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.
Keywords
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Article info
Publication history
Published online: September 25, 2014
Footnotes
The authors declare no conflicts of interest.
The SHELTER study was funded by the EU 7th Framework Programme (IGA-MH-CR NS-10029-4). All researchers, including the coauthors, were independent from the funder, and the funding body did not play any role in the study design, in the collection, analysis, or interpretation of data, in manuscript preparation, or in the decision to submit the article for publication.
Identification
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© 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
