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Acquisition cost of dispensed drugs in individuals with multiple medications--a register-based study in Sweden.

https://arctichealth.org/en/permalink/ahliterature135038
Source
Health Policy. 2011 Jul;101(2):153-61
Publication Type
Article
Date
Jul-2011
Author
Bo Hovstadius
Bengt Åstrand
Ulf Persson
Göran Petersson
Author Affiliation
eHealth Institute and School of Natural Sciences, Linnaeus University, SE-391 82 Kalmar, Sweden. bo.hovstadius@pwc.se
Source
Health Policy. 2011 Jul;101(2):153-61
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Costs and Cost Analysis
Drug Costs
Female
Humans
Infant
Male
Middle Aged
Polypharmacy
Prescription Drugs - economics
Registries
Sweden
Young Adult
Abstract
To analyse the acquisition cost of dispensed prescription drugs for individuals with multiple medications in a national population.
We collected and analysed individual based data regarding the acquisition cost of dispensed prescription drugs for all individuals with five or more dispensed drugs (DP=5) in Sweden 2006 (2.2 million).
Individuals with DP=5 (24.5% of the population) accounted for 78.8% of the total acquisition cost, and individuals with DP=10 (8.6% of the population) and DP=15 (3.0% of the population) accounted for 46.3% and 23.2%, respectively. The average acquisition cost per defined daily doses (DDD) generally decreased with increasing age. The highest average cost per DDD was observed for individuals with DP=10. The acquisition cost for women with DP=5 represented 56.0% of the total acquisition cost. Men with DP=5 represented 44.0% of the total acquisition cost.
In an entire national population, individuals with multiple medication accounted for four fifths of the total acquisition cost of dispensed drugs. Actions to reduce the number of prescription drugs for the group of patients with a number of different drugs may also result in a substantial reduction of the total acquisition cost.
PubMed ID
21514685 View in PubMed
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Adverse drug effects in elderly people -- a disparity between clinical examination and adverse effects self-reported by the patient.

https://arctichealth.org/en/permalink/ahliterature164731
Source
Eur J Clin Pharmacol. 2007 May;63(5):509-15
Publication Type
Article
Date
May-2007
Author
Pasi Lampela
Sirpa Hartikainen
Raimo Sulkava
Risto Huupponen
Author Affiliation
Department of Pharmacology and Toxicology, University of Kuopio, P.O. Box 1627, 70211, Kuopio, Finland. Pasi.Lampela@uku.fi
Source
Eur J Clin Pharmacol. 2007 May;63(5):509-15
Date
May-2007
Language
English
Publication Type
Article
Keywords
Adverse Drug Reaction Reporting Systems - statistics & numerical data
Aged
Aged, 80 and over
Data Collection - methods
Drug-Related Side Effects and Adverse Reactions
Female
Finland
Geriatric Assessment - methods
Humans
Male
Physicians - statistics & numerical data
Polypharmacy
Reproducibility of Results
Abstract
The trend towards polypharmacy is increasing among the elderly, and associated with this trend is an increased risk of adverse drug effects and drug-drug interactions. Our objective was to assess whether drug adverse effects reported by patients are in general agreement with those identified by a physician.
We evaluated the medication of 404 randomly selected individuals aged 75 years or older by means of interviews carried out by trained nurses and examinations conducted by a physician. The medication used by these patients was recorded prior to the physician's examination and modified thereafter if considered appropriate. Adverse effects noted by the physician were compared to those self-reported by the patients.
Almost all of the patients (98.8%) were using at least one drug, and the mean total number of drugs used was 6.5. Adverse effects were self-reported by 11.4% of the patients, whereas the physician observed apparent adverse drug effects in 24.0% of the patients. No adverse effects were reported in 53.2% of the patients. There were only seven patients that had adverse effects that were both self-reported and identified by the physician, and only four of these patients reported the same adverse effect that had been identified by the physician.
There was a great disparity between the adverse effects identified by the physician and those reported by the patients themselves. Based on our results, it would appear that elderly people tend to neglect adverse drug effects and may consider them to be an unavoidable part of normal ageing. Therefore, physicians should enquire about possible adverse effects even though elderly patients may not complain of any drug-related problems.
