Rationales that Providers and Family Members Cited for the Use of Antipsychotic Medications in Nursing Home Residents with Dementia

Bonner, Alice; Field, Terry S.; Lemay, Celeste A.; Mazor, Kathleen M.; Andersen, Ditte K.; Compher, Christina J.; Tjia, Jennifer; Gurwitz, Jerry H.

doi:10.1111/jgs.13230

Cited by 38 publications

(44 citation statements)

References 11 publications

(18 reference statements)

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“…Antipsychotics are commonly prescribed to older adults with dementia in community and long‐term care (LTC) settings for neuropsychiatric symptoms . However, they are considered inappropriate for many of the specific behaviors of concern .…”

Section: Introductionmentioning

confidence: 99%

Relevance of frailty to mortality associated with the use of antipsychotics among community‐residing older adults with impaired cognition

Maxwell

Campitelli

Hogan

et al. 2018

Pharmacoepidemiology and Drug

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Section: Introductionmentioning

confidence: 99%

Relevance of frailty to mortality associated with the use of antipsychotics among community‐residing older adults with impaired cognition

Maxwell

Campitelli

Hogan

et al. 2018

Pharmacoepidemiology and Drug

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“…Antipsychotic (AP) prescribing has frequently been recognized as a last-resort solution in order to manage disturbing symptoms such as aggression and agitation, and psychotic symptoms such as delirium and hallucinations [3]. There is a general lack of evidence about AP efficacy in older people with dementia and about risks of serious adverse events, including short and long-term increased mortality rates [4–6].…”

Section: Introductionmentioning

confidence: 99%

Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

Tifratene

Manera²,

Fabre

et al. 2017

Alz Res Therapy

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BackgroundSafety warnings from health authorities are currently intended to limit the use of antipsychotics (APs) in dementia-related conditions to treat neuropsychiatric symptoms, such as disturbing and/or delusional behaviors. The aim of this study is to investigate prevalence, correlates and trends of AP prescribing among people with dementia between 2010 and 2014 in the French population.MethodsAP prescribing and associated factors among individuals with AD, mixed dementia and vascular dementia in the French National Alzheimer Database between 2010 and 2014 were analyzed using multivariate generalized estimating equations models (n = 199,549).ResultsIn 2014, 7.7% of people with dementia were prescribed an AP. Compared with 2010 there was a 16% increase in AP use. Multivariate analysis showed a linear increase risk of prescription with an adjusted odds ratio (95% confidence interval) of 1.23 (1.17–1.30) in 2014 compared with 2010. Factors associated with AP prescribing were male gender, more severe cognitive decline and living in long-term care facilities. Older age and higher education were protective toward AP prescribing. The type of dementia did not have any influence on AP prescribing.ConclusionAn increase in AP prescribing among individuals with dementia in French specialized settings over the last 5 years occurred despite safety warnings. This phenomenon suggests that alternative solutions for the management of behavioral and psychiatric symptoms in these populations are still urgently needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-017-0256-8) contains supplementary material, which is available to authorized users.

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“…loss of contact with reality, depression, anxiety) and behavioural reasons (e.g. verbal and physical aggression), emotional reasons were cited for the use of antipsychotics including that the resident was angry or agitated, or even ‘sad’ or ‘crying’ – thus also linking emotional consequences to inappropriate prescribing …”

Section: Discussionmentioning

confidence: 99%

“…A recent US study found that the reasons given for the use of antipsychotic medication in nursing-home residents with dementia frequently related to a wide variety of indications for which the medications are not approved and for which evidence of efficacy is lacking. [19] For example, as well as psychiatric (e.g. loss of contact with reality, depression, anxiety) and behavioural reasons (e.g.…”

Section: Discussionmentioning

confidence: 99%

Identifying fallacious arguments in a qualitative study of antipsychotic prescribing in dementia

Donyai

2016

International Journal of Pharmacy Practice

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Fallacious arguments were often formulated to present convincing cases whereby prescribing antipsychotics or maintaining existing doses (versus not starting medication or reducing the dose, for example) appeared as the only acceptable decision but this is not always the case. The findings could help health professionals to recognise and mitigate the effect of logic-based errors in decisions about the prescribing of antipsychotics in dementia.

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Rationales that Providers and Family Members Cited for the Use of Antipsychotic Medications in Nursing Home Residents with Dementia

Abstract: The rationale for use of antipsychotic drug therapy frequently relates to a wide variety of indications for which these drugs are not approved and for which evidence of efficacy is lacking. These findings have implications for clinical practice and policy.

Cited by 38 publications

References 11 publications

Relevance of frailty to mortality associated with the use of antipsychotics among community‐residing older adults with impaired cognition

Relevance of frailty to mortality associated with the use of antipsychotics among community‐residing older adults with impaired cognition

Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

Identifying fallacious arguments in a qualitative study of antipsychotic prescribing in dementia

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