Psychotropic Polypharmacy in Patients with Dementia: Prevalence and Predictors

Ane Nørgaard; Christina Jensen-Dahm; Christiane Gasse; Elsebet Steno Hansen; Gunhild Waldemar

doi:10.3233/JAD-160828

Psychotropic Polypharmacy in Patients with Dementia: Prevalence and Predictors

Ane Nørgaard, Christina Jensen-Dahm, Christiane Gasse, Elsebet Steno Hansen, Gunhild Waldemar

Institut for Klinisk Medicin

29 Citationer (Scopus)

Abstract

BACKGROUND: Antipsychotics and other psychotropics are frequently used to treat neuropsychiatric symptoms in patients with dementia, even though the evidence for effect is limited. Concerns have been raised about the safety of antipsychotics, but concomitant use of multiple psychotropic drug classes (psychotropic polypharmacy) may also pose a risk for patients.

OBJECTIVE: To investigate the prevalence and predictors associated with use of psychotropic polypharmacy in patients with dementia.

METHODS: A population-based study using nationwide registers. Patients with dementia were identified among all Danish residents ≥65 years on January 1, 2012. Data on prescriptions and comorbidity was included in the analysis. Overlapping prescriptions for different psychotropic drug classes were used to determine psychotropic polypharmacy. A multivariable logistic regression analysis was conducted to evaluate factors independently associated with the prescription of other psychotropic drug classes among patients already using antipsychotics.

RESULTS: Among all patients registered with dementia (34,553), 25.3% (8,728) used ≥2 psychotropic drugs. Among patients treated with antipsychotics 75.8% (5,403) used at least one other psychotropic drug during the antipsychotic treatment period. Nursing home residency, number of non-psychotropic medications used in 2011, and prior psychiatric diagnosis were associated with psychotropic polypharmacy among antipsychotic drug users. The most frequent combination of psychotropic drugs was antipsychotics and antidepressants.

CONCLUSION: Concomitant use of psychotropic drugs was frequent in dementia patients. Patients living in nursing homes had the highest risk of receiving a combination of antipsychotics and other psychotropic drugs. Concomitant use of psychotropics may cause adverse events, and potential consequences for patients' safety call for further investigation.

Originalsprog	Engelsk
Tidsskrift	Journal of Alzheimer's Disease
Vol/bind	56
Udgave nummer	2
Sider (fra-til)	707-716
ISSN	1387-2877
DOI	https://doi.org/10.3233/JAD-160828
Status	Udgivet - 2017

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10.3233/JAD-160828

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@article{339b00e7a9ea46d6bc874f66d7fc9d20,

title = "Psychotropic Polypharmacy in Patients with Dementia: Prevalence and Predictors",

abstract = "BACKGROUND: Antipsychotics and other psychotropics are frequently used to treat neuropsychiatric symptoms in patients with dementia, even though the evidence for effect is limited. Concerns have been raised about the safety of antipsychotics, but concomitant use of multiple psychotropic drug classes (psychotropic polypharmacy) may also pose a risk for patients.OBJECTIVE: To investigate the prevalence and predictors associated with use of psychotropic polypharmacy in patients with dementia.METHODS: A population-based study using nationwide registers. Patients with dementia were identified among all Danish residents ≥65 years on January 1, 2012. Data on prescriptions and comorbidity was included in the analysis. Overlapping prescriptions for different psychotropic drug classes were used to determine psychotropic polypharmacy. A multivariable logistic regression analysis was conducted to evaluate factors independently associated with the prescription of other psychotropic drug classes among patients already using antipsychotics.RESULTS: Among all patients registered with dementia (34,553), 25.3% (8,728) used ≥2 psychotropic drugs. Among patients treated with antipsychotics 75.8% (5,403) used at least one other psychotropic drug during the antipsychotic treatment period. Nursing home residency, number of non-psychotropic medications used in 2011, and prior psychiatric diagnosis were associated with psychotropic polypharmacy among antipsychotic drug users. The most frequent combination of psychotropic drugs was antipsychotics and antidepressants.CONCLUSION: Concomitant use of psychotropic drugs was frequent in dementia patients. Patients living in nursing homes had the highest risk of receiving a combination of antipsychotics and other psychotropic drugs. Concomitant use of psychotropics may cause adverse events, and potential consequences for patients' safety call for further investigation.",

keywords = "Aged, Aged, 80 and over, Comorbidity, Dementia/drug therapy, Denmark, Female, Homes for the Aged, Humans, Logistic Models, Male, Multivariate Analysis, Nursing Homes, Odds Ratio, Polypharmacy, Prevalence, Psychotropic Drugs/therapeutic use, Registries, Risk Factors",

author = "Ane N{\o}rgaard and Christina Jensen-Dahm and Christiane Gasse and Hansen, {Elsebet Steno} and Gunhild Waldemar",

