Hostname: page-component-669899f699-7tmb6 Total loading time: 0 Render date: 2025-05-05T03:41:54.200Z Has data issue: false hasContentIssue false
  • English
  • Français

The use of antipsychotics among people treated with medications for dementia in residential aged care facilities

Published online by Cambridge University Press:  18 January 2016

Hee-Young Shin Open the ORCID record for Hee-Young Shin [Opens in a new window] ,
Svetla Gadzhanova ,
Elizabeth E. Roughead ,
Michael B. Ward  and
Lisa G. Pont
Hee-Young Shin*
Affiliation:
Department of Biomedical Science, Chonnam National University Medical School, Gwangju, South Korea
Svetla Gadzhanova
Affiliation:
Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
Elizabeth E. Roughead
Affiliation:
Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
Michael B. Ward
Affiliation:
Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
Lisa G. Pont
Affiliation:
Australian Institute of heath Innovation, Macquarie University, Sydney, Australia
*
Correspondence should be addressed to: Hee-Young Shin, Department of Biomedical Science, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 501–746, South Korea. Phone: +82-62-220-4304; Fax: +82-62-225-9400. Email: [email protected].
Get access

Abstract

Background:

Antipsychotic agents have limited efficacy for Behavioral and Psychological Symptoms of Dementia (BPSD) and there are concerns about their safety. Despite this, they are frequently used for the management of BPSD. This study aimed to assess the use of antipsychotics among people on anti-dementia medicines in Australian residential aged care facilities.

Methods:

Data were obtained from an individual patient unit dose packaging database covering 40 residential aged care facilities in New South Wales, Australia. Residents supplied an anti-dementia medicine between July 2008 and June 2013 were included. Prevalence of concurrent antipsychotic use was established. Incident antipsychotic users between January 2009 and December 2011 were identified. We examined initial antipsychotic dose, maximum titrated doses, type and duration of antipsychotic use, and compared use with Australian guidelines.

Results:

There were 291 residents treated with anti-dementia medicines, 129 (44%) of whom received antipsychotics concomitantly with an anti-dementia medicine. Among the 59 incident antipsychotic users, risperidone (73%) was the most commonly used antipsychotic agent. Amongst the risperidone initiators, 43% of patients had initial doses greater than 0.5 mg/day and 6% of patients exceeded 2.0 mg/day for their maximum dose. 53% of concomitant users received daily treatment for greater than six months.

Conclusions:

Our study using records of individual patient unit dose supply, which represents the intended medication consumption schedule, shows high rates of concurrent use of antipsychotics and anti-dementia medicines and long durations of use. The use of antipsychotics in patients with dementia needs to be carefully monitored to improve patient outcomes.

Keywords

antipsychoticsanti-dementia medicinesBPSDdementiaresidential aged care facility
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 6 , June 2016 , pp. 977 - 982
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

