Hostname: page-component-5d84bcc8dc-pdq9s Total loading time: 0 Render date: 2026-08-13T08:27:02.438Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence of psychotropic polypharmacy in nursing home residents with dementia: a meta-analysis

Published online by Cambridge University Press:  07 January 2021

Dylan J. Jester Open the ORCID record for Dylan J. Jester [Opens in a new window] ,
Victor Molinari ,
Janice C. Zgibor  and
Ladislav Volicer
Dylan J. Jester*
Affiliation:
School of Aging Studies, University of South Florida, Tampa, FL, USA
Victor Molinari
Affiliation:
School of Aging Studies, University of South Florida, Tampa, FL, USA
Janice C. Zgibor
Affiliation:
College of Public Health, University of South Florida, Tampa, FL, USA
Ladislav Volicer
Affiliation:
School of Aging Studies, University of South Florida, Tampa, FL, USA
*
Correspondence should be addressed to: Dylan Jester, School of Aging Studies, University of South Florida, 13301 Bruce B. Downs Blvd., MHC 1318, Tampa, FL, 33612, USA. Phone +813 974-3232. Email: djjester@usf.edu
Get access

Abstract

Objectives:

Nursing home (NH) residents with dementia is exposed to high rates of psychotropic prescriptions. Our objectives were to: (1) pool the prevalence estimates of psychotropic polypharmacy from the existing literature and (2) examine potentially influential factors that are related to a higher or lower prevalence.

Design:

Meta-analysis of data collected from randomized trials, quasi-experimental, prospective or retrospective cohort, and cross-sectional studies. English-language searches of PubMed and PsycINFO were completed by November 2020. Included studies reported prevalence estimates of psychotropic polypharmacy (i.e. defined as either two-or-more or three-or-more medications concurrently) in NH residents with dementia.

Setting and Participants:

NH residents with dementia.

Measurements:

Random-effects models were used to pool the prevalence of psychotropic polypharmacy in NH residents with dementia across studies. Estimates were provided for both two-or-more and three-or-more concurrent medications. Heterogeneity and publication bias were measured. Meta-regression examined the influence of the percentage of the sample who were male, mean age of the sample, geographic region (continent), sample size, and study year on the prevalence of psychotropic polypharmacy.

Results:

Twenty-five unique articles were included comprising medications data from 92,370 NH residents with dementia in 12 countries. One-in-three (33%, [95% CI: 28%, 39%]) NH residents with dementia received two-or-more psychotropic medications concurrently. One-in-eight (13%, [95% CI: 10%, 17%]) received three-or-more psychotropic medications concurrently. Estimates were highly variable across both definitions of psychotropic polypharmacy (p < 0.001). Among study-level demographics, geographic region, sample size, or study year, only male sex was associated with greater use of two-or-more psychotropic medications (Unadjusted OR = 1.02, p = 0.006; Adjusted OR = 1.04, p = 0.07).

Conclusions:

Psychotropic polypharmacy is common among NH residents with dementia. Identifying the causes of utilization and the effects on resident health and well-being should be prioritized by federal entities seeking to improve NH quality.

