Antipsychotic Drug Dispensations in Older Adults, Including Continuation After a Fall-Related Hospitalization: Identifying Adherence to Screening Tool of Older Persons' Potentially Inappropriate Prescriptions Criteria Using the Nova Scotia Seniors' Pharmacare Program and Canadian Institute for Health's Discharge Databases

Shanna C Trenaman, Barbara J Hill-Taylor, Kara J Matheson, David M Gardner, Ingrid S Sketris, Shanna C Trenaman, Barbara J Hill-Taylor, Kara J Matheson, David M Gardner, Ingrid S Sketris

Abstract

Purpose: Despite well-established concerns regarding adverse drug effects, antipsychotics are frequently prescribed for older adults. Our first objective was to identify trends in antipsychotic dispensations to older Nova Scotians. STOPP (Screening Tool of Older Persons' Potentially Inappropriate Prescriptions) criteria identify antipsychotic use in those with a history of falls as potentially inappropriate. Our second objective was to identify trends, predictors, and adherence with this STOPP criteria by identifying continued antipsychotic dispensations following a fall-related hospitalization.

Methods: A descriptive cross-sectional cohort study of Nova Scotia Seniors' Pharmacare Program (NSSPP) beneficiaries ≥ 66 years with at least one antipsychotic dispensation annually from April 1, 2009 to March 31, 2014 was completed. As well, unique beneficiaries with at least one antipsychotic dispensation in the four-year period between April 1, 2009 and March 31, 2013 were linked to fall-related hospitalizations recorded in the Canadian Institute for Health Information Discharge Abstract Database. The relationship of age, sex, fiscal year, days supply and length-of-stay were studied to identify predictors of continued antipsychotic dispensation post-discharge. Descriptive statistics and multivariate logistic analysis were performed. Odds ratios for the association of risk factors and adherence to STOPP criteria were calculated.

Findings: We identified that in each year observed, there were 6% of eligible NSSPP beneficiaries that received at least one antipsychotic dispensation. Approximately 70% of antipsychotic dispensations were for second generation agents, primarily quetiapine and risperidone. Of the unique beneficiaries with at least one antipsychotic dispensation in the four-year period between April 1, 2009 and March 31, 2013 who survived a fall-related hospitalization over 75% were dispensed an antipsychotic in the 100 days following hospital discharge. Logistic regression showed no statistically significant association between potentially inappropriate therapy and potential predictors in multivariate analysis.

Implications: In each year from 2009 to 2014, 6% of Nova Scotia Seniors' Pharmacare beneficiaries were dispensed at least one antipsychotic prescription. Over 75% of the older adults who received an antipsychotic dispensation in the 100 days prior to a fall-related hospitalization, continued the drug class after discharge. This demonstrates that despite the recommendations of quality indicators such as the STOPP criteria, antipsychotics are continued in individuals at a high risk of falling. Future investigations are needed to inform health team, system, and policy interventions to improve concordance with this antipsychotic specific STOPP criterion when appropriate.

Keywords: Antipsychotic drugs; Geriatric; Geriatric Therapeutics; Health services for the Aged; Original Research; Pharmacoepidemiology; STOPP criteria.

Figures

Fig. 1
Fig. 1
Percent of eligible male Nova Scotia Seniors’ Pharmacare Program beneficiaries receiving at least 1 antipsychotic drug dispensation per year, by age category and fiscal year (April 1, 2009–March 31, 2014).
Fig. 2
Fig. 2
Percent of eligible female Nova Scotia Seniors’ Pharmacare Program beneficiaries receiving at least 1 antipsychotic drug dispensation per year, by age category and fiscal year (April 1, 2009–March 31, 2014).
Fig. 3
Fig. 3
Cohort for Objective 2 (post discharge continued dispensation of antipsychotic drugs in older persons who had experienced a fall-related hospitalization). NSSPP = Nova Scotia Seniors’ Pharmacare Program. *Only data from NSSPP; older adults may have received prescriptions from other sources such as private insurance.

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