Notes
Comment In: Eur J Clin Pharmacol. 2007 Oct;63(10):979-80; author reply 98117618426
PubMed ID
17351768 View in PubMed
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Adverse drug events in the elderly population admitted to a tertiary care hospital.

https://arctichealth.org/en/permalink/ahliterature188411
Source
J Healthc Manag. 2002 Sep-Oct;47(5):295-305; discussion 305-6
Publication Type
Article
Author
Nahid Azad
Michael Tierney
Gary Victor
Parul Kumar
Author Affiliation
Faculty of Medicine, Geriatric Assessment Unit, Ottawa Hospital Civic Campus, Canada. nazad@ottawahospital.on.ca
Source
J Healthc Manag. 2002 Sep-Oct;47(5):295-305; discussion 305-6
Language
English
Publication Type
Article
Keywords
Adverse Drug Reaction Reporting Systems
Aged
Aged, 80 and over
Cohort Studies
Drug Prescriptions
Drug Therapy - utilization
Drug Utilization Review
Drug-Related Side Effects and Adverse Reactions
Female
Health Services Research
Hospital Bed Capacity, 500 and over
Hospitals, Teaching - standards - utilization
Humans
Incidence
Inpatients - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Ontario - epidemiology
Polypharmacy
Prospective Studies
Abstract
Older adults take almost one-third of the drugs prescribed today yet represent only about 12 percent of the population. Adverse drug events are common in this population, but often these events appear to be preventable. Interest in adverse events related to the use of prescription drugs has rarely been higher or broader. The research community continues to develop new tools to study adverse effects of drugs in individuals and populations. However, the published literature on drug-related adverse events is fraught with problems, starting with the original reports and extending to systematic reviews. Prospective data are missing, adverse drug events are poorly described, and analytical methods are questionable. This leads to problems with imprecise estimates and generalizability of results.
PubMed ID
12325252 View in PubMed
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[Adverse effects of drugs in patients with heart disease lead to hospital care]

https://arctichealth.org/en/permalink/ahliterature53815
Source
Lakartidningen. 2001 Nov 21;98(47):5349-53
Publication Type
Article
Date
Nov-21-2001
Author
C. Sarlöv
E. Andersén-Karlsson
C. von Bahr
Author Affiliation
Klinisk farmakologi, VO Medicin, Södersjukhuset, Stockholm.
Source
Lakartidningen. 2001 Nov 21;98(47):5349-53
Date
Nov-21-2001
Language
Swedish
Publication Type
Article
Keywords
Adverse Drug Reaction Reporting Systems
Cardiovascular Diseases - drug therapy
Drug Interactions
English Abstract
Female
Heart Diseases - drug therapy
Humans
Male
Patient Admission - statistics & numerical data
Pharmaceutical Preparations - adverse effects
Polypharmacy
Retrospective Studies
Sweden
Abstract
Polypharmacy in patients with cardiovascular disease leads to an increased risk of developing adverse effects. At the Department of Internal Medicine at Stockholm Söder Hospital we studied computerized records and discovered that 14% of those hospitalized patients who were on drug treatment for cardiovascular diseases were admitted due to problems or symptoms possibly caused by their drugs. Interactions were less common; the symptoms which warranted hospitalization were more often caused by additive pharmacological effects. Obviously, adverse effects of drugs decrease quality of life, cause unnecessary suffering and treatment, and are expensive for the health care system. Screening of computerized records helps us detect adverse effects, and facilitates prevention.
PubMed ID
11763634 View in PubMed
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Analgesic use among community-dwelling people aged 75 years and older: A population-based interview study.

https://arctichealth.org/en/permalink/ahliterature142226
Source
Am J Geriatr Pharmacother. 2010 Jun;8(3):233-44
Publication Type
Article
Date
Jun-2010
Author
Niina Pokela
J Simon Bell
Katri Lihavainen
Raimo Sulkava
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Source
Am J Geriatr Pharmacother. 2010 Jun;8(3):233-44
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Analgesics - therapeutic use
Analgesics, Opioid - therapeutic use
Cross-Sectional Studies
Data Collection
Depression - complications
Female
Finland
Health status
Humans
Male
Multivariate Analysis
Pain - drug therapy
Polypharmacy
Residence Characteristics - statistics & numerical data
Sex Factors
Abstract
Pain is often underrecognized and undertreated among older people. However, older people may be particularly susceptible to adverse drug reactions linked to prescription and nonprescription analgesics.
