An investigation of psychoactive polypharmacy and related gender-differences in older adults with dementia: a retrospective cohort study

BMC Geriatrics

Research

Shanna C Trenaman¹  Susan K Bowles²  Susan Kirkland³  Melissa K Andrew⁴  Jack Quach⁵ 

[1] College of Pharmacy, Faculty of Health, Dalhousie University, PO Box 15000, 5968 College Street, B3H 4R2, Halifax, NS, Canada;Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada;College of Pharmacy, Faculty of Health, Dalhousie University, PO Box 15000, 5968 College Street, B3H 4R2, Halifax, NS, Canada;Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada;Nova Scotia Health, Halifax, NS, Canada;Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada;Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada;Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada;Nova Scotia Health, Halifax, NS, Canada;Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada;Faculty of Health, Dalhousie University, Halifax, NS, Canada;

关键词: Dementia;    Polypharmacy;    Geriatrics;    CNS-active medication;    Psychoactive medication;   

DOI  :  10.1186/s12877-023-04353-8

 received in 2023-03-14, accepted in 2023-09-26,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundOlder adults living with dementia may express challenging responsive behaviours. One management strategy is pharmacologic treatment though these options often have limited benefit, which may lead to multiple treatments being prescribed.MethodsThe aim of the present study was to describe psychoactive medication polypharmacy and explore factors associated with psychoactive polypharmacy in a cohort of older adults living with dementia in Nova Scotia, Canada, including a gender-stratified analysis. This was a retrospective cohort study of those aged 65 years or older with a recorded diagnosis of dementia between 2005 and 2015. Medication dispensation data was collected from April 1, 2010, or dementia diagnosis (cohort entry) to either death or March 31, 2015 (cohort exit). Psychoactive medication claims were captured. Psychoactive medication polypharmacy was defined as presence of three or more psychoactive prescription medications dispensed to one subject and overlapping for more than 30 days. Psychoactive polypharmacy episodes were described in duration, quantity, and implicated medications. Regression analysis examined factors associated with experience and frequency of psychoactive polypharmacy. All analysis were stratified by gender.ResultsThe cohort included 15,819 adults living with dementia (mean age 80.7 years; 70.0% female), with 99.4% (n = 15,728) receiving at least one psychoactive medication over the period of follow-up. Psychoactive polypharmacy was present in 19.3% of the cohort. The gender specific logistic regressions demonstrated that for both men and women a younger age was associated with an increased risk of psychoactive polypharmacy (women: OR 0.97, 95%CI[0.96, 0.98], men: OR 0.96, 95%CI[0.95, 0.97]). Men were less likely to experience psychoactive polypharmacy if their location of residence was urban (OR 0.86, 95%CI[0.74, 0.99]). There was no significant association between location of residence (urban or rural) and psychoactive polypharmacy for women living with dementia. Antidepressants were the most dispensed medication class, while quetiapine was the most dispensed medication.ConclusionsThis study suggests that of adults living with dementia those of younger ages were more likely to experience psychoactive polypharmacy and that men living with dementia in rural locations may benefit from increased access to non-pharmacological options for dementia management.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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