Summary
The Danish consumption of antipsychotics among elderly people aged 65 years or above is studied for the period 1996 and 1999-2003. The number of elderly people aged 65 years or above treated with antipsychotics has fallen, whereas the quantity consumption has risen.
The average quantity consumption per person rose among all users, regardless of residence and type of antipsychotic used. The average quantity consumption was significantly larger among nursing home residents than among those living at home. This indicates either a longer duration of treatment or larger doses.
In 2003, 28.2 per cent of nursing home residents were given antipsychotics. This percentage has increased slightly since 1996, where the share was 26.0 per cent. Yet, the difference is marked between the counties. The number of people living at home receiving antipsychotics has, however, fallen slightly from 5.3 per cent in 1996 to 4.3 per cent in 2003.
Regardless of residence, the main part of the antipsychotic users was either treated with olanzapine (e.g. Zyprexa®) or risperidone (Risperdal®). However, the share of users that had these medicinal products prescribed was almost twice as high for nursing home residents (30.5 per cent/ 27.4 per cent respectively) than for people living at home (16.6 per cent/ 15.0 per cent respectively).
Among nursing home residents, 59.3 per cent of the antipsychotic users were given an atypical antipsychotic in 2003, whereas this was only the case for 32.9 per cent of the antipsychotic users living at home. There was a greater variation in the choice of antipsychotics for people living at home than for nursing home residents.
Among the people using antipsychotics in tablet form, there is a significantly lower share of nursing home residents than of the people living at home, who use antipsychotics for short-term treatment. Thus, 12.1 per cent of nursing home residents were given prescriptions corresponding to one tablet a day for less than 6 months, whereas almost 31.1 per cent of people living at home used such prescriptions.
The study shows that there is a distinct use of both benzodiazepines and antidepressants among people using antipsychotics. This is potentially problematic, as interactions frequently occur among the preparations. Hence, almost ¾ of nursing home residents and 63.2 per cent of people living at home and using antipsychotics were given either benzodiazepines, antidepressants or both within a period of 3 months.
Of all dementia patients who used dementia products in 2003, 1.756 people, corresponding to more than 1/5, had also used a prescription for an atypical antipsychotic at some point during that year. This share was twice as big among residents at nursing homes compared to dementia patients living in their own homes. Of these dementia patients, a total of 909 people were treated with olanzapine. Studies have documented an increased mortality rate when treating people suffering from dementia with olanzapine, and hence many dementia patients are potentially at risk.
The high shares of simultaneous treatment of antipsychotic users with antidepressants and benzodiazepines and the high shares – especially in nursing homes – of dementia patients being treated with antipsychotics could indicate that there is a need for more focus on the indication basis on which these medicinal products are prescribed for dementia patients as well as on the importance of not giving unnecessary treatment with benzodiazepines.
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