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

Shin, Hee Young; Gadzhanova, Svetla; Roughead, Elizabeth E.; Ward, Michael; Pont, Lisa G.

doi:10.1017/s1041610215002434

Cited by 13 publications

(15 citation statements)

References 24 publications

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“…In this study, 24.8% of the total population and 35.9% of the population with a diagnosis of dementia had been prescribed an antipsychotic recently. This is in line with rates of antipsychotic medications reported previously in Australian residential aged care facilities which have shown prevalence rates of antipsychotics of 30.2% [26] for all residents, and 28.2% [27] to 44% [28] for residents with dementia. The rate for benzodiazepines (30.5%) was similar for those with or without a diagnosis of dementia and this is higher than in previous studies of residential aged care facilities in Australia: 11.4% for all residents [26] and 18.8% in residents with dementia [27].…”

Section: Discussionsupporting

confidence: 90%

Psychotropic medications in older people in residential care facilities and associations with quality of life: a cross-sectional study

et al. 2018

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Background: Psychotropic medications have been associated with many adverse outcomes in older people living in residential care. Home-like models of residential care may be preferable to traditional models of care and we hypothesized that this model may impact on the prevalence of psychotropic medications. The objectives were to: 1) examine associations between psychotropic medications and quality of life in older adults living in residential care facilities with a high prevalence of cognitive impairment and dementia and 2) determine if there was a difference in prevalence of psychotropic medications in facilities which provide a small group home-like model of residential care compared to a 'standard model' of care. Methods: Participants included 541 residents from 17 residential aged care facilities in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Cross-sectional analyses were completed to examine the above objectives. Quality of life was measured with the dementia quality of life questionnaire (DEMQOL) and the EQ-5D-5L completed by the resident or a proxy. Results: Overall, 70.8% (n = 380) of the population had been prescribed/dispensed at least one psychotropic medication in the 100 days prior to recruitment. An increased number of psychotropic medications was associated with lower quality of life according to DEMQOL-Proxy-Utility scores (β (SE): − 0.012 (0.006), p = 0.04) and EQ-5D-5L scores (− 0.024 (0.011), p = 0.03) after adjustment for resident-level and facility-level characteristics. Analysis of the individual classes of psychotropic medications showed antipsychotics were associated with lower DEMQOL-ProxyUtility scores (− 0.030 (0.014), p = 0.03) and benzodiazepines were associated with lower EQ-5D-5L scores (− 0.059 (0.024), p = 0.01). Participants residing in facilities which had a home-like model of residential care were less likely to be prescribed psychotropic medications (OR (95% CI): 0.24 (0.12, 0.46), p < 0.001). Conclusions: An increased number of psychotropic medications were associated with lower quality of life scores. These medications have many associated adverse effects and the use of these medications should be re-examined when investigating approaches to improve quality of life for older people in residential care. Home-like models of residential care may help to reduce the need for psychotropic medications, but further research is needed to validate these findings.

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Section: Discussionsupporting

confidence: 90%

Psychotropic medications in older people in residential care facilities and associations with quality of life: a cross-sectional study

et al. 2018

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“…In contrast, only a small number of RwAD (16%) were on concomitant use of these medications in the current study. A total of 65% of participants were using antipsychotics for >3 months in an earlier study [45]. Furthermore, in the same study, the duration of use exceeded more than 12-week for most of the residents.…”

