Queen's University Belfast

Academic Institute

Catherine Jane Sinnamon

E078

Dementia affects a person’s memory, thinking and social abilities which impacts their ability to carry out day-to-day activities. It is associated with age and as the proportion of older people increases, the prevalence of dementia is also projected to increase. Dementia therefore presents a significant challenge to our health and social care system. Many people living with dementia experience ‘non-cognitive symptoms’, the most common being anxiety and depression, which often lead to changes in behaviour. The management of non-cognitive symptoms like these can be challenging for patients, their carers and healthcare professionals. Studies have reported that prescribing of medications for depression and anxiety (known as antidepressant and anxiolytic medications) is common amongst people with dementia, despite there being limited evidence and guidance to support their use. Further research is needed to provide up-to-date information about prescribing of these medications for people with dementia in Northern Ireland before we can try to improve management of these symptoms. The aim of this study is to look at what antidepressant and anxiolytic medications are used by people with dementia, who are being prescribed for by a general practitioner (GP). This information will be taken from a database which holds information on all prescriptions that are dispensed by community pharmacists in Northern Ireland. We will look at the types of antidepressant and anxiolytic medications that are being prescribed and we will use information from other linked databases to help us assess if prescribing of these medications is associated with an increased risk of death. We hope that the findings from this study will improve the quality of information about prescribing of antidepressant and anxiolytic medications for people with dementia, and will help patients, their families and healthcare professionals make better choices.

The healthcare sector and in particular, primary care, has an important role in the provision of care and support for PwD and their carers. Up to 96% of patients with confirmed or suspected dementia are reported to receive their diagnosis in a primary care setting, with two-thirds of patients subsequently referred for specialist assessment. Many people with dementia experience non-cognitive symptoms, the most clinically significant being anxiety and depression, which often lead to changes in behaviour. Whilst cognitive symptoms associated with dementia are well understood, the management of non-cognitive symptoms present more of a challenge. Systematic reviews have concluded that although depression is common in PwD and many patients are prescribed antidepressants, there is limited evidence to support the efficacy of antidepressants for the treatment of depression in PwD. Anxiolytics are also widely prescribed, yet there is a lack of guidance and recommendations related to diagnosis and treatment of anxiety in PwD. Recent research conducted in NI has shown that PwD were more likely to receive antidepressants and anxiolytics than those without dementia. This observed variation between populations with and without dementia raises questions for future research with respect to ensuring optimal management of anxiety and depression in PwD. Dementia is a recognised cause of mortality and as the prevalence of dementia increases, the need for a greater understanding of the factors that influence mortality in PwD (such as medication use) becomes more important. This study will provide useful information about prescribing patterns in this patient population, which may help to optimise future prescribing, will add to the evidence base in this area, and may help to inform the future development of interventions to improve the management of depression and anxiety in PwD in primary care in NI.

13/09/2022

TRE