AIHW (2012). Dementia in Australia (p. 14). Canberra: Australian Institute of Health and Welfare.Google Scholar
Alzheimer's Disease International (2013). World Alzheimer report 2013. Alzheimer's Disease International.Google Scholar
AMH (2014). Australian Medicines Handbook 2014. Adelaide: Australian Medicines Handbook Pty Ltd.Google Scholar
Ballard, C. G. and Margallo-Lana, M. L. (2004). The relationship between antipsychotic treatment and quality of life for patients with dementia living in residential and nursing home care facilities. The Journal of Clinical Psychiatry, 65, 23–28.Google Scholar
Ballard, C. et al. (2008). A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD trial). PLoS Medicine, 5, e76. doi: 10.1371/journal.pmed.0050076.Google Scholar
Ballard, C. et al. (2009). The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. The Lancet. Neurology, 8, 151–157. doi: 10.1016/s1474-4422(08)70295-3.Google Scholar
Campbell, N. et al. (2009). The cognitive impact of anticholinergics: a clinical review. Clinical Interventions in Aging, 4, 225–233. doi:.Google Scholar
Cerejeira, J., Lagarto, L. and Mukaetova-Ladinska, E. B. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, 73. doi: 10.3389/fneur.2012.00073.Google Scholar
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.Google Scholar
Cohen-Mansfield, J., Lipson, S., Werner, P., Billig, N., Taylor, L. and Woosley, R. (1999). Withdrawal of haloperidol, thioridazine, and lorazepam in the nursing home: a controlled, double-blind study. Archives of Internal Medicine, 159, 1733–1740.Google Scholar
Declercq, T. et al. (2013). Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. The Cochrane Database of Systematic Reviews, 3, CD007726. doi: 10.1002/14651858.CD007726.pub2.Google Scholar
Gustafsson, M., Karlsson, S. and Lovheim, H. (2013). Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units. BMC Pharmacology & Toxicology, 14, 10. doi: 10.1186/2050-6511-14-10.Google Scholar
Hollingworth, S. A., Siskind, D. J., Nissen, L. M., Robinson, M. and Hall, W. D. (2010). Patterns of antipsychotic medication use in Australia 2002–2007. The Australian and New Zealand Journal of Psychiatry, 44, 372–377. doi: 10.3109/00048670903489890.Google Scholar
Pan, Y. J., Wu, C. S., Gau, S. S., Chan, H. Y. and Banerjee, S. (2014). Antipsychotic discontinuation in patients with dementia: a systematic review and meta-analysis of published randomized controlled studies. Dementia and Geriatric Cognitive Disorders, 37, 125–140. doi: 10.1159/000355418.Google Scholar
Pratt, N., Roughead, E. E., Ramsay, E., Salter, A. and Ryan, P. (2011). Risk of hospitalization for hip fracture and pneumonia associated with antipsychotic prescribing in the elderly: a self-controlled case-series analysis in an Australian health care claims database. Drug Safety, 34, 567–575. doi: 10.2165/11588470-000000000-00000.Google Scholar
Pratt, N., Roughead, E. E., Ryan, P. and Salter, A. (2010a). Antipsychotics and the risk of death in the elderly: an instrumental variable analysis using two preference based instruments. Pharmacoepidemiology and Drug Safety, 19, 699–707. doi: 10.1002/pds.1942.Google Scholar
Pratt, N. L., Roughead, E. E., Ramsay, E., Salter, A. and Ryan, P. (2010b). Risk of hospitalization for stroke associated with antipsychotic use in the elderly: a self-controlled case series. Drugs & Aging, 27, 885–893. doi: 10.2165/11584490-000000000-00000.Google Scholar
Sink, K. M., Holden, K. F. and Yaffe, K. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA, 293, 596–608. doi: 10.1001/jama.293.5.596.CrossRefGoogle ScholarPubMed
Small, G. W. et al. (1997). Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American association for geriatric psychiatry, the Alzheimer's association, and the American geriatrics society. JAMA, 278, 1363–1371. doi:.Google Scholar
Snowdon, J., Brodaty, H., Ames, D. and Day, S. (2006). Duration of risperidone treatment for BPSD. International Journal of Geriatric Psychiatry, 21, 699–701. doi: 10.1002/gps.1559.Google Scholar
Snowdon, J., Day, S. and Baker, W. (2005). Why and how antipsychotic drugs are used in 40 Sydney nursing homes. International Journal of Geriatric Psychiatry, 20, 1146–1152. doi: 10.1002/gps.1407.Google Scholar
Snowdon, J., Galanos, D. and Vaswani, D. (2011). Patterns of psychotropic medication use in nursing homes: surveys in Sydney, allowing comparisons over time and between countries. International Psychogeriatrics / IPA, 23, 1520–1525. doi: 10.1017/s1041610211000445.Google Scholar
Testad, I. et al. (2010). Nursing home structure and association with agitation and use of psychotropic drugs in nursing home residents in three countries: Norway, Austria and England. International Journal of Geriatric Psychiatry, 25, 725–731. doi: 10.1002/gps.2414.Google Scholar
TGA (2010). Australian Public Assessment Report for Risperidone. Canberra: Department of Health and Ageing.Google Scholar
TGA (2015). Medicines Safety Update, August 2015. Canberra: Department of Health and Ageing.Google Scholar
van Reekum, R. et al. (2002). A randomized, placebo-controlled trial of the discontinuation of long-term antipsychotics in dementia. International Psychogeriatrics / IPA, 14, 197–210. doi:.Google Scholar
Weekes, L. M. (2014). Senate Committee recommendations for antipsychotic use in people with dementia. The Medical Journal of Australia, 200, 438. doi:.Google ScholarPubMed
Westbury, J., Beld, K., Jackson, S. and Peterson, G. (2010). Review of psychotropic medication in Tasmanian residential aged care facilities. Australasian Journal on Ageing, 29, 72–76. doi: 10.1111/j.1741-6612.2010.00409.x.Google Scholar
Wetzels, R. B., Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2010). Course of neuropsychiatric symptoms in residents with dementia in nursing homes over 2-year period. The American Journal of Geriatric Psychiatry, 18, 1054–1065. doi:.Google Scholar
Wetzels, R. B., Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2011). Prescribing pattern of psychotropic drugs in nursing home residents with dementia. International Psychogeriatrics / IPA, 23, 1249–1259. doi: 10.1017/s1041610211000755.Google Scholar