Pharmacotherapy of Persons with Dementia in Long-term Care in Australia: A Descriptive Audit of Central Nervous System Medications.
BACKGROUND
Neuropsychiatric symptoms of dementia are often treated through the prescription of one or more psychotropic medications. However, limited efficacy and potential harmful side-effects has resulted in efforts to reduce the use of psychotropic medication in this population, particularly for those living in long-term care.


OBJECTIVE
This study sought to describe the pattern of central nervous system medication usage in older adults with dementia living in long-term care; assess the appropriateness of prescribing against Beers criteria; and detect potential drug interactions from co-administered medications.


METHODS
A retrospective descriptive audit of the medical records of n=415 residents, aged >60 years with a diagnosis of dementia, from 28 long-term care facilities in Queensland, Australia. Information extracted included the types and usage of regular and Pro Re Nata central nervous system medications.


RESULTS
Of those taking medication (n=317), 68% were prescribed at least one potentially inappropriate medication, and there was a significant positive correlation between the number of medications prescribed and the number of potentially inappropriate medications. Two-hundred potential interactions with variable severity were identified from 130 residents on ≥ 1 medication - 38% were potentially severe interactions, 46% were moderate.


CONCLUSIONS
This medication audit raises concerns that prescription of medications may still be the first resort to treat behavioural and psychological symptoms of dementia. There is a need for effective and sustainable person-centred interventions that address barriers for appropriate prescribing practice, and involve the collaboration of all healthcare professionals to optimise prescribing and improve the quality of medicines in older people with dementia.
Menzies Health Institute QLD, Griffith University, 2.10 Health Sciences (N48), 170 Kessels Road, Nathan, Brisbane, Queensland, 4111,Australia.
Wendy
W
Moyle
Menzies Health Institute QLD, Griffith University, Nathan, Brisbane, Queensland,Australia.
Najwan
N
El Saifi
School of Psychiatry, University of New South Wales, Sydney,Australia.
Brian
B
Draper
Menzies Health Institute QLD, Griffith University, Nathan, Brisbane, Queensland,Australia.
Cindy
C
Jones
School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland,Australia.
Elizabeth
E
Beattie
Menzies Health Institute QLD, Griffith University, Nathan, Brisbane, Queensland,Australia.
David
D
Shum
Department of Public Health, College of Health Sciences, Qatar University, Doha,Qatar.
Lukman
L
Thalib
Menzies Health Institute QLD, Griffith University, Nathan, Brisbane, Queensland,Australia.
Cindy
C
Mervin
Menzies Health Institute QLD, Griffith University, Nathan, Brisbane, Queensland,Australia.
Siobhan
S
O'Dwyer
D006801:Humans; D003704:Dementia / Q000188:drug therapy; D012189:Retrospective Studies; D000368:Aged; D008297:Male; D005260:Female; D000369:Aged, 80 and over; D008134:Long-Term Care; D008875:Middle Aged; D002491:Central Nervous System Agents / Q000627:therapeutic use / Q000009:adverse effects; D004347:Drug Interactions; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000627:therapeutic use / Q000009:adverse effects; D001315:Australia; D008485:Medical Audit; D000067561:Potentially Inappropriate Medication List; D011793:Queensland; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data
D002491:Central Nervous System Agents; D011619:Psychotropic Drugs
Dementia; drug interactions; geriatrics; long-term care; medication; prescribing.