Use of Antipsychotic Drugs by Elderly Primary Care Patients and the Effects of Medication Reviews: A Cross-Sectional Study in Sweden

Drugs - Real World Outcomes, Jun 2017

Background Antipsychotics form a class of drugs that should be used with caution among elderly people because of a high risk of adverse events. Despite the risks and modest effects, their use is estimated to be high, especially in nursing homes. Objective The aim was to explore the effects of medication reviews on antipsychotic drug use for elderly primary care patients and describe the extent of, and reasons for, the prescription of antipsychotics. Methods In this cross-sectional study in primary care in Skåne, Sweden, patients aged ≥75 years living in nursing homes or in their own homes with home care were included. The effects of medication reviews were documented, as were the use of antipsychotics and the differences in characteristics between patients receiving or not receiving antipsychotics. Results A total of 1683 patients aged 87.6 (±5.7) years were included in the analysis. Medication reviews reduced the use of antipsychotics by 23% (p < 0.001) in this study. Of the 206 patients using antipsychotics, 43% (n = 93) had an approved indication, while for 15% (n = 32) the indication was not given. Antipsychotic drug use was more common with increasing number of drugs (p = 0.001), and in nursing home residents (p < 0.01). It was also more frequent in patients with cognitive impairment, depressive symptoms or sleeping problems. Conclusion The use of antipsychotic drugs is high in elderly patients in nursing homes. They are often given for indications that are not officially approved or are poorly documented. Medication reviews appear to offer one useful strategy for reducing excessive use of these drugs.

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Use of Antipsychotic Drugs by Elderly Primary Care Patients and the Effects of Medication Reviews: A Cross-Sectional Study in Sweden

Drugs - Real World Outcomes Use of Antipsychotic Drugs by Elderly Primary Care Patients and the Effects of Medication Reviews: A Cross-Sectional Study in Sweden Cecilia Lenander 0 1 2 3 4 Patrik Midlo¨v 0 1 2 3 4 Nina Viberg 0 1 2 3 4 John Chalmers 0 1 2 3 4 Kris Rogers 0 1 2 3 4 A˚ sa Bondesson 0 1 2 3 4 Key Points 0 1 2 3 4 0 Department of Medicines Management and Informatics , Region Ska ̊ne, Kristianstad , Sweden 1 Department of Clinical Sciences in Malmo ̈, Lund University , Jan Waldenstro ̈ms gata 35, 205 02 Malmo ̈ , Sweden 2 & Cecilia Lenander 3 The George Institute for Global Health, University of Sydney , Sydney , Australia 4 Department of Public Health Sciences, Karolinska Institutet , Solna , Sweden Background Antipsychotics form a class of drugs that should be used with caution among elderly people because of a high risk of adverse events. Despite the risks and modest effects, their use is estimated to be high, especially in nursing homes. Objective The aim was to explore the effects of medication reviews on antipsychotic drug use for elderly primary care patients and describe the extent of, and reasons for, the prescription of antipsychotics. Methods In this cross-sectional study in primary care in Ska˚ne, Sweden, patients aged C75 years living in nursing homes or in their own homes with home care were included. The effects of medication reviews were documented, as were the use of antipsychotics and the differences in characteristics between patients receiving or not receiving antipsychotics. Results A total of 1683 patients aged 87.6 (±5.7) years were included in the analysis. Medication reviews reduced the use of antipsychotics by 23% (p 0.001) in this study. Of the 206 patients using antipsychotics, 43% (n = 93) had an approved indication, while for 15% (n = 32) the indication was not given. Antipsychotic drug use was more common with increasing number of drugs (p = 0.001), and in nursing home residents (p \ 0.01). It was also more frequent in patients with cognitive impairment, depressive symptoms or sleeping problems. Conclusion The use of antipsychotic drugs is high in elderly patients in nursing homes. They are often given for indications that are not officially approved or are poorly documented. Medication reviews appear to offer one useful strategy for reducing excessive use of these drugs. 1 Introduction In 2010, the Swedish National Board of Health and Welfare published a report with quality indicators concerning the treatment of elderly patients [ 1 ]. The report points to antipsychotics as a medication group that should be used with caution among elderly people. Prescription of antipsychotics should be limited to patients with psychotic events and potentially to aggressive patients with dementia according to the Swedish National Board of Health and Welfare [ 1 ]. Antipsychotic drugs carry a high risk of adverse events, such as extra-pyramidal symptoms, cognitive impairment, sedation and orthostatic hypotension as well as an increased risk of stroke and premature death in patients with dementia [ 2 ]. The use of antipsychotics for treatment of behavioural and psychological symptoms in dementia (BPSD) is still high. This is despite warnings from, for example, the US Food and Drug Administration (FDA), concerning the use of antipsychotics in patients with dementia [ 3 ]. Moreover, the evidence for the efficacy of antipsychotics for treating BPSD is at best modest for aggression and very weak for other symptoms [ 4 ]. Prescription of antipsychotics for elderly patients with multiple co-morbidities seems to be high and often for indications that are not officially approved. A Swedish study from 2004 [ 5 ], supported by the findings from other studies [ 2, 3, 6, 7 ], reported that 25–30% of patients in nursing homes were given antipsychotics, often without a clear indication. Medication reviews provide a possible strategy to improve the situation. A medication review is a method to analyse, review and follow-up an individual’s drug therapy. The review is done in a structured and systematic way, according to local guidelines and routines [ 8 ], and can be performed in hospitals, in primary care or in nursing homes. Medication reviews can be discussed at a multiprofessional meeting or left as a note to the doctor, with or without patient participation. Medication reviews should, according to the Swedish National Board of Health and Welfare, be performed in patients aged C75 years who have five or more medications. Furthermore, for patients moving to a nursing home, medication reviews should be performed in connection with this and thereafter annually [ 9 ]. The aim of the present study was to assess the effects of medication reviews on antipsychotic drug use in elderly patients. We also wished to explore the extent of, and justification for, the prescription of antipsychotics for elderly patients in everyday practice and whether there were significant differences (...truncated)


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Cecilia Lenander, Patrik Midlöv, Nina Viberg, John Chalmers, Kris Rogers, Åsa Bondesson. Use of Antipsychotic Drugs by Elderly Primary Care Patients and the Effects of Medication Reviews: A Cross-Sectional Study in Sweden, Drugs - Real World Outcomes, 2017, pp. 159-165, Volume 4, Issue 3, DOI: 10.1007/s40801-017-0111-z