Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy

Anna Maria Bargagli, Silvia Cascini, Nera Agabiti, Ursula Kirchmayer, Claudia Marino, Marina Davoli Department of Epidemiology, Regional Health Service Lazio Region, Rome, ItalyCorrespondence: Silvia CasciniDepartment of Epidemiology, Regional Health Service Lazio Region, Via Cristoforo Colombo, Rom...

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Autores principales:	Bargagli AM, Cascini S, Agabiti N, Kirchmayer U, Marino C, Davoli M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	dementia antipsychotics health information systems older adults Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/0b02e623d2554389b8449df694078cbc
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spelling	oai:doaj.org-article:0b02e623d2554389b8449df694078cbc2021-12-02T09:24:24ZDeterminants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy1178-1998https://doaj.org/article/0b02e623d2554389b8449df694078cbc2019-11-01T00:00:00Zhttps://www.dovepress.com/determinants-of-antipsychotic-drugs-prescription-among-community-livin-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Anna Maria Bargagli, Silvia Cascini, Nera Agabiti, Ursula Kirchmayer, Claudia Marino, Marina Davoli Department of Epidemiology, Regional Health Service Lazio Region, Rome, ItalyCorrespondence: Silvia CasciniDepartment of Epidemiology, Regional Health Service Lazio Region, Via Cristoforo Colombo, Rome 112 - 00147, ItalyTel +39 06 9972 2130Fax +39 06 9972 2111Email s.cascini@deplazio.itIntroduction: Despite recommendations from associations of geriatric and psychiatry societies and warnings from drug agencies, antipsychotic (AP) drugs are frequently used to control behavioral and psychological symptoms of dementia. APs are associated with a range of potential adverse events, including increased risk of cerebrovascular events and mortality. Evidence suggests limited efficacy of APs for aggression and psychosis. Our objectives were to investigate patterns and predictors for prescription of APs among older adults with dementia residing in a large region of central Italy, and to identify patient characteristics related to typical or atypical APs prescribing.Methods: This is a retrospective population-based cohort study using data from regional health information systems (HIS). We included dementia patients aged ≥65 years residing in the Lazio region. The exposure was defined as new use vs non-use of APs. Dementia patients with incident use of APs during 2015 were followed-up from the date of first prescription to the earliest among discontinuation of use, death, or end of study (December 31, 2016).Results: We enrolled 24,735 dementia patients, 1727 (6.7%) new users and 23,008 non-users of APs. Forty-four percent of AP users were treated for more than 3 months, and among these about 60% received APs continuously for at least 12 months. Individuals using antidepressant or anti-dementia drugs had higher odds of being prescribed with APs (OR: 1.67 and OR: 1.86, respectively). Patients exposed to polypharmacy were less likely to receive APs (OR: 0.82). Cardiovascular risk factors and comorbidities were not associated with APs use. Low socio-economic position was associated with lower odds of atypical AP prescribing (OR: 0.57).Conclusion: The study showed that a not negligible proportion of patients had a period of AP use longer than recommended by guidelines. We identified socio-demographic and clinical factors associated with first use of APs, providing insight into prescribing practices in a community setting and useful information to address areas of potential inappropriateness.Keywords: dementia, antipsychotics, health information systems, older adultsBargagli AMCascini SAgabiti NKirchmayer UMarino CDavoli MDove Medical Pressarticledementiaantipsychoticshealth information systemsolder adultsGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 14, Pp 2071-2083 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	dementia antipsychotics health information systems older adults Geriatrics RC952-954.6
spellingShingle	dementia antipsychotics health information systems older adults Geriatrics RC952-954.6 Bargagli AM Cascini S Agabiti N Kirchmayer U Marino C Davoli M Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy
description	Anna Maria Bargagli, Silvia Cascini, Nera Agabiti, Ursula Kirchmayer, Claudia Marino, Marina Davoli Department of Epidemiology, Regional Health Service Lazio Region, Rome, ItalyCorrespondence: Silvia CasciniDepartment of Epidemiology, Regional Health Service Lazio Region, Via Cristoforo Colombo, Rome 112 - 00147, ItalyTel +39 06 9972 2130Fax +39 06 9972 2111Email s.cascini@deplazio.itIntroduction: Despite recommendations from associations of geriatric and psychiatry societies and warnings from drug agencies, antipsychotic (AP) drugs are frequently used to control behavioral and psychological symptoms of dementia. APs are associated with a range of potential adverse events, including increased risk of cerebrovascular events and mortality. Evidence suggests limited efficacy of APs for aggression and psychosis. Our objectives were to investigate patterns and predictors for prescription of APs among older adults with dementia residing in a large region of central Italy, and to identify patient characteristics related to typical or atypical APs prescribing.Methods: This is a retrospective population-based cohort study using data from regional health information systems (HIS). We included dementia patients aged ≥65 years residing in the Lazio region. The exposure was defined as new use vs non-use of APs. Dementia patients with incident use of APs during 2015 were followed-up from the date of first prescription to the earliest among discontinuation of use, death, or end of study (December 31, 2016).Results: We enrolled 24,735 dementia patients, 1727 (6.7%) new users and 23,008 non-users of APs. Forty-four percent of AP users were treated for more than 3 months, and among these about 60% received APs continuously for at least 12 months. Individuals using antidepressant or anti-dementia drugs had higher odds of being prescribed with APs (OR: 1.67 and OR: 1.86, respectively). Patients exposed to polypharmacy were less likely to receive APs (OR: 0.82). Cardiovascular risk factors and comorbidities were not associated with APs use. Low socio-economic position was associated with lower odds of atypical AP prescribing (OR: 0.57).Conclusion: The study showed that a not negligible proportion of patients had a period of AP use longer than recommended by guidelines. We identified socio-demographic and clinical factors associated with first use of APs, providing insight into prescribing practices in a community setting and useful information to address areas of potential inappropriateness.Keywords: dementia, antipsychotics, health information systems, older adults
format	article
author	Bargagli AM Cascini S Agabiti N Kirchmayer U Marino C Davoli M
author_facet	Bargagli AM Cascini S Agabiti N Kirchmayer U Marino C Davoli M
author_sort	Bargagli AM
title	Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy
title_short	Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy
title_full	Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy
title_fullStr	Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy
title_full_unstemmed	Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy
title_sort	determinants of antipsychotic drugs prescription among community-living older adults with dementia: a population-based study using health information systems in the lazio region, italy
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/0b02e623d2554389b8449df694078cbc
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Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy

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