Pharmacological Approaches

Pharmacological approaches are a mainstay of treatment for people with dementia. Yet, little research on pharmacological approaches has taken place outside the clinical trial setting. These two papers buck this trend. The first is an attempt to assess, using a national database, national trends with respect to prescribed AD medications, dosing and persistence. The second turns to the topic of psychotropic medicines, and argues for a broader focus beyond anti-psychotic medication and questions the typically narrow focus on people with dementia. Both articles highlight the valuable contribution that national databases provide to policy-relevant research. 

Psychotropic Medications and the Transition into Care: A National Data Linkage Study

Journal of the American Geriatrics Society

Maguire et al. (2013) followed a cohort of older people living in the community in NI as they moved into long-stay residential care.

It used the Enhanced Prescribing Database (EPD), a unique centralised database of all prescriptions dispensed in community pharmacies in NI, to determine the proportion of patients who moved into care between January 2009 and January 2010 who commenced psychotropic medication before entry and the change in psychotropic medication use during the transition into care and after entry. For a small proportion of residents in care homes, use of psychotropic medication was a continuation of a medication regime that had been started before entry. However, one in six individuals with no history of psychotropic drug use in the 6 months before entry had been exposed to at least one antipsychotic prescription within six months of entering care. As well as highlighting the need to focus on reducing psychotropic drugs in care homes, the authors argue that the international concern about the level of psychotropic medication use should be extended to include all older people and not just those with dementia, focus on all types of psychotropic medication and include those living in the community. 

A population-based study of dosing and persistence with anti-dementia medications

European Journal of Clinical Pharmacology

Brewer et al. (2013) assessed the adequacy of dosing and persistence with AD medications (anti-cholinesterase inhibitors and Memantine) and predictors (age, gender and drug sub-type) of these variables in the ‘real world’, i.e. outside the clinical trial setting.

 Using prescription refill information from the HSE Primary Care Reimbursement Services pharmacy claims database in ROI, the study found a substantial increase in the rate of prescribing of AD drugs between 2007 and 2010. Donepezil and Memantine were the most frequently prescribed AD drugs with a significant proportion of patients initiated on these drugs prescribed the maximum dose. However, only two-thirds of patients maintained this dose for at least two consecutive months, suggesting that there may be room for improvement in optimising the prescribing of AD medications, and a need to investigate the reasons why these medications are stopped.