The aims of this study were to assess the prevalence of analgesic use among a random sample of community-dwelling people aged >or=75 years, and to investigate factors associated with daily and as-needed analgesic use.
A random sample of people aged >or=75 years was drawn from the population register in Kuopio, Finland, in November 2003. Data on prescription and nonprescription analgesic use were elicited during nurse interviews conducted once for each participant in 2004. Self-reported drug utilization data were verified against medical records. The interview included items pertaining to sociodemographic factors, living conditions, social contacts, health behavior, and state of health. Physical function was assessed using the Instrumental Activities of Daily Living Scale, and the 10-item Barthel Index. Self-rated mobility was assessed by asking whether respondents could walk 400 meters (yes, yes with difficulty but without help, not without help, or no). Cognitive function was assessed using the Mini-Mental State Examination. The presence of depressive symptoms was assessed using the 15-item Geriatric Depression Scale. Respondents' self-rated health was determined using a 5-point scale (very poor, poor, moderate, good, or very good).
Of the initial random sample of participants (N = 1000), 700 provided consent to participate and were community dwelling. Among the participants, 318 (45.4%) were users of >or=1 analgesic on a daily or as-needed basis. Only 23.3% of analgesic users took an analgesic on a daily basis. Factors associated with any analgesic use included female sex (odds ratio [OR], 1.78 [95 degrees % CI, 1.17-2.71]), living alone (OR, 1.46 [95 degrees % CI, 1.02-2.11]), poor self-rated health (OR, 2.6 [95% CI, 1.22-3.84]), and use of >or=10 nonanalgesic drugs (OR, 2.21 [95% CI, 1.26-3.87]). Among users of >or=1 oral analgesic, factors associated with opioid use included moderate (OR, 2.46 [95% CI, 1.175.14]) and poor (OR, 2.57 [95% CI, 1.03-6.42]) self-rated health. Opioid use (OR, 0.19 [95% CI, 0.04-0.86]) and daily analgesic use (OR, 0.16 [95% CI, 0.34-0.74]) were inversely associated with depressive symptoms. Pain in the previous month was reported by 71.4% of analgesic users and 26.4% of nonusers of analgesics.
Analgesics were used by approximately 50% of community-dwelling people aged >or=75 years. However, age was not significantly associated with increased use of analgesics in multivariate analysis. The majority of analgesic drugs were used on an as-needed rather than a daily basis (76.7% vs 23.3%, respectively). Factors most significantly associated with analgesic use were female sex, living alone, poor self-rated health, and use of >or=10 nonanalgesic drugs.
PubMed ID
20624613 View in PubMed
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An educational intervention to reduce the use of potentially inappropriate medications among older adults (EMPOWER study): protocol for a cluster randomized trial.

https://arctichealth.org/en/permalink/ahliterature115389
Source
Trials. 2013;14:80
Publication Type
Article
Date
2013
Author
Philippe Martin
Robyn Tamblyn
Sara Ahmed
Cara Tannenbaum
Author Affiliation
Faculté de Pharmacie, InstitutUniversitaire de Gériatrie de Montréal, Université de Montréal, Montréal, QC, Canada.
Source
Trials. 2013;14:80
Date
2013
Language
English
Publication Type
Article
Keywords
Age Factors
Benzodiazepines - adverse effects - therapeutic use
Community Pharmacy Services
Drug Interactions
Health Knowledge, Attitudes, Practice
Humans
Inappropriate Prescribing - prevention & control
Intention to Treat Analysis
Interdisciplinary Communication
Patient care team
Patient Education as Topic
Patient Safety
Physician-Patient Relations
Polypharmacy
Quebec
Research Design
Risk assessment
Risk factors
Self Efficacy
Time Factors
Abstract
Currently, far too many older adults consume inappropriate prescriptions, which increase the risk of adverse drug reactions and unnecessary hospitalizations. A health education program directly informing patients of prescription risks may promote inappropriate prescription discontinuation in chronic benzodiazepine users.
