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Antidopaminergic‐Antiparkinsonian Medication Prescribing Cascade in Persons with Alzheimer's Disease
Author(s) -
Singh Sonal,
Cocoros Noelle M.,
Haynes Kevin,
Nair Vinit P.,
Harkins Thomas P.,
Rochon Paula A.,
Platt Richard,
Dashevsky Inna,
Reynolds Juliane,
Mazor Kathleen M.,
Bloomstone Sarah,
Anzuoni Kathryn,
Crawford Sybil L.,
Gurwitz Jerry H.
Publication year - 2021
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.17013
Subject(s) - medicine , cohort , polypharmacy , metoclopramide , pharmacy , antipsychotic , disease , cohort study , pediatrics , psychiatry , schizophrenia (object oriented programming) , family medicine , vomiting
Objectives Persons living with Alzheimer's disease (AD) may be at increased risk for prescribing cascades due to greater multimorbidity, polypharmacy, and the need for more complex care. Our objective was to assess the proportion of the antidopaminergic‐antiparkinsonian medication prescribing cascades among persons living with Alzheimer's disease. Setting Two large administrative claims databases in the United States. Participants We identified patients aged ≥50 on January 1, 2017, who were dispensed a drug used to treat Alzheimer's disease for at least 1 day in the 365 days prior to or on cohort entry date and who had medical and pharmacy coverage in the 365 days prior to the cohort entry date. We excluded individuals with a recent institutional stay. We identified incident antidopaminergic (antipsychotic/metoclopramide) use in the 183 days following cohort entry and identified subsequent incident antiparkinsonian drug use within 8 to 365 days. Results There were 121,538 patients with Alzheimer's disease eligible for inclusion. Approximately 62% were women with a mean age of 79.5 (SD ± 8.6). The mean number of drugs dispensed was 9.2 (SD ± 4.9). There were 36 incident antiparkinsonian users among 4,534 incident antipsychotic/metoclopramide users (0.8%). Conclusion We determined that the proportion of antidopaminergic‐antiparkinsonian medication prescribing cascades, widely considered as high‐priority, was low. Our approach can be used to assess the proportion of prescribing cascades in populations considered to be at high risk and to prioritize system‐level interventional efforts to improve medication safety in these patients.