title: Patterns of psychotropic prescribing and polypharmacy in older hospitalized patients in Ireland: the influence of dementia on prescribing.
abstract: Neuropsychiatric Symptoms (NPS) are ubiquitous in dementia and are often treated pharmacologically. The objectives of this study were to describe the use of psychotropic, anti-cholinergic, and deliriogenic medications and to identify the prevalence of polypharmacy and psychotropic polypharmacy, among older hospitalized patients in Ireland, with and without dementia.
  
  
  
  All older patients (≥ 70 years old) that had elective or emergency admissions to six Irish study hospitals were eligible for inclusion in a longitudinal observational study. Of 676 eligible patients, 598 patients were recruited and diagnosed as having dementia, or not, by medical experts. These 598 patients were assessed for delirium, medication use, co-morbidity, functional ability, and nutritional status. We conducted a retrospective cross-sectional analysis of medication data on admission for 583/598 patients with complete medication data, and controlled for age, sex, and co-morbidity.
  
  
  
  Of 149 patients diagnosed with dementia, only 53 had a previous diagnosis. At hospital admission, 458/583 patients experienced polypharmacy (≥ 5 medications). People with dementia (PwD) were significantly more likely to be prescribed at least one psychotropic medication than patients without dementia (99/147 vs. 182/436; p < 0.001). PwD were also more likely to experience psychotropic polypharmacy (≥ two psychotropics) than those without dementia (54/147 vs. 61/436; p < 0.001). There were no significant differences in the prescribing patterns of anti-cholinergics (23/147 vs. 42/436; p = 0.18) or deliriogenics (79/147 vs. 235/436; p = 0.62).
  
  
  
  Polypharmacy and psychotropic drug use is highly prevalent in older Irish hospitalized patients, especially in PwD. Hospital admission presents an ideal time for medication reviews in PwD.
authors.affiliation: Pharmaceutical Care Research Group,School of Pharmacy,University College Cork,Cork,Ireland.
authors.forename: Kieran Anthony
authors.identifier: 0000-0002-4386-3012
authors.initials: KA
authors.lastname: Walsh
authors.affiliation: Centre for Gerontology and Rehabilitation,School of Medicine,University College Cork,Cork,Ireland.
authors.forename: Niamh A
authors.initials: NA
authors.lastname: O'Regan
authors.affiliation: Pharmaceutical Care Research Group,School of Pharmacy,University College Cork,Cork,Ireland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Byrne
authors.affiliation: Department of Epidemiology and Public Health,University College Cork,Cork,Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Browne
authors.affiliation: Graduate Entry Medical School,University of Limerick,Limerick,Ireland.
authors.forename: David J
authors.initials: DJ
authors.lastname: Meagher
authors.affiliation: Centre for Gerontology and Rehabilitation,School of Medicine,University College Cork,Cork,Ireland.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Timmons
mesh_terms: D000368:Aged; D001526:Behavioral Symptoms / Q000175:diagnosis / Q000188:drug therapy; D002908:Chronic Disease / Q000188:drug therapy / Q000453:epidemiology; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D000076322:Multimorbidity; D019338:Polypharmacy; D000067561:Potentially Inappropriate Medication List / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011619:Psychotropic Drugs / Q000627:therapeutic use*
chemical_list: D011619:Psychotropic Drugs
keywords: anti-psychotics; behavioral and psychological symptoms of dementia (BPSD); delirium; dementia; neuropsychiatric symptoms (NPS)