Network Aging Research, Heidelberg University, Heidelberg, Germany.
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
Int J Geriatr Psychiatry. 2020 Jun;35(6):640-649. doi: 10.1002/gps.5282. Epub 2020 Mar 6.
Psychotropic medication is commonly used among people with dementia (PWD), but it shows modest efficacy and it has been associated with severe adverse events. Hospitalizations are an opportunity for medication management as well as treatment recommendations for outpatient physicians. The aim of this study was to asses factors associated with new use of psychotropic medication after hospitalization among PWD.
We conducted a retrospective dynamic cohort study from 2004 to 2015 using claims data from a German health insurance company. PWD were identified by an algorithm that included ICD-10 diagnosis and diagnostic measures. The medication classes included were antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication. The assessment period was up to 30 days after discharge from the hospital across four hospitalizations.
The main predictors for new use of psychotropic medication were similar across medication classes. Neuropsychiatric symptoms (NPS) and the need of care were associated with higher odds of new use of antidepressants, antipsychotics, and anxiolytics or hypnotics/sedatives. A hospital stay due to dementia was an independent predictor for new use across medication classes as well. Delirium increased the odds for new use of antipsychotics and anxiolytics or hypnotics/sedatives.
Factors associated with new use of psychotropic medication included delirium, NPS, and the need of care in PWD. The findings highlight the need for preventive interventions and non-medical treatment options in regards to delirium and NPS as well as for a more intensive use of screening tools for inappropriate medication use among PWD. Key points The percentage of new users was 1.8%, 7.1%, 2.1%, and 2.5% across hospitalizations for antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication, respectively. 83.0%, 61.9%, 56.9%, and 88.1% of new users received antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication for more than 6 weeks. Delirium and neuropsychiatric symptoms were associated with significantly increased odds of new psychotropic medication use. Hospital stays due to dementia and the need of care were predictors for new use of psychotropic medication.
精神药物在痴呆症患者（PWD）中常被使用，但疗效有限，且与严重不良事件相关。住院为药物管理以及为门诊医生提供治疗建议提供了机会。本研究旨在评估 PWD 住院后使用精神药物的新情况相关因素。
我们使用德国一家健康保险公司的索赔数据，开展了一项 2004 年至 2015 年的回顾性动态队列研究。通过包含 ICD-10 诊断和诊断措施的算法来识别 PWD。研究中包括的药物类别为抗抑郁药、抗精神病药、抗焦虑药或催眠/镇静剂以及阿尔茨海默病药物。评估期为出院后 30 天内的四次住院。
精神药物新使用的主要预测因素在药物类别之间相似。神经精神症状（NPS）和护理需求与抗抑郁药、抗精神病药和抗焦虑药或催眠/镇静剂新使用的可能性增加相关。痴呆症导致的住院也是所有药物类别的独立预测因素。谵妄增加了使用抗精神病药和抗焦虑药或催眠/镇静剂的可能性。
与 PWD 中精神药物新使用相关的因素包括谵妄、NPS 和护理需求。研究结果强调了需要针对谵妄和 NPS 进行预防性干预和非药物治疗，以及在 PWD 中更加强化使用筛选工具来避免不适当的药物使用。
抗抑郁药、抗精神病药、抗焦虑药或催眠/镇静剂以及阿尔茨海默病药物的新使用者百分比分别为 1.8%、7.1%、2.1%和 2.5%。83.0%、61.9%、56.9%和 88.1%的新使用者接受抗抑郁药、抗精神病药、抗焦虑药或催眠/镇静剂和阿尔茨海默病药物的治疗时间超过 6 周。谵妄和神经精神症状与新的精神药物使用的可能性显著增加相关。痴呆症导致的住院和护理需求是使用精神药物的新预测因素。
