Andrea D Foebel1, Rosa Liperoti2, Graziano Onder2, Harriet Finne-Soveri3, Jean Claude Henrard4, Albert Lukas5, Michael D Denkinger5, Giovanni Gambassi2, Roberto Bernabei2. 1. School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada; Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: adfoebel@uwaterloo.ca. 2. Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy. 3. Ageing and Services Unit, National Institute for Health and Welfare, Helsinki, Finland. 4. Laboratoire Santé Environnement Vieillissement, Université de Versailles-Saint-Quentin en Yvelines, Paris, France; Centre de Gérontologie, Hôpital Sainte Périne APHP, Paris, France. 5. AGAPLESION Bethesda Clinic, Geriatric Center, Ulm University, Ulm, Germany.
Abstract
BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are common reasons for use of antipsychotic drugs among older individuals with dementia. These drugs are not approved for such use and both the Food and Drug Administration and European Medicines Agency have issued warnings to limit such use. OBJECTIVES: This study aimed to describe patterns of antipsychotic drug use in a sample of nursing home residents with dementia in 7 European countries and Israel. DESIGN: This cross-sectional, retrospective cohort study used data from the SHELTER study that collected comprehensive resident data using the interRAI Long-Term Care Facility instrument. METHODS: Fifty-seven long-term care facilities participated from 8 countries, and the sample included 4156 long-term care residents from these settings. Individuals with dementia, both Alzheimer and non-Alzheimer types, were identified. Potential correlates of any antipsychotic and atypical versus conventional antipsychotic drug use among residents with dementia were identified using generalized estimation equation modeling. RESULTS: A total of 2091 individuals with dementia were identified. Antipsychotic drug use among these individuals varied by country, with overall prevalence of use being 32.8% (n = 662). Among antipsychotic users, 7 in 10 were receiving atypical agents. Generalized estimation equation analysis revealed that the strongest correlate of any antipsychotic drug use was severe behavioral symptoms, which increased the likelihood by 2.84. Correlates of atypical versus conventional antipsychotic drug use included psychiatric services, more than 10 medications, moderate behavioral symptoms, and female gender. CONCLUSION: Despite recommendations to avoid the use of antipsychotic drugs in patients with dementia, a large proportion of residents in European long-term care facilities continue to receive such agents. Future work should not only establish the appropriateness of such use through outcomes studies, but explore withdrawal strategies as well as alternative treatment modalities.
BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are common reasons for use of antipsychotic drugs among older individuals with dementia. These drugs are not approved for such use and both the Food and Drug Administration and European Medicines Agency have issued warnings to limit such use. OBJECTIVES: This study aimed to describe patterns of antipsychotic drug use in a sample of nursing home residents with dementia in 7 European countries and Israel. DESIGN: This cross-sectional, retrospective cohort study used data from the SHELTER study that collected comprehensive resident data using the interRAI Long-Term Care Facility instrument. METHODS: Fifty-seven long-term care facilities participated from 8 countries, and the sample included 4156 long-term care residents from these settings. Individuals with dementia, both Alzheimer and non-Alzheimer types, were identified. Potential correlates of any antipsychotic and atypical versus conventional antipsychotic drug use among residents with dementia were identified using generalized estimation equation modeling. RESULTS: A total of 2091 individuals with dementia were identified. Antipsychotic drug use among these individuals varied by country, with overall prevalence of use being 32.8% (n = 662). Among antipsychotic users, 7 in 10 were receiving atypical agents. Generalized estimation equation analysis revealed that the strongest correlate of any antipsychotic drug use was severe behavioral symptoms, which increased the likelihood by 2.84. Correlates of atypical versus conventional antipsychotic drug use included psychiatric services, more than 10 medications, moderate behavioral symptoms, and female gender. CONCLUSION: Despite recommendations to avoid the use of antipsychotic drugs in patients with dementia, a large proportion of residents in European long-term care facilities continue to receive such agents. Future work should not only establish the appropriateness of such use through outcomes studies, but explore withdrawal strategies as well as alternative treatment modalities.
Authors: Yoonyoung Park; Jessica M Franklin; Sebastian Schneeweiss; Raisa Levin; Stephen Crystal; Tobias Gerhard; Krista F Huybrechts Journal: J Am Geriatr Soc Date: 2015-03-06 Impact factor: 5.562
Authors: Rebecca Palm; Saskia Jünger; Sven Reuther; Christian G G Schwab; Martin N Dichter; Bernhard Holle; Margareta Halek Journal: BMC Geriatr Date: 2016-04-05 Impact factor: 3.921
Authors: Andrea Foebel; Anna Ballokova; Nathalie I H Wellens; Daniela Fialova; Koen Milisen; Rosa Liperoti; John P Hirdes Journal: BMC Geriatr Date: 2015-10-19 Impact factor: 3.921
Authors: Sebastian Rios; Christopher M Perlman; Andrew Costa; George Heckman; John P Hirdes; Lori Mitchell Journal: BMC Geriatr Date: 2017-10-23 Impact factor: 3.921