Psychotropic medication prescribing among older adults before and after dementia diagnosis: a retrospective study in Yinzhou, China

This is the authors' abstract. We don't add key points for this paper.

Psychotropic medications could pose high risks for patients with dementia. Characterizing prescribing patterns of psychotropic medications before and after the formal dementia diagnosis may help identify clinically important periods for medication review and risk management. We conducted a population-based retrospective study using electronic health records from the Yinzhou Health Information System. The cohort included patients with an incident dementia diagnosis between January 2011 and June 2021, with the index date defined as the day of diagnosis. The primary outcome was the monthly proportion of patients using psychotropic drugs within 12 months before and after the index date. Trend and level changes in psychotropic drug prescribing before and after diagnosis were delineated by interrupt time series analysis. A total of 3,408 adults aged 65 years and above were eligible for inclusion. Before diagnosis, the overall psychotropic medication prescribing showed an increasing trend (𝛽 1 = 0.49, p < 0.001), from 13.1% in the twelfth month before diagnosis to 18.6% in the month before diagnosis. Immediately following the diagnosis, the prescribing showed a significant level increase (𝛽 2 = 2.49, p < 0.001) to 22.1% in the first month following the index date, and subsequently stabilized during the 12-month post-diagnosis period, with a significant attenuated trend compared with the 12-month pre-diagnosis period (𝛽 3 =-0.49, p < 0.001). Significant declines were observed in the prescribing of antipsychotics (𝛽 3 =-0.48, p < 0.001), antidepressants (𝛽 3 =-0.22, p < 0.001), antiepileptics (𝛽 3 =-0.14, p < 0.001), and Z-drugs (𝛽 3 =-0.05, p = 0.007) after the index date, whereas the trend for benzodiazepines remained unchanged (𝛽 3 = 0.12, p = 0.359). Psychotropic medication prescribing increased before dementia diagnosis, showed an immediate level increase at diagnosis, and subsequently stabilized during the 12-month post-diagnosis period. Temporal prescribing patterns differed across drug classes. These results highlight the importance of reevaluating the necessity and safety of all ongoing psychotropic medications once dementia was diagnosed to improve patiet safety and quality of care. Not applicable.