Keywords

dementiameta-analysisnursing homesepidemiologypsychopharmacology

Information

Type
Review Article
Information
International Psychogeriatrics , Volume 33 , Special Issue 10: Issue Theme: Non-cognitive Concerns in People with Dementia , October 2021 , pp. 1083 - 1098
Copyright
© International Psychogeriatric Association 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Alzheimer’s Association (2019). 2019 Alzheimer’s disease facts and figures. Alzheimer’s and Dementia, 15, 321–387. doi: 10.1016/j.jalz.2019.01.010 CrossRefGoogle Scholar
Atramont, A., Bonnet-Zamponi, D., Bourdel-Marchasson, I., Tangre, I., Fagot-Campagna, A., and Tuppin, P. (2018). Health status and drug use 1 year before and 1 year after skilled nursing home admission during the first quarter of 2013 in France: a study based on the French National Health Insurance Information System. European Journal of Clinical Pharmacology, 74, 109–118. doi: 10.1007/s00228-017-2343-y CrossRefGoogle ScholarPubMed
Bartels, S. J., et al. (2003). Agitation and depression in frail nursing home elderly patients with dementia: treatment characteristics and service use. The American Journal of Geriatric Psychiatry, 11, 231–238. doi: 10.1097/00019442-200303000-00014 CrossRefGoogle ScholarPubMed
Bellelli, G., et al. (1998). Special care units for demented patients: A multicenter study. The Gerontologist, 38, 456–462. doi: 10.1093/geront/38.4.456 CrossRefGoogle ScholarPubMed
Breining, A., et al. (2017). Exposure to psychotropics in the French older population living with dementia: a nationwide population-based study. International Journal of Geriatric Psychiatry, 32, 750–760. doi: 10.1002/gps.4517 CrossRefGoogle ScholarPubMed
Brimelow, R. E., Wollin, J. A., Byrne, G. J. and Dissanayaka, N. N. (2019). Prescribing of psychotropic drugs and indicators for use in residential aged care and residents with dementia. International Psychogeriatrics, 31, 837-847. doi: 10.1017/s1041610218001229 CrossRefGoogle Scholar
Brodaty, H., Connors, M.H., Xu, J., Woodward, M., Ames, D., and PRIME Study Group. (2015). The course of neuropsychiatric symptoms in dementia: a 3-year longitudinal study. Journal of the American Medical Directors Association, 16, 380–387. doi: 10.1016/j.jamda.2014.12.018 CrossRefGoogle ScholarPubMed
Callegari, E., Benth, J. Š., Selbæk, G., Grønnerød, C., and Bergh, S. (2020). Does psychotropic drug prescription change in nursing home patients the first 6 months after admission? Journal of the American Medical Directors Association. doi: 10.1016/j.jamda.2020.08.034 Google Scholar
Clague, F., Mercer, S. W., McLean, G., Reynish, E. and Guthrie, B. (2017). Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data. Age and Ageing, 46, 33–39. doi: 10.1093/ageing/afw176 Google ScholarPubMed
Eggermont, L. H. P., de Vries, K. and Scherder, E. J. A. (2009). Psychotropic medication use and cognition in institutionalized older adults with mild to moderate dementia. International Psychogeriatrics, 21, 286–294. doi: 10.1017/S1041610209008552 CrossRefGoogle ScholarPubMed
Fereshtehnejad, S.-M., Johnell, K. and Eriksdotter, M. (2014). Anti-dementia drugs and co-medication among patients with Alzheimer’s disease. Drugs and Aging, 31, 215–224.10.1007/s40266-014-0154-8CrossRefGoogle ScholarPubMed
Gerlach, L. B., Olfson, M., Kales, H. C. and Maust, D. T. (2017). Opioids and other central nervous system–active polypharmacy in older adults in the United States. Journal of the American Geriatrics Society, 65, 2052–2056. doi: 10.1111/jgs.14930 CrossRefGoogle ScholarPubMed
Gerridzen, I. J. and Coossensen, M. A. (2014). Patients with Korsakoff syndrome in nursing homes: Characteristics, comorbidity, and use of psychotropic drugs. International Psychogeriatrics, 26, 115–121. doi: 10.1017/S1041610213001543 CrossRefGoogle ScholarPubMed
Gill, S. S., et al. (2005). A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Archives of Internal Medicine, 165, 808–813. doi: 10.1001/archinte.165.7.808 CrossRefGoogle ScholarPubMed
