Neuropsychiatric co‐morbidities and psychotropic medication use in Medicare beneficiaries with dementia

Abstract

AbstractBackgroundNeuropsychiatric symptoms affect approximately 97% of patients with dementia. Prevalence of symptoms may be different dependent upon age, sex or race. Past studies report high rates of potentially inappropriate prescribing in the dementia population. We investigate differences in neuropsychiatric diagnoses and psychotropic medication prescribing in a local US cohort.MethodWe utilize Medicare claims and Medicare Part D prescription fill records in a cohort of 100% Medicare North and South Carolina fee‐for‐service beneficiaries ages 50 and above for the year 2017 with a dementia diagnosis. We identify dementia based on an ICD‐10‐CM diagnosis of dementia from an inpatient, outpatient, carrier, skilled nursing facility or home health claim, or a prescription claim for drug treatment between 1/1/2017 and 12/31/2017. We quantified neuropsychiatric diagnosis of anxiety, depression and psychosis using validated coding algorithms, searching inpatient, outpatient and physician 2017 claims. Demographic characteristics, including age, sex and race, as well as dual Medicare/Medicaid status were collected from the MSBF file for each individual. We search generic medication names in Medicare Part D claims for anti‐anxiety, antidepressant and antipsychotic medications to determine prescriptions filled during 2017.ResultProviders diagnosed anxiety and depression at higher rates in White patients; and psychosis at higher rates in Black patients. (P<0.001) Providers diagnosed female patients with depression, anxiety and psychosis at higher rates than males. (P<0.001) A provider diagnosis of anxiety, depression or psychosis is most prevalent in the age group 50‐59 and decreases with age to age 90+. Females with anxiety, depression and psychosis filled more anti‐anxiety and antidepressant medications than males. (P<0.001) Black and Other race patients filled more antipsychotic medications for anxiety and depression than White patients. (P<0.001)ConclusionOf concern is the high fill rate of anti‐anxiety (benzodiazepine) medications, especially in females. In patients with a neuropsychiatric diagnosis, consistently over half filled an antidepressant medication and over a quarter filled prescriptions for antipsychotics. These medications may have risks > benefits in this population and lack efficacy. As alternatives, non‐pharmacologic treatment with patient/caregiver education about expectations and psychosocial interventions show promise. Innovative community outreach and care delivery models incorporating these methods may help decrease levels of medication use.