Aims: To compare pre-hospital psychotropic medication prescribing in patients with cognitive impairment admitted to a Specialist Inpatient Dementia Unit (SIDU) in 2017-18 versus 2022-23.
Methods: A single-centre retrospective observational study in a metropolitan Melbourne SIDU, across two 12-month study periods (September 2017 - August 2018 and September 2022 - August 2023). All inpatients aged ≥50 years with cognitive impairment were included (n = 114 and n = 91 respectively). Pre-hospital prescribing of antipsychotics, benzodiazepines, and other psychotropics (composite of antidepressants, cholinesterase inhibitors, memantine, anticonvulsant mood stabilisers, melatonin) were examined. Chlorpromazine and diazepam-equivalent daily doses were calculated. Multivariable logistic regression assessed factors associated with antipsychotic prescribing.
Results: Between 2017-18 and 2022-23, antipsychotic prevalence decreased (34.2% vs. 16.5%), with lower median chlorpromazine-equivalent doses (66.6 mg vs. 25 mg). Benzodiazepine prevalence decreased (28.1% vs. 14.3%), with similar median diazepam-equivalent doses (5.0 mg vs. 5.6 mg). There were fewer admissions from facilities (21.1% vs. 6.6%) and lower dementia prevalence (77.2% vs. 54.9%) in 2022-23 cohort. Antipsychotic use was associated with admission from facilities (adjusted Odds Ratio [aOR] 9.99, 95% confidence interval [CI] 3.79 - 26.33) and dementia (aOR 3.97, 95% CI 1.34 - 11.73), but not admission year (aOR 1.56, 95% CI 0.72 - 3.38). Median length of stay increased in 2022-23 (22 vs. 35 days), independent of antipsychotic exposure.
Conclusions: Pre-hospital antipsychotic and benzodiazepine use declined in 2022-23, with lower antipsychotic doses, no evidence of substitution to other psychotropics, and case-mix differences. Further research is needed to explore the determinants of these trends.