The patterns in psychotropic drug prescriptions among older people with dementia: Lessons learned from Dutch long-term care practice

Most older people with dementia experience neuropsychiatric symptoms (NPSs). Psychotropic drugs are frequently prescribed to treat NPSs despite warnings from guidelines and publicity campaigns. Thus, this thesis aims to explore the patterns of psychotropic drug prescriptions in Dutch long-term care practice over the past decade.

Firstly, we studied the patterns among community-dwelling older people with dementia during the course of dementia and during the COVID-19 pandemic using electronic health records from general practitioners. Additionally, we estimated the patterns among nursing home residents using secondary data from previous trials. Finally, we synthesised evidence for the success of withdrawing psychotropic drugs by introducing a new outcome variable, trial completion.

The prescriptions of antipsychotics and antidepressants in community-dwelling older people with new-onset dementia increased during the five-year follow-up. This increase may prompt general practitioners to reconsider their prescribing habits. Furthermore, the unexpected decrease in psychotropic drug prescriptions during the first two years of the COVID-19 pandemic may reflect the neglect of NPSs during this period. In Dutch nursing homes, there has been a promising decline in antipsychotic prescriptions in recent years, although the prevalence of overall psychotropic drug prescriptions has remained high. Lastly, the synthesis of withdrawal trials indicates that over 80% of older people with dementia can withdraw antipsychotics and anti-dementia drugs within a three-month timeframe.

In conclusion, the findings suggest room for improvement in prescribing practices of psychotropic drugs among both community general practitioners and elderly care physicians in nursing homes.