((A-157)) (A-157) Psychotropic medication prescribing among older adults before and after dementia diagnosis: a retrospective study in Yinzhou, China

Background: Psychotropic drugs could pose high risks for patients with dementia, and their prescribing trends may change after a dementia diagnosis. Measuring trends of psychotropic drug prescribing before and after the diagnosis could provide valuable insights into clinical practice considerations.

Objectives: To examine changes in psychotropic drug prescribing following an incident dementia diagnosis among older individuals.

Methods: We conducted a population-based study using electronic health records from the Yinzhou Health Information System (YHIS), which encompasses over 1.2 million residents in Yinzhou District, Zhejiang Province. YHIS is a database capturing electronic medical records of residents in Yinzhou from all healthcare facilities across Yinzhou since 2008. We included patients with an incident dementia diagnosis between January 2012 and June 2020, with a washout period of 360 days without any dementia diagnosis. The index date was defined as the day of diagnosis of dementia, identified using codes of the International Classification of Diseases, Tenth Revision. We followed cohort patients from 72 days before the index date to 720 days after the index date. We calculated the monthly proportion of patients using psychotropic drugs within 24 months before and after the index date. Trend and level changes in psychotropic prescribing before and after diagnosis were delineated by interrupt time series (ITS) analysis. We reported the baseline drug prescribing (β0), trends in the pre-diagnosis periods (i.e., slopes, β1), the immediate level change following the index date (β2), and changes in slopes of the post-diagnosis period compared with the pre-diagnosis period (β3).

Results: A total of 3,408 adults aged 65 years and above were eligible for inclusion. Before diagnosis, the overall psychotropic prescribing showed an increasing trend (𝛽1=0.18, p< 0.001). Immediately following the index date, the drug prescribing showed a significant level increase (𝛽2=1.83, p< 0.001) and a continuing uprising trend (𝛽3=-0.04, p=0.347) during post-period. Significant declines were observed in the prescribing of antipsychotics (𝛽3=-0.19, p< 0.001) and antidepressants (𝛽3=-0.09, p< 0.001) after the index date, whereas the trend for benzodiazepines remained increasing (𝛽3=0.12, p< 0.001).

Conclusions: The study revealed a marked increase in the prescribing of psychotropic drugs among patients with dementia following a formal diagnosis, and a continuing increasing trend in the prescribing of benzodiazepines during post-period. These results highlight the need to prioritize the development of more effective treatments to satisfy the substantial unmet needs of dementia and its related psychiatric symptoms.