This is a cluster randomized controlled trial using a two-arm parallel-design. A total of 250 older chronic benzodiazepine users recruited from community pharmacies in the greater Montreal area will be studied with informed consent. A participating pharmacy with recruited participants represents a cluster, the unit of randomization. For every four pharmacies recruited, a simple 2:2 randomization is used to allocate clusters into intervention and control arms. Participants will be followed for 1 year. Within the intervention clusters, participants will receive a novel educational intervention detailing risks and safe alternatives to their current potentially inappropriate medication, while the control group will be wait-listed for the intervention for 6 months and receive usual care during that time period. The primary outcome is the rate of change in benzodiazepine use at 6 months. Secondary outcomes are changes in risk perception, self-efficacy for discontinuing benzodiazepines, and activation of patients initiating discussions with their physician or pharmacist about safer prescribing practices. An intention-to-treat analysis will be followed.The rate of change of benzodiazepine use will be compared between intervention and control groups at the individual level at the 6-month follow-up. Risk differences between the control and experimental groups will be calculated, and the robust variance estimator will be used to estimate the associated 95% confidence interval (CI). As a sensitivity analysis (and/or if any confounders are unbalanced between the groups), we will estimate the risk difference for the intervention via a marginal model estimated via generalized estimating equations with an exchangeable correlation structure.
Targeting consumers directly as catalysts for engaging physicians and pharmacists in collaborative discontinuation of benzodiazepine drugs is a novel approach to reduce inappropriate prescriptions. By directly empowering chronic users with knowledge about risks, we hope to imitate the success of individually targeted anti-smoking campaigns.
ClinicalTrials.gov identifier: NCT01148186.
Notes
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PubMed ID
23514019 View in PubMed
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Anti-dementia drugs and co-medication among patients with Alzheimer's disease : investigating real-world drug use in clinical practice using the Swedish Dementia Quality Registry (SveDem).

https://arctichealth.org/en/permalink/ahliterature259016
Source
Drugs Aging. 2014 Mar;31(3):215-24
Publication Type
Article
Date
Mar-2014
Author
Seyed-Mohammad Fereshtehnejad
Kristina Johnell
Maria Eriksdotter
Source
Drugs Aging. 2014 Mar;31(3):215-24
Date
Mar-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy
Cholinesterase Inhibitors - administration & dosage - therapeutic use
Drug Therapy, Combination
Female
Humans
Male
Polypharmacy
Psychotropic Drugs - administration & dosage - therapeutic use
Receptors, N-Methyl-D-Aspartate - antagonists & inhibitors
Registries
Sweden
Abstract
There is a substantial risk of drug-interactions, adverse events, and inappropriate drug use (IDU) among frail Alzheimer's disease (AD) patients; however, there are few studies about co-medication and IDU in clinical settings.
To investigate anti-dementia drugs, associated characteristics of cholinesterase inhibitors (ChEIs) and NMDA antagonists, co-medication, and IDU in a large population of outpatients with mild AD.
In this cross-sectional analysis of medication characteristics, we analyzed data from the Swedish Dementia Quality Registry (SveDem) on 5,907 newly diagnosed AD patients who were registered in memory clinics. SveDem is a national quality registry in Sweden, which was established in 2007 to evaluate and improve dementia healthcare. Comparisons were performed concerning co-medications, use of =3 psychotropic drugs (IDU) and polypharmacy (=5 drugs) based on anti-dementia treatment (ChEIs or NMDA antagonists). Information on baseline characteristics such as age, sex, living conditions, cognitive evaluation based on the Mini-Mental State Examination (MMSE) score, and diagnostic work-up was also evaluated.
