New use of psychotropic medication after hospitalization among people with dementia.
claims data
dementia
hospitalization
psychotropic medication
Journal
International journal of geriatric psychiatry
ISSN: 1099-1166
Titre abrégé: Int J Geriatr Psychiatry
Pays: England
ID NLM: 8710629
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
05
11
2019
revised:
14
01
2020
accepted:
13
02
2020
pubmed:
27
2
2020
medline:
21
11
2020
entrez:
27
2
2020
Statut:
ppublish
Résumé
Psychotropic medication is commonly used among people with dementia (PWD), but it shows modest efficacy and it has been associated with severe adverse events. Hospitalizations are an opportunity for medication management as well as treatment recommendations for outpatient physicians. The aim of this study was to asses factors associated with new use of psychotropic medication after hospitalization among PWD. We conducted a retrospective dynamic cohort study from 2004 to 2015 using claims data from a German health insurance company. PWD were identified by an algorithm that included ICD-10 diagnosis and diagnostic measures. The medication classes included were antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication. The assessment period was up to 30 days after discharge from the hospital across four hospitalizations. The main predictors for new use of psychotropic medication were similar across medication classes. Neuropsychiatric symptoms (NPS) and the need of care were associated with higher odds of new use of antidepressants, antipsychotics, and anxiolytics or hypnotics/sedatives. A hospital stay due to dementia was an independent predictor for new use across medication classes as well. Delirium increased the odds for new use of antipsychotics and anxiolytics or hypnotics/sedatives. Factors associated with new use of psychotropic medication included delirium, NPS, and the need of care in PWD. The findings highlight the need for preventive interventions and non-medical treatment options in regards to delirium and NPS as well as for a more intensive use of screening tools for inappropriate medication use among PWD. Key points The percentage of new users was 1.8%, 7.1%, 2.1%, and 2.5% across hospitalizations for antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication, respectively. 83.0%, 61.9%, 56.9%, and 88.1% of new users received antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication for more than 6 weeks. Delirium and neuropsychiatric symptoms were associated with significantly increased odds of new psychotropic medication use. Hospital stays due to dementia and the need of care were predictors for new use of psychotropic medication.
Substances chimiques
Psychotropic Drugs
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
640-649Informations de copyright
© 2020 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.
Références
Lanctot KL, Amatniek J, Ancoli-Israel S, et al. Neuropsychiatric signs and symptoms of Alzheimer's disease: new treatment paradigms. Alzheimers Dement. 2017;3(3):440-449.
Gustafsson M, Sandman PO, Karlsson S, Gustafson Y, Lovheim H. Association between behavioral and psychological symptoms and psychotropic drug use among old people with cognitive impairment living in geriatric care settings. Int Psychogeriatr. 2013;25(9):1415-1423.
Tormalehto S, Martikainen J, Bell JS, Hallikainen I, Koivisto AM. Use of psychotropic medications in relation to neuropsychiatric symptoms, cognition and functional performance in Alzheimer's disease over a three-year period: Kuopio ALSOVA study. Int Psychogeriatr. 2017;29(10):1723-1733.
Cerejeira J, Lagarto L, Mukaetova-Ladinska EB. Behavioral and psychological symptoms of dementia. Front Neurol. 2012;3:1-21.
Masopust J, Protopopova D, Valis M, Pavelek Z, Klimova B. Treatment of behavioral and psychological symptoms of dementias with psychopharmaceuticals: a review. Neuropsychiatr Dis Treat. 2018;14:1211-1220.
Du Y, Wolf IK, Busch MA, Knopf H. Associations between the use of specific psychotropic drugs and all-cause mortality among older adults in Germany: results of the mortality follow-up of the German National Health Interview and examination survey 1998. PLoS One. 2019;14(1):e0210695. https://doi.org/10.1371/journal.pone.0210695.
Maust DT, Kim HM, Seyfried LS, et al. Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA Psychiat. 2015;72(5):438-445.
Mueller C, Huntley J, Stubbs B, et al. Associations of neuropsychiatric symptoms and antidepressant prescription with survival in Alzheimer's disease. J Am Med Dir Assoc. 2017;18(12):1076-1081.
Sterke CS, van Beeck EF, van der Velde N, et al. New insights: dose-response relationship between psychotropic drugs and falls: a study in nursing home residents with dementia. J Clin Pharmacol. 2012;52(6):947-955.
Wei YJ, Simoni-Wastila L, Lucas JA, Brandt N. Fall and fracture risk in nursing home residents with moderate-to-severe behavioral symptoms of Alzheimer's disease and related dementias initiating antidepressants or antipsychotics. J Gerontol A Biol Sci Med Sci. 2017;72(5):695-702.
Skoldunger A, Fastbom J, Wimo A, Fratiglioni L, Johnell K. Impact of inappropriate drug use on hospitalizations, mortality, and costs in older persons and persons with dementia: findings from the SNAC study. Drugs Aging. 2015;32(8):671-678.