Gulla, C., Selbæk, G., Flo, E., Kjome, R., Kirkevold, O. and Husebo, B. S. (2016). Multi-psychotropic drug prescription and the association to neuropsychiatric symptoms in three Norwegian nursing home cohorts between 2004 and 2011. BMC Geriatrics, 16, 115. doi: 10.1186/s12877-016-0287-1 CrossRefGoogle ScholarPubMed
Gustafsson, M., Karlsson, S., Gustafson, Y. and Lövheim, H. (2013). Psychotropic drug use among people with dementia–a six-month follow-up study. BMC Pharmacology and Toxicology, 14, 56. doi: 10.1186/2050-6511-14-56 CrossRefGoogle ScholarPubMed
Helvik, A. S., Saltyte Benth, J., Wu, B., Engedal, K. and Selbæk, G. (2017). Persistent use of psychotropic drugs in nursing home residents in Norway. BMC Geriatrics, 17, 52. doi: 10.1186/s12877-017-0440-5 CrossRefGoogle ScholarPubMed
Iaboni, A., et al. (2016). Changing pattern of sedative use in older adults: a population-based cohort study. Drugs Aging, 33, 523–533. doi: 10.1007/s40266-016-0380-3 CrossRefGoogle ScholarPubMed
Izza, M. A., Lunt, E., Gordon, A. L., Gladman, J. R., Armstrong, S., and Logan, P. (2020). Polypharmacy, benzodiazepines, and antidepressants, but not antipsychotics, are associated with increased falls risk in UK care home residents: a prospective multi-centre study. European Geriatric Medicine, 1–8. doi: 10.1007/s41999-020-00376-1 Google Scholar
Jacquin-Piques, A., et al. (2016). Psychotropic drug prescription in patients with dementia: Nursing home residents versus patients living at home. Journal of Alzheimers Disease, 49, 671–680. doi: 10.3233/jad-150280 CrossRefGoogle ScholarPubMed
Johnell, K., Jonasdottir Bergman, G., Fastbom, J., Danielsson, B., Borg, N., and Salmi, P. (2017). Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults. International Journal of Geriatric Psychiatry, 32, 414–420. doi: 10.1002/gps.4483 CrossRefGoogle ScholarPubMed
Kim, H. and Whall, A. L. (2006). Factors associated with psychotropic drug usage among nursing home residents with dementia. Nursing Research, 55, 252–258. doi: 10.1097/00006199-200607000-00005 CrossRefGoogle ScholarPubMed
Kristensen, R. U., Nørgaard, A., Jensen-Dahm, C., Gasse, C., Wimberley, T. and Waldemar, G. (2018). Polypharmacy and potentially inappropriate medication in people with dementia: a nationwide study. Journal of Alzheimer’s Disease, 63, 383–394. doi: 10.3233/JAD-170905 CrossRefGoogle ScholarPubMed
Leelakanok, N. and D’Cunha, R. R. (2019). Association between polypharmacy and dementia–A systematic review and metaanalysis. Aging and Mental Health, 23, 932–941. doi: 10.1080/13607863.2018.1468411 CrossRefGoogle ScholarPubMed
Lippert, T., et al. (2020). [Impact of sedating drugs on falls resulting injuries among people with dementia in a nursing home setting]. Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)), 82, 14–22. doi: 10.1055/a-1071-7911 Google Scholar
Loggia, G., et al. (2020). Psychotropic polypharmacy in adults 55 years or older: a risk for impaired global cognition, executive function, and mobility. Frontiers in Pharmacology, 10, 1659. doi: 10.3389/fphar.2019.01659 CrossRefGoogle ScholarPubMed
Lövheim, H., Sandman, P. O., Karlsson, S., and Gustafson, Y. (2009). Sex differences in the prevalence of behavioral and psychological symptoms of dementia. International Psychogeriatrics, 21, 469–475. doi: 10.1017/S1041610209008497 CrossRefGoogle ScholarPubMed
Lustenberger, I., Schupbach, B., von Gunten, A. and Mosimann, U. (2011). Psychotropic medication use in Swiss nursing homes. Swiss Medical Weekly, 141, w13254. doi: 10.4414/smw.2011.13254 Google ScholarPubMed
Maguire, A., Hughes, C., Cardwell, C. and O’Reilly, D. (2013). Psychotropic medications and the transition into care: a national data linkage study. Journal of the American Geriatrics Society, 61, 215–221. doi: 10.1111/jgs.12101 CrossRefGoogle ScholarPubMed
Masnoon, N., Shakib, S., Kalisch-Ellett, L. and Caughey, G. E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatrics, 17, 230. doi: 10.1186/s12877-017-0621-2 CrossRefGoogle ScholarPubMed
