The Inter-relationship Between Psychotropic Use And Health-related Quality Of Life In People Living With Dementia And Their Carers.

• By: LAU, Edward Chun Yin (The University Of Sydney, Australia)
• Co-author(s): Mr Edward Chun Yin Lau (The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia)
  Professor Yun-Hee Jeon (The University of Sydney, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Sydney, Australia)
  Professor Sarah Hilmer (Kolling Institute, The University of Sydney Faculty of Medicine and Health, Northern Clinical School and Royal North Shore Hospital, Sydney, Australia)
  Dr Edwin Tan (The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia)
  
• Abstract:

  Background information: Dementia impacts more than 400,000 people in Australia, with two thirds of individuals residing in the community. People with dementia are high users of medications, including psychotropic medications, and are at a greater risk of adverse drug events. However, there is limited research into psychotropic use and the impact this has on quality of life in people living with dementia and their carers in the community.
  
  Purpose: To investigate (i) the prescribing patterns and risk factors for psychotropic use in people with dementia living in the community and (ii) the inter-relationship between the use of psychotropics and health-related quality of life in people with dementia and their primary carers.
  
  Method: A cross-sectional study using baseline medication data from the Interdisciplinary Home-bAsed Reablement Program (I-HARP) collected between 2018 and 2021 in Sydney, Australia. 130 dyads consisted of people aged over 60 with mild to moderate dementia and their primary carers were recruited from two participating aged care providers and four participating hospital geriatric services in Sydney, Australia. Psychotropic medications were classified according to the Anatomical Therapeutic Chemical (ATC) classification codes (N06A, N05A, N03A, N05B, N05C, N02A). Health related quality of life (HrQoL) of people with dementia and their carers was measured with the weighted EQ5D5L. Logistic regression was used to identify factors associated with use of psychotropics. Analyses were adjusted for age, sex, education, functional ability, physical functioning, dementia severity, depression and carer burden. Furthermore, multilevel modelling was conducted to identify the inter-relationship between the use of psychotropics and HrQoL of people with dementia and their carers, using an actor and partner interdependence model (APIM).
  
  Results: Of the 130 people with dementia included, 43.1% were using at least one psychotropic with 10.7% using two or more. The most commonly used psychotropic classes were antidepressants (33.1%) and antipsychotics (6.9%). Polypharmacy (≥5 medications) was associated with the use of psychotropics (adjusted odds ratio [aOR]: 4.63, 95% confidence interval [CI]:1.93–11.09). People with dementia with a higher education level were less likely to use psychotropics (aOR: 0.36, 95% CI: 0.16–0.81). In the APIM model, the use of psychotropics in people with dementia (b:-0.102, 95% CI: -0.169–-0.034) and their carers (b: -0.084, 95% CI: -0.145–-0.024) was significantly associated with poorer HrQoL in people with dementia; while no statistically significant findings were found on the carer’s HrQoL.
  
  Conclusion: Psychotropics were one of the most commonly used medication classes in people with dementia; the use of psychotropics was associated with a reduced HrQoL. The potential risk and benefits of using psychotropics must be carefully considered before prescribing in people living with dementia. Future longitudinal studies of dyads should be conducted to examine the causal inter-relationship between medication use and HrQoL in both people with dementia and their carers.
  
  Topic area: Social and Administrative Pharmacy Section