Antipsychotic prescribing patterns in a Medicare Advantage population of older individuals with dementia

Abstract

Background: Antipsychotic medications are widely used to treat behavioral symptoms of dementia. However, studies have shown that antipsychotic use in patients with dementia is associated with risk of side effects.

Aims: The aim of this study is to examine antipsychotic prescribing patterns for beneficiaries with dementia enrolled in a Medicare Advantage program and identify opportunities to improve prescribing practices.

Methods: This study includes Medicare Advantage beneficiaries who were 65 years of age or older with dementia. We examined the number of participants that were prescribed an antipsychotic medication. Descriptive analysis was performed, and logistic regression models were used to describe the correlates of antipsychotic exposure.

Results: Of the 8688 individuals in the Medicare Advantage population with a dementia diagnosis, 1061 (12.2%) received an antipsychotic medication. Correlates of receiving an antipsychotic medication included older age, dual eligibility for Medicare and Medicaid, and having a co-morbid diagnosis of depressive disorder or substance use disorder. Being female was associated with decreased antipsychotic medication use. Regional variations were also noted.

Conclusions: Care management programs under Medicare Advantage have opportunities to address behavioral health needs of older adults with dementia and to limit inappropriate use of antipsychotic medications.

Keywords:

• dementia
• antipsychotics
• Medicare
• elderly
• geriatric

Acknowledgements

The authors would like to thank Margaret Spottswood for her thoughtful review of the manuscript, for which no compensation was received.

Declaration of interest

Drs. Kester, Unützer, Hogan, and Huang have no potential conflicts of interest to disclose. Dr. Hogan is employed by Humana Cares, St. Petersburg, FL, USA. This research was supported by the following grants: MH20021-14 and MH0751590. Dr. Huang was supported by the Fulbright Scientific Mobility Scholars Program.