Prescribing of antipsychotics in people with dementia in acute general hospitals in England: 2010-2012

Purpose: Antipsychotics are believed to be over-used in the control, the behavioural and psychological symptoms of dementia. Hospitals are encouraged to audit antipsychotic use in people with dementia. The objectives of this study are to describe antipsychotic use in inpatients with dementia between 2010 and 2012 and to understand the impact of clinical and socio-demographic factors on their use. Design: Retrospective and longitudinal analysis of antipsychotics dispensed to people with dementia in 34 English hospitals between January 2010 and October 2012. The unit of analysis was the period during which an inpatient was under the continuous care of one or more hospitals. Results: Among the inpatients, 16.6% (10,440/63,079) with dementia received an antipsychotic in 13.9% of periods of care (13,643/97,902). Antipsychotic use was higher in inpatients with dementia and schizophrenia (57%) and in those inpatients with dementia and the symptoms and signs involving emotional state (38.2%). Antipsychotic use decreased between 2010 and 2012 (15.9% versus 12.1%, P < 0.001). In people with dementia without schizophrenia, the absence of cerebrovascular or ischaemic heart disease (OR 1.16 [1.12-1.211), the presence of signs or symptoms of emotional state (OR 3.71 [3.29-4.191), increasing deprivation (OR 1.02 [1.01-1.031) and male gender (OR 1.10 [1.06-1.151) were significantly associated with increased antipsychotic use (P < 0.001 in all cases). Increasing age (OR 0.88 [0.87-0.89]) was significantly associated with decreased antipsychotic use (P < 0.001). Conclusion: Antipsychotic use in inpatients with dementia is declining but still more than one in eight periods of care are associated with use of an antipsychotic. Crown Copyright (C) 2014 Published by Elsevier Masson SAS. All rights reserved.