Trends in psychotropic drug use in nursing home residents with dementia and their association with regulatory changes: A routine care data analysis from 2016 to 2023
Charlotte A. W. Albers, Fenne Wouters, Martine C. de Bruijne, Martin Smalbrugge, Karlijn J. JolingIntroduction
Non-pharmacological interventions are the first-choice treatment for managing neuropsychiatric symptoms in nursing home (NH) residents with dementia, yet psychotropic drugs (PDs) are frequently prescribed despite their limited effectiveness. In the current century, policies in various countries have increasingly emphasized the need for restraint in prescribing PDs, partly through amendments to guidelines and legislation. In the Netherlands, regulatory changes included the 2018 revision of the guideline for challenging behavior, the introduction of the Care and Coercion Act (CCA), and a new Dementia Care Standard in 2020. This study examined the prevalence of PD prescriptions (PDPs) from 2016 to 2023 among residents with dementia in Dutch NHs, and the course of the PDP trend in the context of regulatory changes, using routine care data.
Methods
We analyzed routine care data from 11 NH organizations. Quarterly point prevalences were calculated for any PDP and five PD categories separately (antipsychotics, anxiolytics, hypnotics, antidepressants, anti-dementia drugs). We calculated confidence intervals to indicate temporal changes in PDP prevalence and assess the relationship with different reforms. We used interrupted time series (ITS) analysis to explore the association between regulatory changes and the PDP trend.
Results
Data from 17,738 residents showed an overall decline in PDP prevalence from 48.3% in 2016 to 42.7% in 2023. Antidepressants and antipsychotics were the most frequently prescribed PDs. Antidepressants showed the largest absolute prevalence decline over time. Anti-dementia drugs showed the greatest relative decline. ITS showed a steeper declining trend after the combined introduction of the CCA and Dementia Care Standard in the second quarter of 2020, compared with the period after the guideline revision in 2018.
Discussion
The PDP rate decreased over time but was still substantial. Regulatory changes, including new legislation and (clinical) guidelines, appear to have contributed to a further decline from Q2 2020 onwards. This decline suggests that policy and guideline interventions may meaningfully influence prescribing behavior, offering a promising lever for reducing potentially inappropriate psychotropic use in dementia care. Insight into the appropriateness of prescribing practices is essential to identify areas for further improvement.