Psychotropic Medication Use Among Community-Dwelling Dementia Patients: Insights from the Resources for Enhancing Alzheimer's Caregiver Health Trials.

Abstract

Currently, two types of medications, cholinesterase inhibitors and N-methyl d-aspartate (NMDA) receptor antagonists, are approved by the FDA for the treatment of cognitive dementia symptoms; however, there are no approved pharmacologic treatment options available for the management of mood and behavioral disturbances. As a result, several types of psychotropic medications are used “off-label” to mitigate the often troublesome, non-cognitive symptoms of dementia. This practice has come under considerable scrutiny following the 2005 and 2008 FDA black box warnings regarding the increased risk of stroke and death associated with the use of antipsychotics in elderly people with dementia. Despite the associated risks, psychotropics are still prescribed to people with dementia. The lack of safe, alternative medications highlights the need for non-pharmaceutical interventions. In order for future interventions to be effective, they must target modifiable medication risk factors. Current research surrounding psychotropic medication use in people with dementia focuses on residents of nursing homes. Published work examining medication use among community-dwelling dementia patients is rare and none of the existing studies examine the role of informal caregivers. The purpose of this dissertation is to investigate a broad range of care recipient and caregiver characteristics as cross-sectional and longitudinal predictors of psychotropic medication both between and within racially and ethnically diverse populations of community-dwelling dementia patients and their informal caregivers. Using data from the Resources for Enhancing Alzheimer’s Caregiver Health Trials, we found that caregiver and care recipient characteristics are important predictors of psychotropic medication use among community-dwelling dementia patients, and that the association between care recipient symptoms and medication decreases over time. Significant racial/ethnic disparities in psychotropic medication use between care recipients from three racial/ethnic groups were observed in our final study. Within race analyses revealed significant associations between Hispanic/Latino caregiver social networks and care recipient psychotropic medication use. No clear pattern was observed for other racial/ethnic groups. Future public health efforts should focus on a multidisciplinary approach to dementia care where the knowledge and skills of persons trained in cultural competence and non-pharmaceutical interventions work together with physicians and caregivers to provide a safe alternative to psychotropic medication.