Massot Mesquida, M., Tristany Casas, M., Franzi Siso, A., Garcia Munoz, I., Hernandez Vian, O. and Toran Monserrat, P. (2019). Consensus and evidence-based medication review to optimize and potentially reduce psychotropic drug prescription in institutionalized dementia patients. BMC Geriatrics, 19, 7. doi: 10.1186/s12877-018-1015-9 CrossRefGoogle ScholarPubMed
Maust, D. T., Gerlach, L. B., Gibson, A., Kales, H. C., Blow, F. C. and Olfson, M. (2017). Trends in central nervous system–active polypharmacy among older adults seen in outpatient care in the United States. JAMA Internal Medicine, 177, 583–585. doi: 10.1001/jamainternmed.2016.9225 CrossRefGoogle ScholarPubMed
Maust, D. T., Kim, H. M., Chiang, C. and Kales, H. C. (2018). Association of the Centers for Medicare & Medicaid Services’ national partnership to improve dementia care with the use of antipsychotics and other psychotropics in long-term care in the United States from 2009 to 2014. JAMA Internal Medicine, 178, 640–647. doi: 10.1001/jamainternmed.2018.0379 CrossRefGoogle ScholarPubMed
Maust, D. T., Oslin, D. W. and Thase, M. E. (2013). Going beyond antidepressant monotherapy for incomplete response in nonpsychotic late-life depression: a critical review. The American Journal of Geriatric Psychiatry, 21, 973–986. doi: 10.1016/j.jagp.2013.01.030 CrossRefGoogle ScholarPubMed
McMaster, M., Fielding, E., Lim, D., Moyle, W. and Beattie, E. (2018). A cross-sectional examination of the prevalence of psychotropic medications for people living with dementia in Australian long-term care facilities: issues of concern. International Psychogeriatrics, 30, 1019–1026. doi: 10.1017/s1041610217002447 CrossRefGoogle ScholarPubMed
Midlöv, P., Andersson, M., Östgren, C. J. and Mölstad, S. (2014). Depression and use of antidepressants in Swedish nursing homes: A 12-month follow-up study. International Psychogeriatrics, 26, 669–675. doi: 10.1017/S1041610213002354 CrossRefGoogle ScholarPubMed
Mizokami, F., Koide, Y., Noro, T. and Furuta, K. (2012). Polypharmacy with common diseases in hospitalized elderly patients. The American Journal of Geriatric Pharmacotherapy, 10, 123–128. doi: 10.1016/j.amjopharm.2012.02.003 CrossRefGoogle ScholarPubMed
Mjørud, M., Kirkevold, M., Røsvik, J., Selbæk, G. and Engedal, K. (2014a). Variables associated to quality of life among nursing home patients with dementia. Aging and Mental Health, 18, 1013–1021. doi: 10.1080/13607863.2014.903468 CrossRefGoogle ScholarPubMed
Mjørud, M., Røsvik, J., Rokstad, A. M. M., Kirkevold, M. and Engedal, K. (2014b). Variables associated with change in quality of life among persons with dementia in nursing homes: a 10 months follow-up study. PloS ONE, 9, e115248. doi: 10.1371/journal.pone.0115248 CrossRefGoogle ScholarPubMed
Morin, L., Laroche, M.L., Texier, G. and Johnell, K. (2016). Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. Journal of the American Medical Directors Association, 17, 862-e1. doi: 10.1016/j.jamda.2016.06.011 CrossRefGoogle ScholarPubMed
Moyle, W., et al. (2017). Pharmacotherapy of persons with dementia in long-term care in australia: a descriptive audit of central nervous system medications. Current Drug Safety. doi: 10.2174/1574886312666170209113203 CrossRefGoogle ScholarPubMed
Mulders, A., Zuidema, S. U., Leeuwis, R., Bor, H., Verhey, F. R. J. and Koopmans, R. (2019). Prevalence and correlates of psychotropic drug use in Dutch nursing home patients with young-onset dementia. International Journal Geriatric Psychiatry, 34, 1185–1193. doi: 10.1002/gps.5116 CrossRefGoogle ScholarPubMed
Nelson, J. C. and Papakostas, G. I. (2009). Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials. American Journal of Psychiatry, 166, 980–991. doi: 10.1176/appi.ajp.2009.09030312 CrossRefGoogle ScholarPubMed
Nijk, R. M., Zuidema, S. U. and Koopmans, R. T. (2009). Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia. International Psychogeriatrics, 21, 485–493. doi: 10.1017/s1041610209008916 CrossRefGoogle ScholarPubMed
