Kailash Thapaliya1,2, Melissa L Harris3,4, Peta M Forder3,4, Julie E Byles3,4. 1. Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. Kailash.thapaliya@uon.edu.au. 2. Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton, NSW, 2305, Australia. Kailash.thapaliya@uon.edu.au. 3. Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. 4. Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton, NSW, 2305, Australia.
Abstract
BACKGROUND: Older population with dementia use huge range of medications. In this study, we aimed to determine the prevalence of commonly used medications a year before and after first recorded dementia diagnosis among older Australian women. METHODS: The study utilized Australian Longitudinal Study on Women's Health (ALSWH) data from 2090 women with known dementia, linked with administrative health datasets. The Pharmaceutical Benefits Scheme (PBS) data provided detailed information about prescribed medications. We applied latent class analysis (LCA) to the post-dementia data to identify patterns of medication use. Logistic regression model was used to explore the impact of potential predictors for medication utilization. RESULTS: Antipsychotic use increased from 5% before dementia to 19% after dementia, while antidementia medication use increased from < 1 to 28%. There was a modest increase in benzodiazepines and antidepressants. Post-dementia, four distinct groups were identified using LCA (names based on probabilities of medications use) as: "High Psychotropic-Low Cardiovascular" (16% of the sample); "Moderate Psychotropic-High Cardiovascular" (12%); "Low Psychotropic-High Cardiovascular" (27%); and "Low Psychotropic-Low Cardiovascular" (45%). Living in Residential Aged Care (RAC) and frailty were associated with increased odds of being in the higher psychotropic use groups. CONCLUSIONS: Substantial utilization of psychotropic medications by older people with dementia indicates a need for a careful review of the use of these medications. Appropriate alternative approaches to the management of dementia should be practiced with a special focus on RAC residents with frailty.
BACKGROUND: Older population with dementia use huge range of medications. In this study, we aimed to determine the prevalence of commonly used medications a year before and after first recorded dementia diagnosis among older Australian women. METHODS: The study utilized Australian Longitudinal Study on Women's Health (ALSWH) data from 2090 women with known dementia, linked with administrative health datasets. The Pharmaceutical Benefits Scheme (PBS) data provided detailed information about prescribed medications. We applied latent class analysis (LCA) to the post-dementia data to identify patterns of medication use. Logistic regression model was used to explore the impact of potential predictors for medication utilization. RESULTS: Antipsychotic use increased from 5% before dementia to 19% after dementia, while antidementia medication use increased from < 1 to 28%. There was a modest increase in benzodiazepines and antidepressants. Post-dementia, four distinct groups were identified using LCA (names based on probabilities of medications use) as: "High Psychotropic-Low Cardiovascular" (16% of the sample); "Moderate Psychotropic-High Cardiovascular" (12%); "Low Psychotropic-High Cardiovascular" (27%); and "Low Psychotropic-Low Cardiovascular" (45%). Living in Residential Aged Care (RAC) and frailty were associated with increased odds of being in the higher psychotropic use groups. CONCLUSIONS: Substantial utilization of psychotropic medications by older people with dementia indicates a need for a careful review of the use of these medications. Appropriate alternative approaches to the management of dementia should be practiced with a special focus on RAC residents with frailty.
Authors: Gianluca Trifirò; Katia M C Verhamme; Gijsbertus Ziere; Achille P Caputi; Bruno H Ch Stricker; Miriam C J M Sturkenboom Journal: Pharmacoepidemiol Drug Saf Date: 2007-05 Impact factor: 2.890