Use of psychotropic drugs and drugs with anticholinergic properties among residents with dementia in intermediate care facilities for older adults in Japan: a cohort study
Objectives To evaluate the prescription and discontinuation of psychotropic drugs (PD) and drugs with anticholinergic properties (DAP) in residents with dementia admitted to Roken, a major type of long-term care facility in Japan.Design Cohort study.Setting A nationwide questionnaire survey across 3...
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| Format: | Article |
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BMJ Publishing Group
2021-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/4/e045787.full |
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| author | Jiro Okochi Shota Hamada Taro Kojima Yukari Hattori Hiroshi Maruoka Shinya Ishii Masahiro Akishita |
| author_facet | Jiro Okochi Shota Hamada Taro Kojima Yukari Hattori Hiroshi Maruoka Shinya Ishii Masahiro Akishita |
| author_sort | Jiro Okochi |
| collection | DOAJ |
| description | Objectives To evaluate the prescription and discontinuation of psychotropic drugs (PD) and drugs with anticholinergic properties (DAP) in residents with dementia admitted to Roken, a major type of long-term care facility in Japan.Design Cohort study.Setting A nationwide questionnaire survey across 3598 Roken in Japan in 2015 (up to five randomly selected residents per facility).Participants This study included 1201 residents from 343 Roken (response rate: 10%). We determined the presence and severity of dementia using a nationally standardised measure.Primary and secondary outcome measures Prescriptions of PD and DAP at admission and 2 months after admission were evaluated. Multivariable logistic regression was used to evaluate the associations of residents’ baseline characteristics with prescriptions or discontinuation.Results Prescription rates decreased for antidementia drugs (19.4% to 13.0%), hypnotics (25.1% to 22.6%) and anxiolytics (12.3% to 10.7%), whereas those for other PD, such as antipsychotics (13.2% to 13.6%), antidepressants (7.4% to 6.7%), antiepileptic drugs (7.1% to 7.8%) and DAP (35.2% to 36.6%) did not statistically significantly decrease. Some factors were associated with the prescriptions, for example, for antipsychotics, older age (≥85 years) (adjusted OR (aOR), 0.60; 95% CI 0.43 to 0.85) and being bedridden (aOR 0.67; 95% CI 0.47 to 0.97) were associated with a lower use of antipsychotics, whereas severe dementia was associated with a higher use of antipsychotics (aOR 3.26; 95% CI 2.26 to 4.70). At an individual level, a quarter of residents prescribed PD or DAP at admission had discontinued at least one PD or DAP, respectively, 2 months after admission. Antidementia drug use in severe dementia (aOR 1.86; 95% CI 1.04 to 3.31) and PD use in older age (aOR 1.61; 95% CI 1.00 to 2.60; in residents with disabling dementia) were associated with discontinuation.Conclusions There is possible scope for deprescribing PD and DAP in Roken residents with dementia to mitigate the risks of adverse events. |
| format | Article |
| id | doaj-art-131f97e1064f404cab75ef3b7ad67480 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-131f97e1064f404cab75ef3b7ad674802024-11-21T10:40:11ZengBMJ Publishing GroupBMJ Open2044-60552021-04-0111410.1136/bmjopen-2020-045787Use of psychotropic drugs and drugs with anticholinergic properties among residents with dementia in intermediate care facilities for older adults in Japan: a cohort studyJiro Okochi0Shota Hamada1Taro Kojima2Yukari Hattori3Hiroshi Maruoka4Shinya Ishii5Masahiro Akishita6Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanDepartment of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan1 Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan1 Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanYokohama Aobanosato Geriatric Health Services Facility, Yokohama, JapanChugai Pharmaceutical Co Ltd, Yokohama, Kanagawa, Japan1 Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanObjectives To evaluate the prescription and discontinuation of psychotropic drugs (PD) and drugs with anticholinergic properties (DAP) in residents with dementia admitted to Roken, a major type of long-term care facility in Japan.Design Cohort study.Setting A nationwide questionnaire survey across 3598 Roken in Japan in 2015 (up to five randomly selected residents per facility).Participants This study included 1201 residents from 343 Roken (response rate: 10%). We determined the presence and severity of dementia using a nationally standardised measure.Primary and secondary outcome measures Prescriptions of PD and DAP at admission and 2 months after admission were evaluated. Multivariable logistic regression was used to evaluate the associations of residents’ baseline characteristics with prescriptions or discontinuation.Results Prescription rates decreased for antidementia drugs (19.4% to 13.0%), hypnotics (25.1% to 22.6%) and anxiolytics (12.3% to 10.7%), whereas those for other PD, such as antipsychotics (13.2% to 13.6%), antidepressants (7.4% to 6.7%), antiepileptic drugs (7.1% to 7.8%) and DAP (35.2% to 36.6%) did not statistically significantly decrease. Some factors were associated with the prescriptions, for example, for antipsychotics, older age (≥85 years) (adjusted OR (aOR), 0.60; 95% CI 0.43 to 0.85) and being bedridden (aOR 0.67; 95% CI 0.47 to 0.97) were associated with a lower use of antipsychotics, whereas severe dementia was associated with a higher use of antipsychotics (aOR 3.26; 95% CI 2.26 to 4.70). At an individual level, a quarter of residents prescribed PD or DAP at admission had discontinued at least one PD or DAP, respectively, 2 months after admission. Antidementia drug use in severe dementia (aOR 1.86; 95% CI 1.04 to 3.31) and PD use in older age (aOR 1.61; 95% CI 1.00 to 2.60; in residents with disabling dementia) were associated with discontinuation.Conclusions There is possible scope for deprescribing PD and DAP in Roken residents with dementia to mitigate the risks of adverse events.https://bmjopen.bmj.com/content/11/4/e045787.full |
| spellingShingle | Jiro Okochi Shota Hamada Taro Kojima Yukari Hattori Hiroshi Maruoka Shinya Ishii Masahiro Akishita Use of psychotropic drugs and drugs with anticholinergic properties among residents with dementia in intermediate care facilities for older adults in Japan: a cohort study BMJ Open |
| title | Use of psychotropic drugs and drugs with anticholinergic properties among residents with dementia in intermediate care facilities for older adults in Japan: a cohort study |
| title_full | Use of psychotropic drugs and drugs with anticholinergic properties among residents with dementia in intermediate care facilities for older adults in Japan: a cohort study |
| title_fullStr | Use of psychotropic drugs and drugs with anticholinergic properties among residents with dementia in intermediate care facilities for older adults in Japan: a cohort study |
| title_full_unstemmed | Use of psychotropic drugs and drugs with anticholinergic properties among residents with dementia in intermediate care facilities for older adults in Japan: a cohort study |
| title_short | Use of psychotropic drugs and drugs with anticholinergic properties among residents with dementia in intermediate care facilities for older adults in Japan: a cohort study |
| title_sort | use of psychotropic drugs and drugs with anticholinergic properties among residents with dementia in intermediate care facilities for older adults in japan a cohort study |
| url | https://bmjopen.bmj.com/content/11/4/e045787.full |
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