Dementia Care: Prescribing Trends of Antipsychotics, Mood Stabilizers, and Psychotropic Medications

Researchers investigated trends in antipsychotic and other psychotropic medication use among older adults in long-term care, with the intent of examining the efficacy of the recently established Centers for Medicare & Medicaid Services’ National Partnership to Improve Dementia Care in Nursing Homes (referred to hereafter as “the partnership”). The findings were published in JAMA Internal Medicine.

Researchers conducted an interrupted time-series analysis among 637,426 Medicare beneficiaries in long-term (≥100 days) care. Study analyses captured the quarterly prevalence of use of antipsychotics as well as mood stabilizers, antidepressants, benzodiazepines, and other psychotropic medications. At the start of the study in January 2009, 21.3% of patients were prescribed antipsychotics, which declined at a quarterly rate of −0.53% (P <.001) until the start of the partnership. After the partnership’s establishment, the quarterly decline rate decreased to −0.29% (P <.001).

For mood stabilizers, the initiation of the partnership was associated with an accelerated rate of increase, from a first quarter rate of 0.07% to a postpartnership rate of 0.14% (P <.001). Antidepressant use declined across both study periods, although the rate of decline slowed by 0.34% (P <.001) after initiation of the partnership. Study trends were similar among the subset of patients with dementia: Mood stabilizer use increased during both study periods, although at an accelerated rate in the second period (P <.001). The use of antipsychotics and antidepressants declined steadily across periods, with no apparent association with the partnership.

Researchers concluded that the partnership did not accelerate the overall decline in antipsychotic medication use among study participants. In addition, the increase in use of mood stabilizers, possibly as a substitute for antipsychotics, accelerated after the initiation of the partnership.

Investigators concluded that antipsychotic use alone is an insufficient measure of care quality in patients with dementia, and that focus on antipsychotics may have contributed to a shift in prescribing trends with a poorer risk-benefit balance. Although the Medicare-specific patient cohort could limit data generalizability, study results may be helpful in tailoring pharmacological care strategies for patients with and without dementia.

Reference

Maust DT, Kim HM, Chiang C, Kales HC. Association of the Centers for Medicare & Medicaid Services’ National Partnership to Improve Dementia Care with the use of antipsychotics and other psychotropics in long-term care in the United States from 2009 to 2014 [published online March 17, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.0379