Do prescription rates of psychotropic drugs change over three years from nursing home admission?

Enrico Callegari, Jūratė Šaltytė Benth, Geir Selbæk, Cato Grønnerød, Sverre Bergh, Enrico Callegari, Jūratė Šaltytė Benth, Geir Selbæk, Cato Grønnerød, Sverre Bergh

Abstract

Background: In this longitudinal study, we describe how psychotropic drugs (PTDs) are prescribed in nursing home (NH) patients from admission and over a 3-year period, to understand which clinical and environmental factors are associated with PTD prescription.

Methods: We used data from the Resource Use and Disease Course in Dementia - Nursing Home (REDIC-NH) study, examining physical and mental health, dementia, and PTD prescription during a 3-year period from admission to a NH. Data were collected every six months. At baseline, we included 696 participants from 47 Norwegian NHs. We presented prevalence, incidence, and deprescribing rates of PTD prescriptions for each assessment point. We calculated the odds of receiving PTDs and used a generalized linear mixed model to analyze the variables associated with a change in odds throughout the 3-year period.

Results: PTD prescriptions were frequent throughout the 3-year period. Antidepressants had the highest prescription rates (28.4%-42.2%). Every PTD category had the highest incidence rate between admission and six months, and antipsychotics had the highest values (49.4%). Deprescribing rates were comparable between assessment points. The odds of antipsychotic prescriptions were lower for older people (OR = 0.96, 95%CI:0.92-0.99, p = 0.023). People with more severe dementia had lower odds of being prescribed sedatives/hypnotics (OR = 0.89, 95%CI:0.85-0.94, p < 0.001).

Conclusions: PTDs, particularly antidepressants, are widely prescribed over time to NH patients. Older patients are less likely to receive antipsychotics. A higher severity of dementia decreases the odds of being prescribed sedatives/hypnotics. Close attention should be paid to PTD prescriptions during long-term NH stay to avoid prolonged and excessive treatment with these types of drugs.

Trial registration: ClinicalTrials.gov Identifier: NCT01920100 .

Keywords: Geriatric pharmacotherapy; Nursing homes; Psychotropic drugs.

Conflict of interest statement

GS has received honoraria for participating in a meeting of the Norwegian advisory board for Biogen, regarding the aducanumab trials. The other named authors have no competing interests, financial or otherwise.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart: selection of patients for analysis
Fig. 2
Fig. 2
Prevalence of psychotropic drugs prescription between baseline (BL) and 36 months (36m)
Fig. 3
Fig. 3
Incidence and deprescribing rates of psychotropic drugs between baseline (BL) and 36 months (36m)
Fig. 4
Fig. 4
Graphical representation of the unadjusted time trends for the odds of prescribing psychotropic drugs
Fig. 5
Fig. 5
Interaction between CSDD† score and change in odds of prescribing sedatives and hypnotics: graphical representation. Legends: † CSDD: Cornell Scale for Depression in Dementia

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