National Estimates of Prevalence and Patterns of Psychotropic Polypharmacy Among Elderly Individuals with Parkinson's Disease in Nursing Home and Home Healthcare Settings in the United States.

PND11 NatioNal estimates of PrevaleNce aND PatterNs of PsycHotroPic PolyPHarmacy amoNg elDerly iNDiviDuals witH ParkiNsoN’s Disease iN NursiNg Home aND Home HealtHcare settiNgs iN tHe uNiteD states Bhattacharjee S, Goldstone L, Warholak T The University of Arizona, Tucson, AZ, USA Objectives: Some elderly individuals with Parkinson’s disease (PD) may suffer from more than one psychiatric comorbidity, which necessitates the use of concurrent psychotropic medications. To the best of the author’s knowledge there are no nationally representative estimates of psychotropic polypharmacy among elderly individuals with PD in the United States. Therefore, the primary objective of this study was to examine the prevalence and patterns of psychotropic polypharmacy among elderly individuals with PD. MethOds: A retrospective, cross-sectional study design with 2004 National Nursing Home Survey (NNHS) and 2007 National Home and Hospice Care Survey (NHHCS) data was used. The analytic sample included elderly (age ≥ 65 years) individuals with PD (identified by ICD-9-CM code of 332.xx). Antidepressants, antipsychotics, sedative/hypnotics, and anti-anxiety medications constituted the psychotropic medication classes. Concurrent use of two or more psychotropic medications was classified as psychotropic polypharmacy. National estimates of psychotropic medication use were obtained by using SAS survey procedures. Results: National estimate of approximately 93,648 [95% Confidence Interval (CI), 86535 – 100,761] and 37,439 (95% CI, 25,910 – 48,968) elderly individuals with PD resided in nursing homes and home health settings respectively. Among elderly nursing home residents with PD, the nationally representative prevalence of psychotropic polypharmacy was 26.28% (95% CI, 22.81% – 29.75%), whereas, it was 21.36% (95% CI, 8.12% – 34.6%) in the home health setting. Use of antidepressant medications constituted the majority of the psychotropic medication use among both nursing home (48.91%, 95% CI, 44.9% – 52.8%) and home health (40.98%, 95% CI, 25.37% 56.61%) residents with PD. Nearly one-third (31.26%, 95% CI, 27.6% 34.9%) nursing home residents with PD were prescribed antipsychotic medications among whom less than one-fourth had a documented psychotic diagnosis. cOnclusiOns: These findings underscore the importance of evidence-based prescribing when psychotropic medications are used in elderly individuals with PD to reduce unnecessary polypharmacy.