Antipsychotic Drugs Predominate in Pharmacotherapy of Nursing Home Residents with Dementia

M. Huber; M. Kölzsch; M. A. Rapp; I. Wulff; S. Kalinowski; J. Bolbrinker; W. Hofmann; J. Scholze; D. Dräger; R. Kreutz

doi:10.1055/s-0031-1301285

Pharmacopsychiatry, Table of Contents

Pharmacopsychiatry 2012; 45(05): 182-188
DOI: 10.1055/s-0031-1301285

Original Paper

Antipsychotic Drugs Predominate in Pharmacotherapy of Nursing Home Residents with Dementia

M. Huber^*

¹Institute of Clinical Pharmacology and Toxicology, Charité – Universitätsmedizin Berlin, Berlin, Germany

,

M. Kölzsch^*

¹Institute of Clinical Pharmacology and Toxicology, Charité – Universitätsmedizin Berlin, Berlin, Germany

,

M. A. Rapp

²Department of Psychiatry and Psychotherapy (CCM), Charité – Universitätsmedizin Berlin, Berlin, Germany

,

I. Wulff

³Institute of Medical Sociology, Charité – Universitätsmedizin Berlin, Berlin, Germany

,

S. Kalinowski

³Institute of Medical Sociology, Charité – Universitätsmedizin Berlin, Berlin, Germany

,

J. Bolbrinker

¹Institute of Clinical Pharmacology and Toxicology, Charité – Universitätsmedizin Berlin, Berlin, Germany

,

W. Hofmann

³Institute of Medical Sociology, Charité – Universitätsmedizin Berlin, Berlin, Germany

,

J. Scholze

⁴Department of Medicine, Outpatient Clinic, Charité Centrum für Innere Medizin und Dermatologie, Charité – Universitätsmedizin Berlin, Berlin, Germany

,

D. Dräger

³Institute of Medical Sociology, Charité – Universitätsmedizin Berlin, Berlin, Germany

,

R. Kreutz

¹Institute of Clinical Pharmacology and Toxicology, Charité – Universitätsmedizin Berlin, Berlin, Germany

⁴Department of Medicine, Outpatient Clinic, Charité Centrum für Innere Medizin und Dermatologie, Charité – Universitätsmedizin Berlin, Berlin, Germany

› Author Affiliations

Abstract

Introduction:

The aim of this study was to investigate the frequency of benzodiazepines, antidementia and antipsychotic drug prescriptions in nursing home residents (NHR).

Methods:

Data of a German health insurance company were retrospectively analyzed for the year 2008.

Results:

The study cohort comprised 13 042 NHR (82% women, mean age 83.6±7 years). Following analgetics, antipsychotic drugs were the second most frequently prescribed drug group with 13.3% of all prescriptions. Dementia was diagnosed in 8 017 (61.5%) NHR. Thereof 51.6% received an antipsychotic, 17.3% a benzodiazepine and 15.2% an antidementia pharmaceutical, respectively. 18.1% of NHR with dementia and antipsychotic drug prescriptions were in combined treatment with antidementia pharmaceuticals. The rate of antipsychotic drug prescribing was significantly doubled in NHR with dementia compared to those without this diagnosis (p<0.01); the most frequently prescribed antipsychotics were melperone, risperidone and pipamperone.

Discussion:

This study demonstrates the wide-spread use of psychotropic drugs in NHR. Moreover, dementia in NHR was associated with antipsychotic drug prescribing in every second patient. This highlights the need for further studies analyzing alternative treatments for dementia-related symptoms.

