How Prolific is Psychotropic Medicines Use in People with Dementia in Australia Within the Community Setting? A Retrospective Analysis

Drugs - Real World Outcomes, Sep 2015

Background When used for a therapeutic purpose such as for psychiatric illness, psychotropic drugs may enhance quality of life; however, when used to treat behaviours associated with dementia, they may have only a modest effect but lead to negative outcomes. Objective We undertook an analysis of community-dwelling people with dementia or cognitive impairment to ascertain how prolific psychotropic medicine use is within the Australian community setting, which psychotropic medicines are being prescribed and to whom, and whether the use of such medicines is in accordance with therapeutic guidelines. Methods We undertook a retrospective review of medication records, including medication charts, for 412 people with cognitive impairment, discharged from a home nursing service in Victoria, Australia, during the 6-month period between 1 January and 30 June 2013. Results Cholinesterase inhibitor use exceeded the number of individuals with a recorded diagnosis of Alzheimer’s disease; in some cases, the dosage exceeded recommendations. Antidepressants were used by more than double the number of people documented with a history of depression. Antipsychotic medicines were prescribed for undocumented purposes, in some cases above maximum response levels, and multiple benzodiazepines were prescribed. Conclusions Psychotropic medicine use was common in our study population, and use of these medicines was often not in line with therapeutic guidelines. Further research is required to ascertain reasons for the high use of psychotropic medicines in this group, and greater consideration is required by health professionals of the appropriate use and regular review of psychotropic medicines. Improved documentation of diagnoses and the indications for prescribing psychotropic medicines is needed, as is greater implementation of educational programmes to support care workers and carers.

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How Prolific is Psychotropic Medicines Use in People with Dementia in Australia Within the Community Setting? A Retrospective Analysis

Drugs - Real World Outcomes How Prolific is Psychotropic Medicines Use in People with Dementia in Australia Within the Community Setting? A Retrospective Analysis Dianne Goeman 0 1 2 3 Kira Harvey 0 1 2 3 Cik Yin Lee 0 1 2 3 Neil Petrie 0 1 2 3 Chris Beanland 0 1 2 3 Christine Culhane 0 1 2 3 Susan Koch 0 1 2 3 Key Points 0 1 2 3 0 Suite 5 No 10 Station Rd , Cheltenham, VIC 3192 , Australia 1 RDNS Institute , 31 Alma Rd, St Kilda, VIC 3182 , Australia 2 & Dianne Goeman 3 Psychotropic Drug Advisory Service, The Florey Institute of Neuroscience and Mental Health , Parkville, VIC , Australia Background When used for a therapeutic purpose such as for psychiatric illness, psychotropic drugs may enhance quality of life; however, when used to treat behaviours associated with dementia, they may have only a modest effect but lead to negative outcomes. Objective We undertook an analysis of communitydwelling people with dementia or cognitive impairment to ascertain how prolific psychotropic medicine use is within the Australian community setting, which psychotropic medicines are being prescribed and to whom, and whether the use of such medicines is in accordance with therapeutic guidelines. Methods We undertook a retrospective review of medication records, including medication charts, for 412 people with cognitive impairment, discharged from a home nursing service in Victoria, Australia, during the 6-month period between 1 January and 30 June 2013. Results Cholinesterase inhibitor use exceeded the number of individuals with a recorded diagnosis of Alzheimer's disease; in some cases, the dosage exceeded recommendations. Antidepressants were used by more than double the number of people documented with a history of depression. Antipsychotic medicines were prescribed for undocumented purposes, in some cases above maximum response levels, and multiple benzodiazepines were prescribed. 1 Background Psychotropic drugs are medicines that impact on mental functioning and may alter cognition, emotions and behaviour. The word psychotropic originates from the Greek term ‘psycho’, referring to ‘the mind’, and ‘tropic’, referring to ‘turning’. Psychotropic drugs may be used in either a positive or a negative manner. When used for a therapeutic purpose such as for the treatment of psychiatric illness, these drugs may enhance quality of life; however, when used to treat behaviours associated with dementia, they have been shown to have only a modest effect and may lead to many negative outcomes [ 1 ]. Psychotropic medicines include the following: antipsychotics—medicines used to treat psychotic disorders; antidepressants—medicines used to treat depression and anxiety disorders; anxiolytics—medicines used to treat anxiety disorders; hypnotics—used to treat insomnia; mood stabilisers—used to treat bipolar disorders; and cholinesterase inhibitors—used as cognition-enhancing agents in Alzhiemer’s disease [ 2 ]. More specifically, antipsychotic medicines, benzodiazepines and antidepressants became available in the 1950s as a treatment for schizophrenia, psychosis, paranoid delusions, abnormal thoughts or behavioural disorders and depression. However, since the late 1980 s, there has been a steady stream of new agents introduced to treat depression, anxiety, insomnia and neuropsychiatric and behavioural disturbances [ 2 ]. Behavioural and psychological symptoms of dementia (BPSD), including agitation and aggression, are increasingly recognised as a major risk factor for caregiver stress and institutionalisation of people with dementia [ 3–5 ]. The use of psychotropic drugs to control BPSD in older people with dementia is widespread, both in Australia [ 6 ] and internationally [ 7, 8 ]. Treatment of BPSD using psychopharmacological approaches, especially antipsychotics, is problematic, as exposure to anticholinergic and sedative medications is associated with functional impairment in older people; additionally, the use of antipsychotic medicines in older people frequently leads to adverse effects, including the risk of cerebrovascular events (increased risk of stroke), extrapyramidal side effects, tardive dyskinesia (movement disorders) and mortality [9]. Consequently, the use of antipsychotic medicine to control BPSD in older people with dementia has become controversial [ 5, 10–13 ]. A recent study of Scottish nursing homes reported that three-quarters of all residents received at least one antipsychotic medicine to manage behavioural symptoms, and over 70 % of 1715 people admitted to aged care homes during this study commenced the medication prior to their admission [ 14 ]. Rattinger et al. [ 15 ] similarly reported a high use of psychotropic medicines in older people with dementia, both in residential care facilities and in those living in the community in the USA. Currently, in Australia there is also evidence of an increase in the prescribing of psychotropic medicines for older people living in aged care homes (...truncated)


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Dianne Goeman, Kira Harvey, Cik Yin Lee, Neil Petrie, Chris Beanland, Christine Culhane, Susan Koch. How Prolific is Psychotropic Medicines Use in People with Dementia in Australia Within the Community Setting? A Retrospective Analysis, Drugs - Real World Outcomes, 2015, pp. 289-298, Volume 2, Issue 3, DOI: 10.1007/s40801-015-0038-1