Prevalence and persistent use of psychotropic drugs in older adults receiving domiciliary care at baseline

Jūratė Šaltytė Benth,Sverre Bergh,Anne-Sofie Helvik,Marte Aarøen,Marie Turmo Lornstad

doi:10.1186/s12877-019-1126-y

Abstract

BackgroundLittle is known about the use of psychotropic drugs in older adults receiving domiciliary care. The first aim was to describe the prevalence and persistency of use of psychotropic drugs in older adults (≥ 70 years) with and without dementia receiving domiciliary care. Furthermore, the second aim was to explore factors associated with persistent drug use at two consecutive time-points. Lastly, we aimed to examine if use of psychotropic drugs changed after admission to a nursing home.MethodsIn total, 1001 community-dwelling older adults receiving domiciliary care at inclusion participated in the study. Information about psychotropic drug use was collected at baseline, after 18 months and after 36 months. The participants’ cognitive function, neuropsychiatric symptoms (NPS) and physical health were assessed at the same assessments. Participants were evaluated for dementia based on all gathered information. Formal level of care (domiciliary care or in a nursing home) was registered at the follow-up assessments.ResultsPrevalence and persistent use of psychotropic drugs in older adults receiving domiciliary care was high. Participants with dementia more often used antipsychotics and antidepressants than participants without dementia. The majority of the participants using antipsychotic drugs used traditional antipsychotics. Younger age was associated with higher odds for persistent use of antipsychotics and antidepressants, and lower odds for persistent use of sedatives. Severity of NPS was associated with persistent use of antidepressants. The odds for use of antipsychotics and antidepressants were higher in those admitted to a nursing home as compared to the community-dwelling participants at the last follow-up.ConclusionThere was a high prevalence and persistency of use of psychotropic drugs. The prevalence of use of traditional antipsychotics was surprisingly high, which is alarming. Monitoring the effect and adverse effects of psychotropic drugs is an important part of the treatment, and discontinuation should be considered when possible due to the odds for severe adverse effects of such drugs in people with dementia.

Highlights

Little is known about the use of psychotropic drugs in older adults receiving domiciliary care
The majority of the participants using antipsychotics used traditional antipsychotics, and traditional antipsychotics were more frequently used by participants with dementia than by participants without dementia at all time-points
The odds for use of antipsychotics and antidepressants were higher in those admitted to a nursing home as compared to the community-dwelling participants at Assessment 3 (A3)

Summary

Introduction

Little is known about the use of psychotropic drugs in older adults receiving domiciliary care. The first aim was to describe the prevalence and persistency of use of psychotropic drugs in older adults (≥ 70 years) with and without dementia receiving domiciliary care. In community-dwelling older adults, people with dementia more often use psychotropic drugs than those without dementia [6, 7]. Chan et al reported that in a group of community-dwelling older adults, a clinical diagnosis of dementia, but not the severity of NPS, was associated with the use of psychotropic drugs [10]. Nursing home residents with dementia more often use antipsychotics than residents without dementia [11,12,13], and the severity of their NPS is associated with persistent use of psychotropic drugs [14]. Non-pharmacological interventions should be the first-choice treatment of NPS in dementia [15,16,17,18], but with severe NPS psychotropic drug use may be unavoidable

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