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Patient characteristics and treatment choice in a 65‐84 vs a ≥85 year old population with dementia‐related psychosis: Results from a secondary data claims study
Author(s) -
Ramos Brett A.,
Whitford Alex,
Brain Cecilia
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.047137
Subject(s) - dementia , psychosis , medicine , psychiatry , population , polypharmacy , medical prescription , pediatrics , disease , environmental health , pharmacology
Background Dementia affects approximately 8 million people in the US and about 2.4 million experience dementia‐related psychosis, i.e. hallucinations and delusions, 1‐15 for which there is no approved treatment. Antipsychotics (APs) are routinely used “off‐label” and carry a box warning as they have been shown to increase the mortality risk in dementia 16Method Criteria for identifying patients with dementia‐related psychosis leveraged the Anonymized Patient Level Data from IBM Truven, a widely utilized claims database, was evaluated for either 2+ ICD 9/10 diagnosis (Dx) OR 2+ prescriptions (Rx) related to Dementia AND Psychosis AND 1+ Dx for Dementia before the first psychosis Dx or Rx. Patients were then excluded based on 2+ Dx on the ICD excluded list (schizophrenia, bipolar, manic). Continuous enrollment criteria were applied in the 2 year washout period and index year within a 5 year study period. The patients were segmented based on age groups and key metrics were investigated to categorize the differences between the two age groups. Result The age group of ≥ 85 compared to the 65‐75 group, ran a significantly higher risk of cardiovascular disease, receiving APs, anti‐hypertensives, hypothyroid and diuretic drugs, despite fewer consultations with medical specialists (including psychiatrists); less brain imaging and fewer neurological diagnostics or hospitalizations yet they ran a higher risk of being admitted to inpatient ER, short‐term skilled nursing facilities and being transitioned to Long‐Term Care (LTC). Conclusion The ≥ 85 age group with dementia‐related psychosis were shown to have a higher comorbid disease burden and, despite an increased mortality risk in this vulnerable population, an even higher off‐label AP use compared to the 65‐75 year old group. Further studies are needed to explore the risks of AP use in this potentially sensitive elderly population of dementia‐related psychosis.