Key words

dementia - antipsychotic drugs - anti-dementia drugs - nursing home residents - elderly

Full Text

References

References
1 Sink KM, Holden KF, Yaffe K. Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA 2005; 293: 596-608
2 Small GW, Rabins PV, Barry PP et al. Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer’s Association, and the American Geriatrics Society. JAMA 1997; 278: 1363-1371
3 Fratiglioni L, De RD, Aguero-Torres H. Worldwide prevalence and incidence of dementia. Drugs Aging 1999; 15: 365-375
4 Tjia J, Rothman MR, Kiely DK et al. Daily medication use in nursing home residents with advanced dementia. J Am Geriatr Soc 2010; 58: 880-888
5 Cavalieri M, Enzinger C, Petrovic K et al. Vascular dementia and Alzheimer’s disease − are we in a dead-end road?. Neurodegener Dis 2010; 7: 122-126
6 Parsons C, Briesacher BA, Givens JL et al. Cholinesterase inhibitor and memantine use in newly admitted nursing home residents with dementia. J Am Geriatr Soc 2011; 59: 1253-1259
7 Ballard CG, Gauthier S, Cummings JL et al. Management of agitation and aggression associated with Alzheimer disease. Nat Rev Neurol 2009; 5: 245-255
8 Cummings JL, Mackell J, Kaufer D. Behavioral effects of current Alzheimer’s disease treatments: a descriptive review. Alzheimers Dement 2008; 4: 49-60
9 Snowden M, Sato K, Roy-Byrne P. Assessment and treatment of nursing home residents with depression or behavioral symptoms associated with dementia: a review of the literature. J Am Geriatr Soc 2003; 51: 1305-1317
10 Franchi C, Lucca U, Tettamanti M et al. Cholinesterase inhibitor use in Alzheimer’s disease: the EPIFARM-Elderly Project. Pharmacoepidemiol Drug Saf 2011; 20: 497-505
11 Kaduszkiewicz H, Zimmermann T, Beck-Bornholdt HP et al. Cholinesterase inhibitors for patients with Alzheimer’s disease: systematic review of randomised clinical trials. BMJ 2005; 331 (7512) 321-327
12 Lanctot KL, Herrmann N, Yau KK et al. Efficacy and safety of cholinesterase inhibitors in Alzheimer’s disease: a meta-analysis. CMAJ 2003; 169: 557-564
13 Majic T, Pluta JP, Mell T et al. The pharmacotherapy of neuropsychiatric symptoms of dementia: a cross-sectional study in 18 homes for the elderly in Berlin. Dtsch Arztebl Int 2010; 107: 320-327
14 O’Brien J. Antipsychotics for people with dementia. BMJ 2008; 337: a602
15 Petek SM, Cedilnik GE. Psychotropic medication use among elderly nursing home residents in Slovenia: cross-sectional study. Croat Med J 2011; 52: 16-24
16 Schneider LS, Tariot PN, Dagerman KS et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer’s disease. N Engl J Med 2006; 355: 1525-1538
17 Ballard C, Hanney ML, Theodoulou M et al. The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol 2009; 8: 151-157
18 Trifiro G, Verhamme KM, Ziere G et al. All-cause mortality associated with atypical and typical antipsychotics in demented outpatients. Pharmacoepidemiol Drug Saf 2007; 16: 538-544
19 Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA 2005; 294: 1934-1943
20 World Health Organization. Anatomical Therapeutic Chemical (ATC) classification system.
21 World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10^th Revision.
22 Federal Statistical Office of Germany Pflegestatistik 2009 (Statistical Analysis about Nursing and Care)
23 Azermai M, Elseviers M, Petrovic M et al. Geriatric drug utilisation of psychotropics in Belgian nursing homes. Hum Psychopharmacol Mar 2011;
24 Nishtala PS, McLachlan AJ, Bell JS et al. Determinants of antipsychotic medication use among older people living in aged care homes in Australia. Int J Geriatr Psychiatry 2010; 25: 449-457
25 Azermai M, Elseviers M, Petrovic M et al. Assessment of antipsychotic prescribing in Belgian nursing homes. Int Psychogeriatr 2011; 23: 1240-1248
26 Beers MH, Ouslander JG, Fingold SF et al. Inappropriate medication prescribing in skilled-nursing facilities. Ann Intern Med 1992; 117: 684-689