year = "2017",

doi = "10.3233/JAD-160828",

language = "English",

volume = "56",

pages = "707--716",

journal = "Journal of Alzheimer's Disease",

issn = "1387-2877",

publisher = "I O S Press",

number = "2",

}

TY - JOUR

T1 - Psychotropic Polypharmacy in Patients with Dementia

T2 - Prevalence and Predictors

AU - Nørgaard, Ane

AU - Jensen-Dahm, Christina

AU - Gasse, Christiane

AU - Hansen, Elsebet Steno

AU - Waldemar, Gunhild

PY - 2017

Y1 - 2017

N2 - BACKGROUND: Antipsychotics and other psychotropics are frequently used to treat neuropsychiatric symptoms in patients with dementia, even though the evidence for effect is limited. Concerns have been raised about the safety of antipsychotics, but concomitant use of multiple psychotropic drug classes (psychotropic polypharmacy) may also pose a risk for patients.OBJECTIVE: To investigate the prevalence and predictors associated with use of psychotropic polypharmacy in patients with dementia.METHODS: A population-based study using nationwide registers. Patients with dementia were identified among all Danish residents ≥65 years on January 1, 2012. Data on prescriptions and comorbidity was included in the analysis. Overlapping prescriptions for different psychotropic drug classes were used to determine psychotropic polypharmacy. A multivariable logistic regression analysis was conducted to evaluate factors independently associated with the prescription of other psychotropic drug classes among patients already using antipsychotics.RESULTS: Among all patients registered with dementia (34,553), 25.3% (8,728) used ≥2 psychotropic drugs. Among patients treated with antipsychotics 75.8% (5,403) used at least one other psychotropic drug during the antipsychotic treatment period. Nursing home residency, number of non-psychotropic medications used in 2011, and prior psychiatric diagnosis were associated with psychotropic polypharmacy among antipsychotic drug users. The most frequent combination of psychotropic drugs was antipsychotics and antidepressants.CONCLUSION: Concomitant use of psychotropic drugs was frequent in dementia patients. Patients living in nursing homes had the highest risk of receiving a combination of antipsychotics and other psychotropic drugs. Concomitant use of psychotropics may cause adverse events, and potential consequences for patients' safety call for further investigation.

AB - BACKGROUND: Antipsychotics and other psychotropics are frequently used to treat neuropsychiatric symptoms in patients with dementia, even though the evidence for effect is limited. Concerns have been raised about the safety of antipsychotics, but concomitant use of multiple psychotropic drug classes (psychotropic polypharmacy) may also pose a risk for patients.OBJECTIVE: To investigate the prevalence and predictors associated with use of psychotropic polypharmacy in patients with dementia.METHODS: A population-based study using nationwide registers. Patients with dementia were identified among all Danish residents ≥65 years on January 1, 2012. Data on prescriptions and comorbidity was included in the analysis. Overlapping prescriptions for different psychotropic drug classes were used to determine psychotropic polypharmacy. A multivariable logistic regression analysis was conducted to evaluate factors independently associated with the prescription of other psychotropic drug classes among patients already using antipsychotics.RESULTS: Among all patients registered with dementia (34,553), 25.3% (8,728) used ≥2 psychotropic drugs. Among patients treated with antipsychotics 75.8% (5,403) used at least one other psychotropic drug during the antipsychotic treatment period. Nursing home residency, number of non-psychotropic medications used in 2011, and prior psychiatric diagnosis were associated with psychotropic polypharmacy among antipsychotic drug users. The most frequent combination of psychotropic drugs was antipsychotics and antidepressants.CONCLUSION: Concomitant use of psychotropic drugs was frequent in dementia patients. Patients living in nursing homes had the highest risk of receiving a combination of antipsychotics and other psychotropic drugs. Concomitant use of psychotropics may cause adverse events, and potential consequences for patients' safety call for further investigation.

KW - Aged

KW - Aged, 80 and over

KW - Comorbidity

KW - Dementia/drug therapy

KW - Denmark

KW - Female

KW - Homes for the Aged

KW - Humans

KW - Logistic Models

KW - Male

KW - Multivariate Analysis

KW - Nursing Homes

KW - Odds Ratio

KW - Polypharmacy

KW - Prevalence

KW - Psychotropic Drugs/therapeutic use

KW - Registries

KW - Risk Factors

U2 - 10.3233/JAD-160828

DO - 10.3233/JAD-160828

M3 - Journal article

C2 - 28035931

SN - 1387-2877

VL - 56

SP - 707

EP - 716

JO - Journal of Alzheimer's Disease

JF - Journal of Alzheimer's Disease

IS - 2

ER -

Psychotropic Polypharmacy in Patients with Dementia: Prevalence and Predictors

Abstract

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