Psychotropic medication burden and factors associated with antipsychotic use: an analysis of a population-based sample of community-dwelling older persons with dementia.

Objectives: To estimate the proportion of community-dwelling older adults with dementia being prescribed a psychotropic and to identify patient and caregiver factors associated with antipsychotic use.

Methods: Retrospective cohort study of the Aging, Demographics, and Memory Study (ADAMS) from 2002 to 2004 designed to assess dementia severity and service use of community-dwelling older adults. The frequency of psychotropic medication (antipsychotics, antidepressants, anticonvulsants, and benzodiazepines) use was tabulated and weighted to the U.S. population according to dementia diagnosis. Logistic regression analysis identified factors associated with antipsychotic use.

Results: The 307 ADAMS participants had the following dementia diagnoses: Alzheimer's disease (69.3%), vascular dementia (17.7%), and other dementia (12.4%). The proportion of participants prescribed a psychotropic medication broken down according to therapeutic class was 19.1% antipsychotics, 29.1% antidepressants, 9.8% benzodiazepines, and 8.8% anticonvulsants. Older adults with dementia were significantly more likely to receive an antipsychotic if they had moderate (odds ratio (OR) = 7.4, P = .002) or severe (OR = 5.80, P = .002) dementia than if they had mild dementia or were diagnosed with Alzheimer's disease (OR = 6.7, P = .04) compared to vascular dementia. Older adults with dementia who lived with a caregiver were significantly less likely to taking an antipsychotic (OR = 0.19, P = .001) than those who lived alone. Also, persons with dementia were significantly less likely to be prescribed an antipsychotic if their caregiver was clinically depressed (OR = 0.03, P = .005) than if their caregiver was not depressed.

Conclusion: Psychotropic medication use is common in community-dwelling older adults with dementia. Caregivers appear to have a substantial effect on whether an antipsychotic is prescribed, which adds additional complexity to conversations discussing the risk:benefit ratio of this medication class.