Koponen M, Lavikainen P, Taipale H, et al. Accumulation of hospital days among antipsychotic initiators with Alzheimer's disease. J Am Med Dir Assoc. 2019;20:1488-1494.e3. https://doi.org/10.1016/j.jamda.2019.07.009.
Ellul J, Archer N, Foy CM, et al. The effects of commonly prescribed drugs in patients with Alzheimer's disease on the rate of deterioration. J Neurol Neurosurg Psychiatry. 2007;78(3):233-239.
Rosenberg PB, Mielke MM, Han D, et al. The association of psychotropic medication use with the cognitive, functional, and neuropsychiatric trajectory of Alzheimer's disease. Int J Geriatr Psychiatry. 2012;27(12):1248-1257.
By the American Geriatrics Society Beers Criteria Update Expert P. American Geriatrics Society 2019 updated AGS beers criteria(R) for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674-694.
O'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213-218.
Breining A, Bonnet-Zamponi D, Zerah L, et al. Exposure to psychotropics in the French older population living with dementia: a nationwide population-based study. Int J Geriatr Psychiatry. 2017;32(7):750-760.
Calvo-Perxas L, Turro-Garriga O, Aguirregomozcorta M, et al. Psychotropic drugs in patients with Alzheimer's disease: a longitudinal study by the registry of dementias of Girona (ReDeGi) in Catalonia. Spain J Am Med Dir Assoc. 2014;15(7):497-503.
Harrison SL, Bradley C, Milte R, et al. Psychotropic medications in older people in residential care facilities and associations with quality of life: a cross-sectional study. BMC Geriatr. 2018;18(1):60. https://doi.org/10.1186/s12877-018-0752-0.
Hessmann P, Dodel R, Baum E, et al. Antipsychotic treatment of community-dwelling and institutionalised patients with dementia in Germany. Int J Psychiat Clin. 2018;22(3):232-239.
Smeets CHW, Gerritsen DL, Zuidema SU, et al. Psychotropic drug prescription for nursing home residents with dementia: prevalence and associations with non-resident-related factors. Aging Ment Health. 2018;22(9):1239-1246.
Gutierrez-Valencia M, Izquierdo M, Malafarina V, et al. Impact of hospitalization in an acute geriatric unit on polypharmacy and potentially inappropriate prescriptions: a retrospective study. Geriatr Gerontol Int. 2017;17(12):2354-2360.
Perez T, Moriarty F, Wallace E, McDowell R, Redmond P, Fahey T. Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study. BMJ. 2018;363:k4524.
Phelan EA, Borson S, Grothaus L, Balch S, Larson EB. Association of incident dementia with hospitalizations. JAMA. 2012;307(2):165-172.
Norgaard A, Jensen-Dahm C, Gasse C, Hansen ES, Waldemar G. Psychotropic Polypharmacy in patients with dementia: prevalence and predictors. J Alzheimers Dis. 2017;56(2):707-716.
Orsel K, Taipale H, Tolppanen AM, et al. Psychotropic drugs use and psychotropic polypharmacy among persons with Alzheimer's disease. Eur Neuropsychopharmacol. 2018;28(11):1260-1269.
Reinold J, Palese F, Romanese F, Logroscino G, Riedel O, Pisa FE. Anticholinergic burden before and after hospitalization in older adults with dementia: increase due to antipsychotic medications. Int J Geriatr Psychiatry. 2019;34(6):868-880.
Ihle P, Koster I, Herholz H, Rambow-Bertram P, Schardt T, Schubert I. Sample survey of persons insured in statutory health insurance institutions in Hessen-Concept and realisation of person-related data base. Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes [Germany]). 2005;67(8-9):638-645.
Möllers T, Perna L, Ihle P, Schubert I, Bauer J, Brenner H. Factors associated with length of stay in hospital patients with and without dementia. J Alzheimers Dis. 2019;67:1055-1065.
Wei JT, Lin DY, WEissfeld L. Regression analysis of multivariate incomplete failure time data by modeling marginal distributions. J Am Stat Assoc. 1989;84(408):1065-1073.
Maust DT, Langa KM, Blow FC, Kales HC. Psychotropic use and associated neuropsychiatric symptoms among patients with dementia in the USA. Int J Geriatr Psychiatry. 2017;32(2):164-174.
Vidal X, Agusti A, Vallano A, et al. Elderly patients treated with psychotropic medicines admitted to hospital: associated characteristics and inappropriate use. Eur J Clin Pharmacol. 2016;72(6):755-764.
Nikooie R, Neufeld KJ, Oh ES, et al. Antipsychotics for treating delirium in hospitalized adults: a systematic review. Ann Intern Med. 2019;171:485. https://doi.org/10.7326/M19-1860.
Oh ES, Needham DM, Nikooie R, et al. Antipsychotics for preventing delirium in hospitalized adults: a systematic review. Ann Intern Med. 2019;171:474. https://doi.org/10.7326/M19-1859.