The majority of the AD patients were in the mild stage of the disease. Overall, 4,342 (75.4 %) patients received any ChEI, 438 (7.6 %) used an NMDA antagonist and 74 (1.3 %) patients were treated with both. However, 907 (15.7 %) patients were not treated with any anti-dementia drug. While polypharmacy was seen in 33.5 % of patients, only 2.6 % concurrently used =3 psychotropic medications. Patients on ChEIs were significantly younger, had a higher MMSE score and were treated with a smaller number of medications (a proxy for overall co-morbidity). Co-medication with antipsychotics [3.3 vs. 7.6 %; adjusted odds ratio (OR) 0.55 (95 % CI 0.38-0.79)] and anxiolytics [5.8 vs. 10.9 %; adjusted OR 0.62 (95 % CI 0.46-0.84)] was significantly lower in the ChEI+ group than in those with no anti-dementia treatment.
Patients taking ChEIs were treated with less antipsychotics and anxiolytics than those not taking ChEIs. More research is warranted to elucidate whether use of ChEIs in clinical practice can reduce the need for psychotropic drugs in AD patients.
PubMed ID
24497071 View in PubMed
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Antidepressants, warfarin, and the risk of hemorrhage.

https://arctichealth.org/en/permalink/ahliterature171982
Source
J Clin Psychopharmacol. 2005 Dec;25(6):561-4
Publication Type
Article
Date
Dec-2005
Author
Paul A Kurdyak
David N Juurlink
Alexander Kopp
Nathan Herrmann
Muhammad M Mamdani
Author Affiliation
The Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. paul_kurdyak@camh.net
Source
J Clin Psychopharmacol. 2005 Dec;25(6):561-4
Date
Dec-2005
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anticoagulants - administration & dosage
Antidepressive Agents, Tricyclic - administration & dosage
Case-Control Studies
Female
Gastrointestinal Hemorrhage - epidemiology
Hospitalization - statistics & numerical data
Humans
Male
Ontario - epidemiology
Polypharmacy
Risk assessment
Serotonin Uptake Inhibitors - administration & dosage
Warfarin - administration & dosage
Abstract
Case reports suggest that some selective serotonin reuptake inhibitors can interact with warfarin to increase the likelihood of bleeding. We speculated that, among patients receiving warfarin, initiation of selective serotonin reuptake inhibitor treatment would be associated with an increased risk of hospitalization for upper gastrointestinal tract bleeding (UGIB).
We conducted a population-based, nested, case-control study involving Ontario residents 66 years or older continuously treated with warfarin for at least 1 year. Cases admitted with UGIB were compared with matched controls (1:10) to explore the odds ratio for initiation of various antidepressants within 42, 90, and 180 days before the index admission.
From January 1994 to December 2002, we identified 98,784 elderly patients continuously receiving warfarin for at least 1 year; of whom 1538 (0.6%) were admitted to hospital for UGIB. The adjusted odds ratio for fluoxetine/fluvoxamine exposure in 90 days before UGIB hospitalization is 1.2 (95% confidence interval, 0.8-1.7), and the adjusted odds ratio for other selective serotonin reuptake inhibitors in the same period was 1.1 (95% confidence interval, 0.9-1.4). The odds ratios for exposure to antidepressants in 180 days before UGIB hospitalization were similar.
The initiation of selective serotonin reuptake inhibitor treatment in patients receiving warfarin was not associated with a significant increase in the risk of hospitalization for UGIB.
PubMed ID
16282838 View in PubMed
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Anti-osteoporotic therapy in Denmark--predictors and demographics of poor refill compliance and poor persistence.

https://arctichealth.org/en/permalink/ahliterature118687
Source
Osteoporos Int. 2013 Jul;24(7):2079-97
Publication Type
Article
Date
Jul-2013
Author
C. Hansen
B D Pedersen
H. Konradsen
B. Abrahamsen
Author Affiliation
Research Unit of Nursing, Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark. chansen@health.sdu.dk
Source
Osteoporos Int. 2013 Jul;24(7):2079-97
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Administration, Oral
Adult
Aged
Aged, 80 and over
Bone Density Conservation Agents - administration & dosage - therapeutic use
Cohort Studies
Comorbidity
Denmark - epidemiology
Diphosphonates - administration & dosage - therapeutic use
Female
Humans
Kaplan-Meier Estimate
Male
Medication Adherence - statistics & numerical data
Middle Aged
Osteoporosis - drug therapy - epidemiology
Osteoporotic Fractures - prevention & control
Polypharmacy
Risk factors
Socioeconomic Factors
Abstract
In this study of 100,949 new users of oral bisphosphonates age = 35 years, "early quitters" were found to differ from others with poor refill compliance in terms of socioeconomic, demographic, and treatment-related characteristics. New risk factors for poor compliance and persistence were identified.
