Dementia management programme in a community setting and the use of psychotropic drugs in the elderly population

Abstract

Background and objective. The number of elderly persons in society is increasing, placing additional demands on the public health system. Extensive use of drugs is common in the elderly, and in patients with dementia this further increases their vulnerability. Since 1998 the municipality of Kalmar, Sweden, has worked with a dementia management programme that focuses on early intervention in order to identify the patient's help needs at an early stage. An important part of the programme aims at optimizing pharmacological treatment. The objective of the present study is to evaluate whether the dementia programme had a secondary effect on the use of psychotropic medication in the elderly population in general. Design and setting. A retrospective, drug utilization study analysing the use of selected drug categories by the elderly (75 years and older) in the Kalmar municipality compared with the whole of Sweden. Results and conclusions. The results suggest that the dementia programme contributed to an improvement in psychotropic drug use in the elderly as a secondary effect. Furthermore, the implementation of this programme did not require allocation of extra funding.

Key Words::

• Alzheimer's disease
• dementia
• dementia nurse
• disease management programme
• drug monitoring
• general practitioner
• health economics

Acknowledgements

Many thanks are offered to all patients and primary care staff in the Kalmar Municipality. Special thanks go to Maud Löfström, Margareta Johansson, Kristian Aranäs, Anneli Adolfsson, Marianne Jakobsson, Helen Holmström Ann-Christen Arvidsson, Katarina Jervelind, Janet Mosén, Lena Rundgren, Thomas Johansson, and Gunvor Adolfsson. Statistical support and advice from Gunnar Edman. Finally, the authors would like to thank Gunilla Johansson and Roberta Boson for linguistic support.

Ethical approval

The study was approved by the Ethical Committees at Linköping University (Dnr. 03-494) and Karolinska Institutet, Stockholm (Dnr 2006/948-31).

Funding

The Swedish Alzheimer Association and the Foundation for the Memory of Ragnhild and Einar Lundströms.

Potential conflict of interests

The main author, E. Jedenius, is also medical adviser at Janssen Pharmaceutica in Sweden.