Tampi RR, Tampi DJ, Balachandran S, Srinivasan S. Antipsychotic use in dementia: a systematic review of benefits and risks from metaanalyses. Ther Adv Chronic Dis. 2016;7(5):229-245.
Kales HC, Lyketsos CG, Miller EM, Ballard C. Management of behavioral and psychological symptoms in people with Alzheimer's disease: an international Delphi consensus. Int Psychogeriatr. 2019;31(1):83-90.
Atri A, Grossberg G, Hendrix S, Ellison N, Johnstone MR, Edwards J. Memantine added to background cholinesterase-inhibitors reduces agitation and neuropsychiatric symptoms in Alzheimer's disease. Neurology. 2017;88(Suppl).
Holmes C, Wilkinson D, Dean C, et al. The efficacy of donepezil in the treatment of neuropsychiatric symptoms in Alzheimer disease. Neurology. 2004;63:214-219.
Matsunaga S, Kishi T, Yasue I, Iwata N. Cholinesterase inhibitors for Lewy body disorders: a meta-analysis. Int J Neuropsychopharmacol. 2015;19(2). https://doi.org/10.1093/ijnp/pyv086.
Bjoerke-Bertheussen J, Ehrt U, Rongve A, Ballard C, Aarsland D. Neuropsychiatric symptoms in mild dementia with lewy bodies and Alzheimer's disease. Dement Geriatr Cogn Disord. 2012;34(1):1-6.
Bougea A, Stefanis L, Paraskevas GP, et al. Neuropsychiatric symptoms and alpha-Synuclein profile of patients with Parkinson's disease dementia, dementia with Lewy bodies and Alzheimer's disease. J Neurol. 2018;265(10):2295-2301.
Fitzgerald JM, Perera G, Chang-Tave A, et al. The incidence of recorded delirium episodes before and after dementia diagnosis: differences between dementia with Lewy bodies and Alzheimer's disease. J Am Med Dir Assoc. 2019;20(5):604-609.
Gore RL, Vardy ER, O'Brien JT. Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum? J Neurol Neurosurg Psychiatry. 2015;86(1):50-59.
McKeith IG, Boeve BF, Dickson DW, et al. Diagnosis and management of dementia with Lewy bodies, fourth consensus report of the DLB consortium. Neurology. 2017;89:88-100.
Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. The impact of different diagnostic criteria on prevalence rates for delirium. Dement Geriatr Cogn Disord. 2003;16(3):156-162.
Sorbi S, Hort J, Erkinjuntti T, et al. EFNS-ENS guidelines on the diagnosis and management of disorders associated with dementia. Eur J Neurol. 2012;19(9):1159-1179.
van der Spek K, Gerritsen DL, Smalbrugge M, et al. Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-Study. Int Psychogeriatr. 2016;28(10):1589-1595.
Black CM, Fillit H, Xie L, et al. Economic burden, mortality, and institutionalization in patients newly diagnosed with Alzheimer's disease. J Alzheimers Dis. 2018;61(1):185-193.
Dou KX, Tan MS, Tan CC, et al. Comparative safety and effectiveness of cholinesterase inhibitors and memantine for Alzheimer's disease: a network meta-analysis of 41 randomized controlled trials. Alzheimers Res Ther. 2018;10(1):126. https://doi.org/10.1186/s13195-018-0457-9.
Hager K, Baseman AS, Nye JS, et al. Effects of galantamine in a 2-year, randomized, placebo-controlled study in Alzheimer's disease. Neuropsychiatr Dis Treat. 2014;10:391-401.
Hapca S, Burton JK, Cvoro V, Reynish E, Donnan PT. Are antidementia drugs associated with reduced mortality after a hospital emergency admission in the population with dementia aged 65 years and older? Alzheimers Dement. 2019;5:431-440.
Möllers T, Perna L, Stocker H, et al. Alzheimer's disease medication and outcomes of hospitalisation among patients with dementia. Epidemiol Psychiatr Sci. 2019;29. https://doi.org/10.1017/S2045796019000702.
Richter T, Mann E, Meyer G, Haastert B, Kopke S. Prevalence of psychotropic medication use among German and Austrian nursing home residents: a comparison of 3 cohorts. J Am Med Dir Assoc. 2012;13(2):187 e7-87 e13.
Tartaglia MC, Hu B, Mehta K, et al. Demographic and neuropsychiatric factors associated with off-label medication use in frontotemporal dementia and Alzheimer's disease. Alzheimer Dis Assoc Disord. 2014;28(2):182-189.
German Society for Psychiary, Psychotherapie, Psychosomatics and Neurology, German Society for Neurology, Deutschen Alzheimer Gesellschaft e.V. - Selbsthilfe Demenz. S3-Leitline “Demenzen” (Langversion). 2016. https://www.awmf.org/uploads/tx_szleitlinien/038-013l_S3-Demenzen-2016-07.pdf. Stand: 03.01.2020.