Display options
Share it on

Drugs Real World Outcomes. 2015 Sep;2(3):289-298. doi: 10.1007/s40801-015-0038-1.

How Prolific is Psychotropic Medicines Use in People with Dementia in Australia Within the Community Setting? A Retrospective Analysis.

Drugs - real world outcomes

Dianne Goeman, Kira Harvey, Cik Yin Lee, Neil Petrie, Chris Beanland, Christine Culhane, Susan Koch

Affiliations

  1. RDNS Institute, 31 Alma Rd, St Kilda, VIC, 3182, Australia. [email protected].
  2. RDNS Institute, 31 Alma Rd, St Kilda, VIC, 3182, Australia.
  3. , Suite 5 No 10 Station Rd, Cheltenham, VIC, 3192, Australia.
  4. Psychotropic Drug Advisory Service, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia.

PMID: 27747574 PMCID: PMC4883220 DOI: 10.1007/s40801-015-0038-1

Abstract

BACKGROUND: When used for a therapeutic purpose such as for psychiatric illness, psychotropic drugs may enhance quality of life; however, when used to treat behaviours associated with dementia, they may have only a modest effect but lead to negative outcomes.

OBJECTIVE: We undertook an analysis of community-dwelling people with dementia or cognitive impairment to ascertain how prolific psychotropic medicine use is within the Australian community setting, which psychotropic medicines are being prescribed and to whom, and whether the use of such medicines is in accordance with therapeutic guidelines.

METHODS: We undertook a retrospective review of medication records, including medication charts, for 412 people with cognitive impairment, discharged from a home nursing service in Victoria, Australia, during the 6-month period between 1 January and 30 June 2013.

RESULTS: Cholinesterase inhibitor use exceeded the number of individuals with a recorded diagnosis of Alzheimer's disease; in some cases, the dosage exceeded recommendations. Antidepressants were used by more than double the number of people documented with a history of depression. Antipsychotic medicines were prescribed for undocumented purposes, in some cases above maximum response levels, and multiple benzodiazepines were prescribed.

CONCLUSIONS: Psychotropic medicine use was common in our study population, and use of these medicines was often not in line with therapeutic guidelines. Further research is required to ascertain reasons for the high use of psychotropic medicines in this group, and greater consideration is required by health professionals of the appropriate use and regular review of psychotropic medicines. Improved documentation of diagnoses and the indications for prescribing psychotropic medicines is needed, as is greater implementation of educational programmes to support care workers and carers.

Conflict of interest statement

Compliance with Ethical Standards Funding No specific funding was received for this research. Conflict of interest Dr Dianne Goeman, Ms Kira Harvey, Dr Cik Yin Lee, Dr Christine Beanland, Mr Neil Petr

References

  1. BMJ Open. 2014 Dec 18;4(12 ):e006135 - PubMed
  2. Geriatr Gerontol Int. 2014 Jan;14(1):89-93 - PubMed
  3. Int Psychogeriatr. 2010 May;22(3):346-72 - PubMed
  4. Am J Geriatr Psychiatry. 2004 Sep-Oct;12(5):499-508 - PubMed
  5. Aust N Z J Psychiatry. 2010 Apr;44(4):372-7 - PubMed
  6. Drugs Aging. 2001;18(1):45-61 - PubMed
  7. JAMA. 2005 Oct 19;294(15):1934-43 - PubMed
  8. J Am Geriatr Soc. 2005 Aug;53(8):1290-5 - PubMed
  9. N Engl J Med. 2009 Jan 15;360(3):225-35 - PubMed
  10. Br J Clin Pharmacol. 2007 Feb;63(2):163-70 - PubMed
  11. Med J Aust. 2011 Mar 7;194(5):270-1 - PubMed
  12. Ageing Res Rev. 2013 Jan;12(1):354-64 - PubMed
  13. Med J Aust. 2005 Mar 21;182(6):267-70 - PubMed
  14. Int Psychogeriatr. 2011 Oct;23(8):1260-9 - PubMed
  15. J Psychiatr Res. 1975 Nov;12(3):189-98 - PubMed
  16. Nat Rev Neurol. 2009 May;5(5):245-55 - PubMed
  17. Int Psychogeriatr. 2013 Feb;25(2):328-38 - PubMed
  18. Drugs Aging. 2010 Feb 1;27(2):135-48 - PubMed
  19. Int J Geriatr Psychiatry. 2010 May;25(5):449-57 - PubMed
  20. J Clin Nurs. 2015 Mar;24(5-6):872-5 - PubMed
  21. Arch Intern Med. 2009 Jul 27;169(14):1317-24 - PubMed
  22. Aust N Z J Psychiatry. 2007 Sep;41(9):751-8 - PubMed
  23. Int Psychogeriatr. 2004 Mar;16(1):13-31 - PubMed
  24. Am J Alzheimers Dis Other Demen. 2011 Feb;26(1):10-28 - PubMed
  25. Drugs Today (Barc). 2003 Jul;39(7):551-7 - PubMed
  26. Australas Psychiatry. 2011 Feb;19(1):59-63 - PubMed
  27. Age Ageing. 2010 Sep;39(5):637-42 - PubMed
  28. J Am Geriatr Soc. 2013 May;61(5):723-33 - PubMed
  29. Med J Aust. 2013 Jul 22;199(2):98 - PubMed
  30. J Am Med Dir Assoc. 2012 Jan;13(1):80.e1-6 - PubMed
  31. Age Ageing. 2013 Jan;42(1):51-6 - PubMed

Publication Types