Nørgaard, A., Jensen-Dahm, C., Gasse, C., Hansen, E. S. and Waldemar, G. (2017). Psychotropic polypharmacy in patients with dementia: prevalence and predictors. Journal of Alzheimer’s Disease, 56, 707–716. doi: 10.3233/JAD-160828 CrossRefGoogle ScholarPubMed
Nørgaard, A., Jensen-Dahm, C., Gasse, C., Wimberley, T., Hansen, E. S., and Waldemar, G. (2020). Association of benzodiazepines and antidepressants with 180-day mortality among patients with dementia receiving antipsychotic pharmacotherapy: a nationwide registry-based study. The Journal of Clinical Psychiatry, 81, e1–e7. doi: 10.4088/JCP.19m12828 CrossRefGoogle ScholarPubMed
Nygaard, H. A., Ruths, S., Straand, J. and Naik, M. (2004). Not less but different: psychotropic drug utilization trends in Norwegian nursing homes during a 12-year period. The Bergen District Nursing Home (BEDNURS) Study. Aging Clinical Experimental Research, 16, 277–282. doi: 10.1007/bf03324552 CrossRefGoogle ScholarPubMed
Oesterhus, R., Aarsland, D., Soennesyn, H., Rongve, A., Selbæk, G. and Kjosavik, S. R. (2017). Potentially inappropriate medications and drug–drug interactions in home-dwelling people with mild dementia. International Journal of Geriatric Psychiatry, 32, 183–192. doi: 10.1002/gps.4456 CrossRefGoogle ScholarPubMed
Olsson, J., et al. (2010). Quality of drug prescribing in elderly people in nursing homes and special care units for dementia. Clinical Drug Investigation, 30, 289–300. doi: 10.2165/11534320-000000000-00000 CrossRefGoogle ScholarPubMed
Orsel, K., et al. (2018). Psychotropic drugs use and psychotropic polypharmacy among persons with Alzheimer’s disease. European Neuropsychopharmacology, 28, 1260–1269. doi: 10.1016/j.euroneuro.2018.04.005 CrossRefGoogle ScholarPubMed
Ozaki, T., Katsumata, Y. and Arai, A. (2017). The use of psychotropic drugs for behavioral and psychological symptoms of dementia among residents in long-term care facilities in Japan. Aging and Mental Health, 21, 1248–1255. doi: 10.1080/13607863.2016.1220922 CrossRefGoogle ScholarPubMed
Pasina, L., Novella, A., Cortesi, L., Nobili, A., Tettamanti, M., and Ianes, A. (2020). Drug prescriptions in nursing home residents: an Italian multicenter observational study. European Journal of Clinical Pharmacology. doi: 10.1007/s00228-020-02871-7 CrossRefGoogle ScholarPubMed
Resnick, B., et al. (2019). Current psychotropic medication use and contributing factors among nursing home residents with cognitive impairment. Clinical Nursing Research, 1054773819838678. doi: 10.1177/1054773819838678 Google ScholarPubMed
Rochon, P. A. and Gurwitz, J. H. (1997). Optimising drug treatment for elderly people: the prescribing cascade. BMJ, 315, 1096–1099. doi: 10.1136/bmj.315.7115.1096 CrossRefGoogle ScholarPubMed
Rochon, P. A. and Gurwitz, J. H. (2017). The prescribing cascade revisited. The Lancet, 389, 1778–1780. doi: 10.1016/S0140-6736(17)31188-1 CrossRefGoogle ScholarPubMed
Roitto, H. M., Kautiainen, H., Aalto, U. L., Ohman, H., Laurila, J. and Pitkala, K. H. (2019). Fourteen-year trends in the use of psychotropic medications, opioids, and other sedatives among institutionalized older people in Helsinki, Finland. Journal of the American Medical Directors Association, 20, 305–311. doi: 10.1016/j.jamda.2018.12.022 CrossRefGoogle ScholarPubMed
Rolland, Y., Andrieu, S., Crochard, A., Goni, S., Hein, C. and Vellas, B. (2012). Psychotropic drug consumption at admission and discharge of nursing home residents. Journal of the American Medical Directors Association, 13, 407.e407–412. doi: 10.1016/j.jamda.2011.12.056 CrossRefGoogle ScholarPubMed
Ruths, S., et al. (2013). Trends in psychotropic drug prescribing in Norwegian nursing homes from 1997 to 2009: A comparison of six cohorts. International Journal of Geriatric Psychiatry, 28, 868–876. doi: 10.1002/gps.3902 CrossRefGoogle ScholarPubMed
