title: Trends in Psychotropic Dispensing Among Older Adults with Dementia Living in Long-Term Care Facilities: 2004-2013.
abstract: OBJECTIVE
  Guidelines worldwide have cautioned against the use of antipsychotics as first-line agents to treat neuropsychiatric symptoms of dementia. We aimed to investigate the changes over time in the dispensing of antipsychotics and other psychotropics among older adults with dementia living in long-term care facilities.
  
  
  METHODS
  We used drug claims data from Ontario, Canada, to calculate quarterly rates of prescription dispensing of six psychotropic drug classes among all elderly (≥65 years of age) long-term care residents with dementia from January 1, 2004, to March 31, 2013. Psychotropic drugs were classified into the following categories: atypical and conventional antipsychotics, non-sedative and sedative antidepressants, anti-epileptics, and benzodiazepines. We used time-series analysis to assess trends over time.
  
  
  RESULTS
  The study sample increased by 21% over the 10-year study period, from 49,251 patients to 59,785 patients. The majority of patients (within the range of 75%-79%) were dispensed at least one psychotropic medication. At the beginning of the study period atypical antipsychotics (38%) were the most frequently dispensed psychotropic, followed by benzodiazepines (28%), non-sedative antidepressants (27%), sedative antidepressants (17%), anti-epileptics (7%), and conventional antipsychotics (3%). Dispensing of anti-epileptics (2% increase) and conventional antipsychotics (1% decrease) displayed modest changes over time, but we observed more pronounced changes in dispensing of benzodiazepines (11% decrease) and atypical antipsychotics (4% decrease). Concurrently, we observed a substantial growth in the dispensing of both sedative (15% increase) and non-sedative (9% increase) antidepressants. The proportion of patients dispensed two or more psychotropic drug classes increased from 42% in 2004 to 50% in 2013.
  
  
  CONCLUSIONS
  Utilization patterns of psychotropic drugs in institutionalized patients with dementia have changed over the past decade. Although their use declined slightly over the study period, atypical antipsychotics continue to be used at a high rate. A decline in the use of benzodiazepines along with an increased use of sedative and non-sedative antidepressants suggests that the latter class of drugs is being substituted for the former in the management of neuropsychiatric symptoms. Psychotropic polypharmacy continues to be highly prevalent in these patient samples.
authors.affiliation: Division of Geriatric Psychiatry, Department of Psychiatry, Western University, London, Canada; Division of Clinical Pharmacology, Department of Medicine, Western University, London, Canada. Electronic address: akshya.vasudev@uwo.ca.
authors.forename: Akshya
authors.initials: A
authors.lastname: Vasudev
authors.affiliation: Institute for Clinical Evaluative Sciences, London, Canada.
authors.forename: Salimah Z
authors.initials: SZ
authors.lastname: Shariff
authors.affiliation: Institute for Clinical Evaluative Sciences, London, Canada.
authors.forename: Kuan
authors.initials: K
authors.lastname: Liu
authors.affiliation: Division of Geriatric Psychiatry, Department of Psychiatry, Western University, London, Canada.
authors.forename: Amer M
authors.initials: AM
authors.lastname: Burhan
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.affiliation: Institute for Clinical Evaluative Sciences, London, Canada.
authors.forename: Sean
authors.initials: S
authors.lastname: Leonard
authors.affiliation: Institute for Clinical Evaluative Sciences, London, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
mesh_terms: D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003704:Dementia / Q000188:drug therapy*; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D009864:Ontario; D011619:Psychotropic Drugs / Q000627:therapeutic use*
chemical_list: D011619:Psychotropic Drugs
keywords: Dispensing; antipsychotics; dementia; long-term care; psychotropics