Guidelines recommend short-term targeted use of antipsychotic medications for behavioral and psychological symptoms of dementia only when other strategies have failed. Antipsychotic prescribing in dementia is common internationally, but data on duration of use are limited. Our objectives were to determine duration, time to initiation, and prevalence of antipsychotic use among people with dementia.
This work was a retrospective dynamic cohort study of people aged 65 years or above with dementia in 68 residential aged facilities during the period spanning from 2014 to 2017. Medication administration records were used to identify antipsychotic medication use. Medication outcomes (prevalence, duration, and time to initiation) were estimated using regression. Covariates included comorbidities and sociodemographic and facility characteristics.
A total of 5825 residents with dementia were identified. The annual prevalence of antipsychotic use ranged from 27.6% to 32.6%. Mean time to initiation after admission was 308.4 days (for female individuals) and 173.2 days (for male individuals). An overall 65% of people who used antipsychotics did so for >3 months even without psychiatric comorbidities; mean durations were 212.74 (95% confidence interval: 170.24, 255.25) days (for female individuals) and 216.10 (95% confidence interval: 165.31, 266.89) days (for male individuals) at median ages.
Antipsychotics are often used longer than recommended. Current guidelines and restrictions may be insufficient to limit antipsychotic medication use. Further efforts are needed to ensure that antipsychotic medications are used as recommended in dementia.
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
A preliminary version of this project was presented on May 30, 2018, at the Choosing Wisely Australia conference in Canberra, Australian Capital Territory.
Supported by an Australian Research Council Linkage Grant (LP120200814), and M.Z.R. is supported by a National Health and Medical Research Council Early Career Fellowship (APP1143941).
The authors declare no conflicts of interest.
Reprints: Kimberly E. Lind, PhD, MPH, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia (e-mail: firstname.lastname@example.org).
Received February 27, 2019
Accepted June 18, 2019