Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
Community Clinic Tsukuba, Ibaraki, Japan.
Int J Geriatr Psychiatry. 2019 Mar;34(3):472-479. doi: 10.1002/gps.5041. Epub 2018 Dec 27.
Antipsychotics are used to manage the behavioral and psychological symptoms of dementia (BPSD), despite their association with greater risks for mortality and cerebrovascular events. Previous studies in Japan have estimated the prevalence of antipsychotics among older adults who took antidementia drugs. Using long-term care (LTC) data, we aimed to obtain more accurate estimates of the prevalence of antipsychotics and to determine factors related to their use in older adults with dementia.
Medical and LTC claims data and LTC certification data between April 2012 and September 2013 were obtained from a middle-sized suburban city. The 1-year prevalence of antipsychotic use was estimated among individuals with probable dementia aged greater than or equal to 75 years who were prescribed antidementia drugs and/or had dementia based on LTC needs certification data.
Of 25 919 participants, 4865 had probable dementia and 1506 were prescribed antidementia drugs. The prevalence of antipsychotics among participants with probable dementia was 10.7%, which was lower than that in those who were prescribed antidementia drugs (16.4%). Among participants with probable dementia with LTC certification data available (N = 4419), lower cognitive function (vs mild; adjusted odds ratio 2.16, 95% confidence interval 1.63-2.86), antidementia drug use (2.27, 1.84-2.81), and institutional LTC services use (2.34, 1.85-2.97) were associated with greater odds of antipsychotic use, whereas older age (greater than or equal to 92 years) was associated with lower odds (vs less than 77 years; 0.42, 0.27-0.65).
These findings may be useful for estimating the burden of BPSD and for taking measures to reduce inappropriate antipsychotic prescription.
抗精神病药物用于治疗痴呆患者的行为和心理症状（BPSD），尽管它们与更高的死亡率和脑血管事件风险相关。以前在日本的研究估计了在服用抗痴呆药物的老年人中使用抗精神病药物的流行率。利用长期护理（LTC）数据，我们旨在更准确地估计抗精神病药物的流行率，并确定与痴呆老年人使用抗精神病药物相关的因素。
从一个中等规模的郊区城市获得了 2012 年 4 月至 2013 年 9 月的医疗和 LTC 理赔数据以及 LTC 认证数据。根据 LTC 需要认证数据，估计了大于或等于 75 岁且处方有抗痴呆药物和/或有痴呆症的可能性的个体中抗精神病药物的 1 年使用率。
在 25919 名参与者中，有 4865 名患有可能的痴呆症，有 1506 名被处方抗痴呆药物。在患有可能的痴呆症的参与者中，抗精神病药物的使用率为 10.7%，低于处方抗痴呆药物的参与者（16.4%）。在有 LTC 认证数据的患有可能的痴呆症的参与者中（N=4419），较低的认知功能（与轻度相比；调整后的优势比 2.16，95%置信区间 1.63-2.86）、使用抗痴呆药物（2.27，1.84-2.81）和使用机构性 LTC 服务（2.34，1.85-2.97）与使用抗精神病药物的几率增加相关，而年龄较大（大于或等于 92 岁）与使用抗精神病药物的几率降低相关（与小于 77 岁相比；0.42，0.27-0.65）。
这些发现可能有助于估计 BPSD 的负担，并采取措施减少不适当的抗精神病药物处方。
