Factors correlated with initiating antipsychotics among dementia patients in Korean long-term care facilities: National Health Insurance Service-Senior Cohort (2002-2013)

Abstract

Background/Objectives: This study aimed to identify the pattern of initial antipsychotic prescriptions among dementia patients in Korean long-term care facilities (LTCFs), despite safety issues, and to investigate various factors correlated with their use. Methods: We used a population-based senior cohort database of the Korean National Health Insurance Service (2002Service ( -2013 to target dementia patients newly admitted to LTCFs with no history of schizophrenia or bipolar disorder, and no history of antipsychotic use within six months prior to institutionalization (N=1,986). The sociodemographic, clinical, and facility-related characteristics were compared between the antipsychotic prescription and non-prescription groups. We used multivariate logistic regression models to identify factors that may affect the prescription of antipsychotics. Results: The mean initial prescription rate of antipsychotics was 38.1%. A higher prescription rate of antipsychotics during institutionalization was correlated with male gender, use of memantine, schizophrenia, bipolar disorder, sleep disorder, depression, anxiety disorder, a greater number of pre-admission BPSD, and lower pre-admission functional dependence. A total of 59.4% of cases with antipsychotic prescriptions presented with psychotic symptoms, aggression, and agitation, of which 20.8%, and 19.8% presented with other behavioral and psychological symptoms of dementia (BPSD), and no BPSD, respectively. Conclusions: The rate of initial antipsychotic prescriptions in Korean LTCF residents with dementia was high, and the prescription of antipsychotics was more strongly affected by the clinical characteristics of the patients than by sociodemographic or facility-related factors. Notably, more than 40% of the dementia patients in LTCFs received antipsychotics without appropriate indications.

Bipolar Disorder and Manic-Like Symptoms in Alzheimer’s, Vascular and Frontotemporal Dementia: A Systematic Review

“…Among patients with dementia, those with behavioural disorders, such as agitation or aggression, and psychotic symptoms are more likely to receive antipsychotics [ 164 , 166 - 168 ]. Importantly, BD comorbidity is one of the strongest predictors of antipsychotic medication use in patients with dementia [ 164 , 166 , 167 ]. Nevertheless, no randomized controlled trials of antipsychotic treatments for manic episodes in patients with dementia have been conducted so far.…”