27 Doshi JA, Shaffer T, Briesacher BA. National estimates of medication use in nursing homes: findings from the 1997 medicare current beneficiary survey and the 1996 medical expenditure survey. J Am Geriatr Soc 2005; 53: 438-443
28 Gruber-Baldini AL, Stuart B, Zuckerman IH et al. Treatment of dementia in community-dwelling and institutionalized medicare beneficiaries. J Am Geriatr Soc 2007; 55: 1508-1516
29 Magaziner J, German P, Zimmerman SI et al. The prevalence of dementia in a statewide sample of new nursing home admissions aged 65 and older: diagnosis by expert panel. Epidemiology of Dementia in Nursing Homes Research Group. Gerontologist 2000; 40: 663-672
30 Qaseem A, Snow V, Cross JT et al. Current pharmacologic treatment of dementia: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med 2008; 148: 370-378
31 Lucca U, Nobili A, Riva E et al. Cholinesterase inhibitor use and age in the general population. Arch Neurol 2006; 63: 154-155
32 Schoenmaker N, van Gool WA. The age gap between patients in clinical studies and in the general population: a pitfall for dementia research. Lancet Neurol 2004; 3: 627-630
33 Holmes HM, Sachs GA, Shega JW et al. Integrating palliative medicine into the care of persons with advanced dementia: identifying appropriate medication use. J Am Geriatr Soc 2008; 56: 1306-1311
34 Alanen HM, Finne-Soveri H, Noro A et al. Use of antipsychotic medications among elderly residents in long-term institutional care: a three-year follow-up. Int J Geriatr Psychiatry 2006; 21: 288-295
35 Furniss L, Craig SK, Burns A.. Medication use in nursing homes for elderly people. Int J Geriatr Psychiatry 1998; 13: 433-439
36 Holmquist IB, Svensson B, Hoglund P. Psychotropic drugs in nursing- and old-age homes: relationships between needs of care and mental health status. Eur J Clin Pharmacol 2003; 59: 669-676
37 Macdonald AJ, Carpenter GI, Box O et al. Dementia and use of psychotropic medication in non-‘Elderly Mentally Infirm’ nursing homes in South East England. Age Ageing 2002; 31: 58-64
38 Finkel S. Introduction to behavioural and psychological symptoms of dementia (BPSD). Int J Geriatr Psychiatry 2000; 15 (Suppl. 01) S2-S4
39 Ballard C, Waite J. The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer’s disease. Cochrane Database Syst Rev 2006; (01) CD003476
40 Paleacu D, Barak Y, Mirecky I et al. Quetiapine treatment for behavioural and psychological symptoms of dementia in Alzheimer’s disease patients: a 6-week, double-blind, placebo-controlled study. Int J Geriatr Psychiatry 2008; 23: 393-400
41 Gurwitz JH, Field TS, Avorn J et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med 2000; 109: 87-94
42 FDA − Food and Drug Administration. Public Health Advisory: Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances.
43 FDA − Food and Drug Administration. Boxed Warnings on Older Class of Antipsychotic Drugs.
44 EMEA – European Medicines Agency Opinion of the Committee for Medicinal Products for Human Use Pursuant to Article 5(3) of Regulation (EC) No 726/2004, on Conventional Antipsychotics
45 Molter-Bock E, Hasford J, Pfundstein T. Psychopharmacological drug treatment in Munich nursing homes. Z Gerontol Geriatr 2006; 39: 336-343
46 Hughes CM, Lapane KL. Administrative initiatives for reducing inappropriate prescribing of psychotropic drugs in nursing homes: how successful have they been?. Drugs Aging 2005; 22: 339-351
47 Castle NG, Hanlon JT, Handler SM. Results of a longitudinal analysis of national data to examine relationships between organizational and market characteristics and changes in antipsychotic prescribing in US nursing homes from 1996 through 2006. Am J Geriatr Pharmacother 2009; 7: 143-150
48 Stevenson DG, Decker SL, Dwyer LL et al. Antipsychotic and benzodiazepine use among nursing home residents: findings from the 2004 National Nursing Home Survey. Am J Geriatr Psychiatry 2010; 18: 1078-1092