Section: Discussionmentioning

confidence: 72%

Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

Parajuli

Kuot

Hamiduzzaman

et al. 2020

Preprint

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BackgroundHigh rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with advanced dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold (PLST) and person-centered music intervention.MethodsOur larger study was a quasi-experimental design conducted in five rural nursing homes in Queensland and South Australia. Medication charts (n = 31) were collected retrospectively from three Australian rural aged care facilities through contacting the facility managers before the intervention and after 6 months. Fifty-three staff participated in 31 semi-structured interviews and 8 focus group at post-intervention, and at 1-month and 3-months follow up.ResultsThe median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% in the use of at least any psychotropic medication, 19.6% reduction in antipsychotics and benzodiazepines, and 6.5% reduction in antidementia medicines prescription from baseline to at post-intervention, however, these were not statistically significant. There was a decreasing trend in the use of inappropriate use of medications. Psychotropic medications were prescribed up to 43% and antidementia in 45% of participants for more than 6 months. Major themes extracted from qualitative data were reduced/decreased/cessation of medication use, introducing a rest period and the music intervention combined was an alternative approach for medications use, and less behaviors, and ultimately the less use of medications.ConclusionsOur findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications and inappropriate medications in rural nursing homes as supported by findings from both quantitative and qualitative data.Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

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“…This was the first study to examine antidementia medication use in residents with dementia living in Australian RACFs; prior studies have included broader samples such as all residents of RACFS, 27 all adults in Australia, [21][22][23] memory clinic patients with all levels of cognitive impairment, 26 or specific subgroups of people with dementia. 24,25 One prior study evaluated antidementia medication use in community-dwelling Australians with dementia, but this was before subsidisation of antidementia medications in Australia.…”

Section: Discussionmentioning

confidence: 99%

“…Australian studies that examined specific subpopulations have included inpatients with BPSD, 24 veterans who initiated CEI use between 25 2003 and 2006-or included people with dementia but also those with mild cognitive impairment 26 (antidementia medications are not effective for MCI), or all residents of aged care facilities. 27 Within these varied samples, antidementia medication use was consistently low-4.5% of aged care facility residents used an antidementia medication during 27 2008 to 2013, 11.3% of memory clinic patients (with MCI or dementia) used an antidementia medication during 26 2005 to 2011 and among inpatients with BPSD 14% to 33% used a CEI and 3% to 8% used memantine across three separate psychogeriatric inpatient units. 24 One study reported that the median time on CEIs among veterans who initiated CEI use during 2003 to 2006 was 199 to 203 days (depending on the specific CEI).…”

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confidence: 99%

Antidementia medication use by aged care facility residents with dementia

Lind

Gray

Raban

et al. 2019

Int J Geriat Psychiatry

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Objectives Little is known about the use of antidementia medications in Australia. Other countries have reported sociodemographic disparities in use. Our objective was to estimate prevalence, duration, and time to initiation of antidementia medication (cholinesterase inhibitors or memantine) among Australians with dementia in residential aged care facilities and to evaluate resident and facility factors associated with use. Methods Dynamic retrospective cohort study of people with dementia in 68 residential aged care facilities during 2014 to 2017 using electronic health record and medication administration data. Regression evaluated relationships between medication use (prevalence, duration, and time to initiation) and resident and facility characteristics. Results Five thousand three hundred fifty‐four residents with dementia were included in the analyses. Annual prevalence of antidementia medication use was less than 10% each year and decreased during the study period by 2‐percentage points by 2017 (relative to 2014). Antidementia medication use varied by sociodemographic characteristics (3‐points lower for single, 4‐points lower for divorced relative to married residents, and 3‐points higher for Australian‐born). Each point in ADL score was associated with 0.1‐point lower medication use. Antidementia medication use was lower in outer regional facilities. Most comorbidities were associated with lower antidementia medication use (myocardial infarction, cerebrovascular disease and heart failure 3‐points lower, respiratory disease, and diabetes 2‐points lower). Age had a complex relationship with antidementia medication use that varied by sex and if medication was started before or after admission. After admission, males initiated antidementia medication earlier than females. Conclusions Antidementia medication use in Australian facilities was lower than in other countries and varied by clinical and sociodemographic factors.

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

Cited by 13 publications

References 24 publications

Psychotropic medications in older people in residential care facilities and associations with quality of life: a cross-sectional study

Psychotropic medications in older people in residential care facilities and associations with quality of life: a cross-sectional study

Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

Antidementia medication use by aged care facility residents with dementia

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