Abstract
Neuropsychiatric Symptoms (NPS) are ubiquitous in dementia and are often treated pharmacologically. The objectives of this study were to describe the use of psychotropic, anti-cholinergic, and deliriogenic medications and to identify the prevalence of polypharmacy and psychotropic polypharmacy, among older hospitalized patients in Ireland, with and without dementia. All older patients (≥ 70 years old) that had elective or emergency admissions to six Irish study hospitals were eligible for inclusion in a longitudinal observational study. Of 676 eligible patients, 598 patients were recruited and diagnosed as having dementia, or not, by medical experts. These 598 patients were assessed for delirium, medication use, co-morbidity, functional ability, and nutritional status. We conducted a retrospective cross-sectional analysis of medication data on admission for 583/598 patients with complete medication data, and controlled for age, sex, and co-morbidity. Of 149 patients diagnosed with dementia, only 53 had a previous diagnosis. At hospital admission, 458/583 patients experienced polypharmacy (≥ 5 medications). People with dementia (PwD) were significantly more likely to be prescribed at least one psychotropic medication than patients without dementia (99/147 vs. 182/436; p < 0.001). PwD were also more likely to experience psychotropic polypharmacy (≥ two psychotropics) than those without dementia (54/147 vs. 61/436; p < 0.001). There were no significant differences in the prescribing patterns of anti-cholinergics (23/147 vs. 42/436; p = 0.18) or deliriogenics (79/147 vs. 235/436; p = 0.62). Polypharmacy and psychotropic drug use is highly prevalent in older Irish hospitalized patients, especially in PwD. Hospital admission presents an ideal time for medication reviews in PwD.
Highlights
The number of people with dementia (PwD) is escalating worldwide; estimates project the prevalence at over 131.5 million by 2050 (Alzheimer’s Disease International, 2015)
Guidelines generally recommend that nonpharmacological treatments should be used as firstline treatment of Behavioral and Psychological Symptoms of Dementia (BPSD), and only when these fail should psychotropic agents be trialed for shortterm use (Azermai et al, 2012)
PwD were significantly more likely to be admitted from a nursing home, to be acutely admitted to hospital, or to have delirium on admission
Summary
The number of people with dementia (PwD) is escalating worldwide; estimates project the prevalence at over 131.5 million by 2050 (Alzheimer’s Disease International, 2015). The majority will experience Behavioral and Psychological Symptoms of Dementia (BPSD), referred to as Neuropsychiatric Symptoms (NPS) during their disease (Lawlor, 2002). BPSD refers to the spectrum of distressing, non-cognitive symptoms of dementia, ranging from wandering and agitation to delusional and aggressive behavior (Cahill et al, 2012). Neuropsychiatric Symptoms (NPS) are ubiquitous in dementia and are often treated pharmacologically. The objectives of this study were to describe the use of psychotropic, anti-cholinergic, and deliriogenic medications and to identify the prevalence of polypharmacy and psychotropic polypharmacy, among older hospitalized patients in Ireland, with and without dementia
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