Time trends in psychotropic drug prescriptions in Dutch nursing home residents with dementia between 2003 and 2018

Abstract

Objective Several European studies investigated the trends in psychotropic drug prescriptions (PDPs) among nursing home (NH) residents and reported a decline in antipsychotics prescriptions. Since the Dutch long‐term care system differs from other European systems (e.g. higher threshold for NH admission and trained elderly care physicians), this study explores the trends in PDPs in Dutch NH residents with dementia. Methods The study used data from nine studies, comprising two cross‐sectional studies, one cohort study, and six cluster‐randomized controlled trials, collected in Dutch NHs between 2003 and 2018. With multilevel logistic regression analysis, NHs as a random effect, we estimated the trends in PDPs overall and for five specific psychotropic drug groups (antipsychotics, antidepressants, anxiolytics, hypnotics, and anti‐dementia drugs), adjusting for confounders: age, gender, severity of dementia, severity of neuropsychiatric symptoms, and length of stay in NHs. Results The absolute prescription rate of antipsychotics was 37.5% in 2003 and decreased (OR = 0.947, 95% CI [0.926, 0.970]) every year. The absolute prescription rate of anti‐dementia drugs was 0.8% in 2003 and increased (OR = 1.162, 95% CI [1.105, 1.223]) per year. The absolute rate of overall PDPs declined from 62.7% in 2003 to 40.4% in 2018. Conclusions Among Dutch NH residents with dementia, the odds of antipsychotics prescriptions decreased by 5.3% per year while the odds of anti‐dementia drug prescriptions increased by 16.2%. There were no distinct trends in antidepressants, anxiolytics, and hypnotics prescriptions. However, overall PDPs were still high. The PDPs in NH residents remain an issue of concern.

Psychotropic substitutions: Out of the frying pan and into the fire

“…In Canada, an online public reporting initiative was associated with a 6% reduction in antipsychotic use in nursing homes over a 3 year period 9 . A similar decreasing antipsychotic trend was reported in nursing homes in several European countries, including Sweden and the Netherlands 10,11 . While applauding these efforts, several authors of these studies warned about the potential unintended consequences of targeting antipsychotics, including psychotropic substitutions involving an increase in the use of non‐antipsychotic off‐label prescriptions with similar risks of harm 9,12 …”

“…The American Geriatrics Society's Choosing Wisely Guidelines likewise recommends that antipsychotics should not be used as the first choice to treat BPSD 7 . These warnings and guidelines accompanied increased public attention as well as campaigns using audit, feedback and reporting which resulted in decreased antipsychotic use among nursing home residents in several countries 8–11 . Two US studies have demonstrated a decrease in antipsychotic prescribing from 33.7% to 27.5% between 2009 and 2018, 8 and from 32.1% to 27.9% between 2015 and 2019 1 .…”

“…well as campaigns using audit, feedback and reporting which resulted in decreased antipsychotic use among nursing home residents in several countries. [8][9][10][11] Two US studies have demonstrated a decrease in antipsychotic prescribing from 33.7% to 27.5% between 2009 and 2018, 8 and from 32.1% to 27.9% between 2015 and 2019. 1 In Canada, an online public reporting initiative was associated with a 6% reduction in antipsychotic use in nursing homes over a 3 year period.…”

“…9 A similar decreasing antipsychotic trend was reported in nursing homes in several European countries, including Sweden and the Netherlands. 10,11 While applauding these efforts, several authors of these studies warned about the potential unintended consequences of targeting antipsychotics, including psychotropic substitutions involving an increase in the use of non-antipsychotic off-label prescriptions with similar risks of harm. 9,12 Unfortunately, the decline in antipsychotic use in nursing homes has indeed coincided with an alarming increase in the use of off-label gabapentin and other antiepileptics.…”

National surveillance using a clinical quality indicator for prolonged antipsychotic use among older Australians with dementia who access aged care services

“…Decreased use of antipsychotics has been observed in studies conducted in PRAC facilities in the United States and Netherlands, 43,44 but not the United Kingdom. 45 The 3% annual decrease in prolonged use observed in our study likely reflects changes to the product information for risperidone 21 and large-scale policy and quality improvement initiatives 46 diagnosis coding 52 which may also need to be monitored if the CQI tested in our study is implemented.…”