Ryden, M. B., et al. (1999). Relationships between aggressive behavior in cognitively impaired nursing home residents and use of restraints, psychoactive drugs, and secured units. Archives of Psychiatric Nursing, 13, 170–178. doi: 10.1016/S0883-9417(99)80003-X CrossRefGoogle ScholarPubMed
Schjøtt, J. and Aßmus, J. (2019). A retrospective comparison of inappropriate prescribing of psychotropics in three Norwegian nursing homes in 2000 and 2016 with prescribing quality indicators. BMC Medical Informatics and Decision Making, 19, 102. doi: 10.1186/s12911-019-0821-0 CrossRefGoogle ScholarPubMed
Shah, S. M., Carey, I. M., Harris, T., DeWilde, S. and Cook, D. G. (2012). Quality of prescribing in care homes and the community in England and Wales. British Journal of General Practice, 62, e329–336. doi: 10.3399/bjgp12X641447 CrossRefGoogle ScholarPubMed
Simpson, K. M., Richards, K. C., Enderlin, C. A., O’Sullivan, P. S. and Koehn, M. (2006). Medications and sleep in nursing home residents with dementia. Journal of the American Psychiatric Nurses Association, 12, 279–285. doi: 10.1177/1078390306295654 CrossRefGoogle Scholar
Sterke, C. S., et al. (2012). New insights: dose-response relationship between psychotropic drugs and falls: a study in nursing home residents with dementia. Journal of Clinical Pharmacology, 52, 947–955. doi: 10.1177/0091270011405665 CrossRefGoogle ScholarPubMed
Sterke, C. S., Verhagen, A. P., van Beeck, E. F. and van der Cammen, T. J. M. (2008). The influence of drug use on fall incidents among nursing home residents: A systematic review. International Psychogeriatrics, 20, 890–910. doi: 10.1017/S104161020800714X CrossRefGoogle ScholarPubMed
Thapa, P. B., Gideon, P., Fought, R. L. and Ray, W. A. (1995). Psychotropic drugs and risk of recurrent falls in ambulatory nursing home residents. American Journal of Epidemiology, 142, 202–211. doi: 10.1093/oxfordjournals.aje.a117619 CrossRefGoogle ScholarPubMed
van der Spek, K., et al. (2016). Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-study. International Psychogeriatrics, 28, 1589–1595. doi: 10.1017/s104161021600082x CrossRefGoogle ScholarPubMed
van der Spek, K., et al. (2018). Factors associated with appropriate psychotropic drug prescription in nursing home patients with severe dementia. International Psychogeriatrics, 30, 547–556. doi: 10.1017/s1041610217001958 CrossRefGoogle ScholarPubMed
Vasudev, A., et al. (2015). Trends in psychotropic dispensing among older adults with dementia living in long-term care facilities: 2004-2013. American Journal of Geriatric Psychiatry, 23, 1259–1269. doi: 10.1016/j.jagp.2015.07.001 CrossRefGoogle ScholarPubMed
Vetrano, D. L., et al. (2013). Polypharmacy in nursing home residents with severe cognitive impairment: results from the SHELTER Study. Alzheimer’s and Dementia, 9, 587–593. doi: 10.1016/j.jalz.2012.09.009 CrossRefGoogle ScholarPubMed
Walsh, K. A., O’Regan, N. A., Byrne, S., Browne, J., Meagher, D. J. and Timmons, S. (2016). Patterns of psychotropic prescribing and polypharmacy in older hospitalized patients in Ireland: the influence of dementia on prescribing. International Psychogeriatrics, 28, 1807–1820. doi: 10.1017/S1041610216001307 CrossRefGoogle ScholarPubMed
Wetzels, R. B., Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2011). Prescribing pattern of psychotropic drugs in nursing home residents with dementia. International Psychogeriatrics, 23, 1249–1259. doi: 10.1017/s1041610211000755 CrossRefGoogle ScholarPubMed
Zerah, L., et al. (2017). Association between psychotropic and cardiovascular iatrogenic alerts and risk of hospitalizations in elderly people treated for dementia: a self-controlled case series study based on the matching of 2 French health insurance databases. Journal of the American Medical Directors Association, 18, 549–e1. doi: 10.1016/j.jamda.2017.02.001 CrossRefGoogle ScholarPubMed
Supplementary material: File

Jester et al. supplementary material

Figures S1 and S2

Download Jester et al. supplementary material(File)
File 58 KB