Poor compliance with anti-osteoporotic therapy is an on-going worldwide challenge. In this study, we hypothesized that "early quitters" differ in socioeconomics, demographics, co-medications, and comorbid conditions from other patients with low compliance.
The study was a register-based nationwide cohort study of anti-osteoporotic therapy comprising 100,949 men and women. Statistical analysis including backward stepwise logistic regression analysis was used to explain causes of treatment failure and Kaplan-Meier survival analysis to estimate persistence of treatment.
It was noted that 56.6 % of the patients were persistent and compliant, 4.7 % of the patients were persistent but "low compliant" while 38.7 % of the patients were "early quitters". "Early quitters" were found to differ in socioeconomics from "low compliant" patients. Differences concerning increased risk of "early quitters" were associated with high household income, subjects' age 71.9-79 years, living in the countryside or village, prior treatment with analgesics and anti-parkinson drugs, and dementia. Differences concerning decreased risk of "early quitters" were associated with male, living in an apartment, children living at home, living close to a university hospital, anti-osteoporotic therapy other than alendronate, number of drugs especially above three, pulmonary disease, collagen disease.
The results suggest a need for improved support for patients to facilitate the interpretation of the disease and the perception of the benefits and risks of treatment-to reduce the risk of "early quitters". We were able to identify new risk groups that may be candidates for targeted actions.
PubMed ID
23179576 View in PubMed
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Antipsychotic polypharmacy among a nationwide sample of community-dwelling persons with Alzheimer's disease.

https://arctichealth.org/en/permalink/ahliterature261391
Source
J Alzheimers Dis. 2014;41(4):1223-8
Publication Type
Article
Date
2014
Author
Heidi Taipale
Marjaana Koponen
Antti Tanskanen
Anna-Maija Tolppanen
Jari Tiihonen
Sirpa Hartikainen
Source
J Alzheimers Dis. 2014;41(4):1223-8
Date
2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy - epidemiology - psychology
Antipsychotic Agents - therapeutic use
Cohort Studies
Confidence Intervals
Databases, Factual - statistics & numerical data
Female
Finland
Humans
Male
Middle Aged
Polypharmacy
Residence Characteristics
Abstract
Antipsychotic polypharmacy (APP) is not recommended in treatment of behavioral and psychological symptoms of dementia (BPSD). There is lack of studies concerning prevalence of APP among persons with dementia.
The objective of our study was to describe prevalence and risk factors associated with antipsychotic polypharmacy among antipsychotic users with Alzheimer's disease (AD).
Data from nationwide MEDALZ-2005 cohort including all community-dwelling persons diagnosed with AD in Finland was utilized. Register-based data included prescriptions, comorbidities, and hospital discharge diagnoses. Users of antipsychotics during 2006-2009 were included (n = 9,803). The risk of starting antipsychotic polypharmacy was evaluated with Cox proportional hazards model.
Prevalence of antipsychotic polypharmacy was 8% (n = 750) among antipsychotic users (n = 9,803). Quetiapine and risperidone was the most common combination of two antipsychotics followed by combination of quetiapine and haloperidol. Antipsychotic polypharmacy was associated with younger age (HR 1.35 [Confidence Interval, CI, 1.16-1.56]), male gender (HR 1.18 [CI 1.02-1.38]), and history of psychiatric disorder (HR 1.50 [CI 1.26-1.78]) in the adjusted model.
In conclusion, we found higher prevalence of APP than previously reported among older populations. This is concerning since effectiveness of APP has not been demonstrated and APP is not recommended in the treatment of BPSD. Clinicians should pay more attention to avoid APP and use of antipsychotics to other indications than BPSD among persons with AD.
PubMed ID
24787914 View in PubMed
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