1. The (ab)use of antipsychotics in people with dementia according to the living conditions
Rocha, V.1, Marques, A.1,2, Figueiredo D.1,2, Pinto M.1,2, Sousa L.2,3
1Escola Superior de Saúde, Universidade de Aveiro, Aveiro, Portugal
2Unidade de Investigação e Formação de Adultos e Idosos, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
3Secção Autónoma de Ciências da saúde, Universidade de Aveiro, Aveiro, Portugal
10th March 2012

2. Introduction
Antipsychotic medication Behavioural and psychological symptoms of dementia [1, 2, 3].
Antipsychotics prescription is a serious health problem, as they are:
Used as first line approach [12].
Associated with a high number of side effects and modest benefits [13,14].
Prescribed without regular medical revision[9,15].
Side effects:
Increases the risk of dying
Increases the risk of having a stroke
Intensifies cognitive decline in older people with dementia
Cause falls and fractures
Gait disturbance
Modest benefits:
minimal efficacy for the treatment of global behaviour disturbance, and aggression;
Limited evidence on antipsychotics for treatment of symptoms of psychosis in dementia
International concern over the excessive and potential inappropriate use of antipsychotics in dementia [4,5,6].

3. Introduction
Most of the available evidence on antipsychotics prescription are from studies conducted in residential homes [4,7,8].
Research regarding medication prescription in different settings, e.g., residential homes vs. community, is lacking [4,7,8].
This information is essential to guide health professionals’ practice and to estimate the resources needed to reduce inappropriate prescription [9].

4. Aims
To report the prevalence of antipsychotics in people with dementia.
To explore their use according to the living conditions, i.e., residential homes vs. community.

5. Methods
Study Design
Cross-sectional study - people with medical diagnosis of dementia (DSM-IV criteria).
Sample
Group 1
N=38
Community
Group 2
N=38
Residential homes

6. Methods Data collection
Socio-demographics; Living condition; Antipsychotics intake was collected with a structured questionnaire based on the ICF-checklist [10].
Cognition and severity of dementia – Mini-Mental State Examination [11].
Statistical analysis
Descriptive statistics and non-parametric tests were used in data analysis.
We collected Socio-demographics; Living condition; Antipsychotics intake from the clinical file or through conversation with managers, health professionals (physiotherapist; nurse) and formal caregivers.

7. Results Sample characterisation Group 1 Group 2 n % Gender Female Male 19 50 21 17
55.3
44.7
Marital status
Single
Married/Living with a partner
Divorced/Separated
Widowed 3 22 1 12
7.9
57.9
2.6
31.6 7 6 24
18.4
15.8
63.2
Level of education (years)
Illiterate
1-4
5-9
+10
Missing 9 2
23.7
5.3 14 4
36.8
10.5
Severity of dementia
Mild
Moderate
Severe 5 20 13
13.2
34.2 10
26.3
Cognition (Mean± SD)
12.7±7.2
9.4±9.4
Age (Mean± SD)
77.8±6.3
83.7±6.3

8. Results
Groups were similar at baseline for marital status, level of education, cognition and severity of dementia.
55.3% of the total sample were prescribed with antipsychotics (1.2 ± 0.4).

9. Results
Institutionalised people with dementia were significantly higher prescribed with antipsychotics than participants living in the community. %
ρ=0.001

10. Conclusion
People with dementia were highly prescribed with antipsychotics.
Higher use of antipsychotics seems to be related with the institutionalisation.

11. Conclusion Future research
Further investigation should be conducted in community settings - as prescription in the community is less well explored and documented [9].
Studies are also needed on non-pharmacological interventions as they have shown potential to reduce the need of antipsychotics in people with dementia [16,17].
Research is also needed on non-pharmacological interventions, as potential approaches – evidence remains scarce.

12. Email: vania.rocha@ua.pt
Thank You!
Vânia Rocha
Alda Marques
Margarida Pinto
Daniela Figueiredo
Liliana Sousa

13. References
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14. References
[9] SHAH, S. M., CAREY, I. M., HARRIS, T., DEWILDE, S. and COOK, D. G. Antipsychotic prescribing to older people living in care homes and the community in England and Wales. Int J Geriatr Psychiatry [10] WORLD HEALTH ORGANIZATION, WHO. ICF Checklist. Geneva: World Health Organization [11] Folstein, M. S., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state". A pratical method for grading the mental state of patients for the clinician. Journal Psychiatric Research, 12, [12] MUSICCO, M., PALMER, K., RUSSO, A., CALTAGIRONE, C., ADORNI, F., PETTENATI, C. and BISANTI, L. Association between prescription of conventional or atypical antipsychotic drugs and mortality in older persons with Alzheimer's disease. Dement Geriatr Cogn Disord [13] SCHNEIDER, L. S., DAGERMAN, K. and INSEL, P. S. Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry [14] DOUGLAS, I. J. and SMEETH, L. Exposure to antipsychotic and risk of stroke: self-controlled case series study. BMJ. a [15] BANERJEE, S. The use of antipsychotic medication for people with dementia: time for action. A report for the Minister of State for Care Services [16] RABINS, P. V., BLACKER, D., ROVNER, B. W., RUMMANS, T., SCHNEIDER, L. S., TARIOT, P. N. and BLASS, D. M. APA Practice Guideline for the Treatment of Patients With Alzheimer’s Disease and Other Dementias [17] FOSSEY, J., BALLARD, C., JUSZCZAK, E., JAMES, I., ALDER, N., JACOBY, R. and HOWARD, R. Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial. BMJ