Assistant Professor Dalhousie University Dalhousie University Halifax, Canada
Background: Older adults with dementia may express challenging responsive behaviours. One management strategy is pharmacologic treatment though these options have limited benefit. The limited benefit may lead to multiple treatments prescribed.
Objectives: To describe psychoactive medication polypharmacy and explore factors associated with psychoactive polypharmacy in a cohort of older adults with dementia in Nova Scotia, Canada including a sex-stratified analysis.
Methods: 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 and overlapping for more than 30 days to one subject. 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 sex.
Results: The cohort included 15,819 adults with dementia (mean age 80.7 years; 70.0% female), with 54.3% (n = 15,728) receiving at least one psychoactive medication. 19.3% met the definition of psychoactive polypharmacy. Logistic regression adjusted for age at dementia diagnosis, year of dementia diagnosis, and rural or urban location of residence demonstrated for both men and women that younger age was associated with 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 more likely to experience psychoactive polypharmacy if their location of residence was rural (OR 0.86, 95%CI[0.74, 0.99]), but there was no significant association between location of residence (urban or rural) and polypharmacy for older women with dementia. Antidepressants were the most dispensed class, but quetiapine the most dispensed medication.
Conclusions: This study suggests that younger adults with dementia are dispensed more psychoactive medications and that older men living with dementia residing in rural locations may need increased access to non-pharmacological options and supportive care for dementia management.
.jpg "Shanna C. Trenaman, BScH, BScPharm, MAHSR, ACPR, PhD (she/her/hers) photo")
