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Nationwide study of antipsychotic use among community-dwelling persons with Alzheimer's disease in Finland

Published online by Cambridge University Press:  26 August 2011

Marja-Liisa Laitinen ,
J. Simon Bell ,
Piia Lavikainen ,
Eija Lönnroos ,
Raimo Sulkava  and
Sirpa Hartikainen
Marja-Liisa Laitinen*
Affiliation:
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland Institute of Public Health and Clinical Nutrition, Department of Geriatrics, University of Eastern Finland, Kuopio, Finland
J. Simon Bell
Affiliation:
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia, Adelaide, Australia
Piia Lavikainen
Affiliation:
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
Eija Lönnroos
Affiliation:
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland Institute of Public Health and Clinical Nutrition, Department of Geriatrics, University of Eastern Finland, Kuopio, Finland
Raimo Sulkava
Affiliation:
Institute of Public Health and Clinical Nutrition, Department of Geriatrics, University of Eastern Finland, Kuopio, Finland Department of Neurology, Kuopio University Hospital, Kuopio, Finland
Sirpa Hartikainen
Affiliation:
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland Leppävirta Health Centre, Leppävirta, Finland
*
Correspondence should be addressed to: Marja-Liisa Laitinen, MD, Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland. Phone: +358445361308; Fax +35817162424. Email: marja-liisa.laitinen@uef.fi.
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Abstract

Background: Antipsychotics continue to be widely used in the treatment of behavioral and psychological symptoms of dementia despite their limited effectiveness and well-known risks, including increased mortality. Our aim was to investigate the national pattern of antipsychotic use among community-dwelling persons with and without Alzheimer's disease (AD) in Finland.

Methods: The Social Insurance Institution of Finland (SII) identified all persons with a verified diagnosis of AD in Finland on 31 December 2005. A control for each person with AD, matched in terms of age, sex and region of residence, was also identified. Data on reimbursed drug purchases in 2005 were extracted from the Finnish National Prescription Register. Conditional logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the use of antipsychotics.

Results: The study population comprised 28,089 matched pairs of persons with and without AD (mean age 80.0 years, SD 6.8, 32.2% men). The annual prevalence of antipsychotic use was higher among persons with than without AD (22.1% vs. 4.4%, adjusted OR = 5.91; 95% CI 5.91–6.31). Among persons with AD, the prevalence of antipsychotic use was similar across all age groups. Of the antipsychotic users, 85.2% with AD and 51.3% without AD purchased second generation antipsychotics. Most antipsychotic prescriptions – 67.8% in the AD and 62.9% in the non-AD group – were generated in primary care situations.

Conclusion: One-fifth of persons with AD used antipsychotic drugs. Antipsychotic use was six times more prevalent among persons with AD than without AD. Most antipsychotics were prescribed by primary care physicians.

Keywords

psychotropic drugsdrug utilizationdementiaregister-basedepidemiology
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 10 , December 2011 , pp. 1623 - 1631
Copyright
Copyright © International Psychogeriatric Association 2011

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