1041610215000745.CrossRefGoogle ScholarPubMed