Psychotropic medication co-prescribing to older adults with dementia in Ireland: a retrospective cross-sectional analysis of national prescribing in 2022

Abstract Introduction Behavioural and psychological symptoms of dementia (BPSD) can affect over 90% of people with dementia.[1] While non-pharmacological interventions may improve BPSD, sometimes judicious short-term psychotropic prescribing is justified. To address risks, guidelines on appropriate psychotropic prescribing for BPSD were published in 2019 in the Republic of Ireland,[2] and education around these guidelines commenced in 2023. The rationale for this study was to evaluate baseline trends in psychotropic prescribing for older adults with dementia before implementation of national guidelines, addressing a knowledge gap and facilitating future assessment of effectiveness of the guidelines. Aim To analyse the baseline prescribing trends of co-prescribed psychotropics with anti-dementia drugs in 2022, prior to national guideline implementation. Methods Data were obtained from the Health Service Executive Primary Care Reimbursement Services (HSE-PCRS) General Medical Services (GMS) dispensed data in 2022. The study population was adults aged 80 years and older who experienced co-prescribing, defined as concomitant prescribing of an anti-dementia drug (used as proxy for dementia diagnosis, Anatomic Therapeutic Chemical classification N06D) and any one or more of the following psychotropics: antiepileptics (N03A), antipsychotics (N05A, excluding lithium), benzodiazepines (N05B), hypnotics and sedatives (N05C) and antidepressants (N06A). Analysis was completed using R version 4.5.1. An upset plot was produced using ComplexUpset (Fig. 1). Results Of 12 605 people prescribed an anti-dementia drug in 2022, 63.5% (n = 8004) were prescribed memantine, 40.7% (n = 5136) donepezil, 12.5% (n = 1574) rivastigmine and 2.5% (n = 309) galantamine. Antidepressants were prescribed to 67.8% (n = 8541) of the population, antipsychotics to 51.5% (n = 6488), hypnotics and sedatives to 29.3% (n = 3687), benzodiazepines to 16% (n = 2022), and antiepileptics to 10.5% (n = 1329). The most frequently co-prescribed medication was an antidepressant (24.9%, n = 3137), followed by both an antidepressant and an antipsychotic (15.0%, n = 1888), then an antipsychotic only (14.0%, n = 1770). Conclusion This first investigation of co-prescribing of anti-dementia drugs with psychotropics in Ireland using dispensing data offers new information on the breadth of psychotropic co-prescribing. Strengths include analysis of a large representative database. Limitations include lack of comorbidity data. Future work will involve comparison with figures post-implementation of National Clinical Guidelines, with the implication of assessing their success in improving psychotropic prescribing practices.