Hostname: page-component-5c6d5d7d68-wp2c8 Total loading time: 0 Render date: 2024-08-24T23:10:44.488Z Has data issue: false hasContentIssue false

Improving psychotropic medication use among persons with dementia

Published online by Cambridge University Press:  23 September 2016

Donovan T. Maust*
Affiliation:
Department of Psychiatry, University of Michigan, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA

Extract

The use of psychotropic medication among persons with dementia (PWD) both in nursing home (Wetzels et al., 2011) and community settings (Maust et al., 2016) far exceeds what might be expected based on their limited evidence for benefit (Kales et al., 2015). This relatively high use persists despite years of evidence about the potential harms associated with their use in older adults generally and PWD in particular (e.g. Wang et al., 2001; Schneider et al., 2005). However, the solution to relatively high psychotropic use is not to end all psychotropic use, as there are individual patients for whom use of such medication is appropriate. For example, a policy that defines all antipsychotic use as inappropriate may simply lead to increased use of alternatives with even less evidence of benefit, as suggested by the response to antipsychotics’ black box warning in the United States (Kales et al., 2011).

Type
Commentary
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kales, H. C., Gitlin, L. N. and Lyketsos, C. G. (2014). Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. Journal of the American Geriatrics Society, 62, 762769.CrossRefGoogle ScholarPubMed
Kales, H. C., Gitlin, L. N. and Lyketsos, C. G. (2015). Assessment and management of behavioral and psychological symptoms of dementia. BMJ, 350, h369h369.CrossRefGoogle ScholarPubMed
Kales, H. C. et al. (2011). Trends in antipsychotic use in dementia 1999–2007. Archives of General Psychiatry, 68, 190197.CrossRefGoogle ScholarPubMed
Maust, D. T., Langa, K. M., Blow, F. C. and Kales, H. C. (2016). Psychotropic use and associated neuropsychiatric symptoms among patients with dementia in the USA. International Journal of Geriatric Psychiatry. Epub ahead of print. doi: 10.1002/gps.4452.CrossRefGoogle ScholarPubMed
Maust, D. T. et al. (2011). Telephone-based behavioral health assessment for older adults starting a new psychiatric medication. American Journal of Geriatric Psychiatry, 19, 851858.CrossRefGoogle ScholarPubMed
Schneider, L. S., Dagerman, K. S. and Insel, P. (2005). Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA, 294, 19341943.CrossRefGoogle ScholarPubMed
van der Spek, K. et al. (2016). Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-study. International Psychogeriatrics. Epub ahead of print. doi:10.1017/S104161021600082X.CrossRefGoogle ScholarPubMed
Wang, P. S., Bohn, R. L., Glynn, R. J., Mogun, H. and Avorn, J. (2001). Hazardous benzodiazepine regimens in the elderly: effects of half-life, dosage, and duration on risk of hip fracture. American Journal of Psychiatry, 158, 892898.CrossRefGoogle ScholarPubMed
Wetzels, R. B., Zuidema, S. U., de Jonghe, J. F. M., Verhey, F. R. J. and Koopmans, R. T. C. M. (2011). Prescribing pattern of psychotropic drugs in nursing home residents with dementia. International Psychogeriatrics, 23, 12491259.CrossRefGoogle ScholarPubMed
Wiechers, I. R., Kirwin, P. D. and Rosenheck, R. A. (2014). Increased risk among older veterans of prescribing psychotropic medication in the absence of psychiatric diagnoses. American Journal of Geriatric Psychiatry, 22, 531539.CrossRefGoogle ScholarPubMed