Trends in the use of psychotropics in older people with dementia: interrupted time series of Finnish clinical guidelines of behavioural and psychological symptoms of dementia

BACKGROUND: Up to 90% of people with dementia experience behavioural and psychological symptoms of dementia (BPSD) as part of their illness. Psychotropics are not recommended as the first-line treatment of BPSD because older people are more prone to adverse reactions. In this study, we evaluate the impact of the Finnish clinical guidelines of BPSD (published in 2017) on psychotropic use in people with dementia. METHODS: This study is based on Finnish Prescription Register data from 2009 to 2020. The data included all community-dwelling Finnish people aged ≥65 and who had anti-dementia medication purchases (n = 217,778). We used three-phased interrupted time series design to evaluate the changes in levels and trends of monthly (n = 144) psychotropic user rates compared with the predicted trends. In addition, we evaluated the changes in levels and trends of monthly new psychotropic user rates. RESULTS: The level of monthly psychotropic user rate decreased non-significantly during the intervention period (β −0.057, P = 0.853), and during the post-intervention period, there was an increase in the level (β 0.443, P = 0.091) and slope (β 0.199, P = 0.198), but not statistically significant. The level of monthly new psychotropic user rate (β −0.009, P = 0.949) during the intervention period and the level (β 0.044, P = 0.714) and slope (β 0.021, P = 0.705) during the post-intervention period were almost unchanged. CONCLUSIONS: Results may indicate possible challenges in deprescribing and better adherence to the guidelines at the beginning of BPSD treatment. Further research into the barriers to implement BPSD guidelines and the availability of non-pharmacological treatments is needed.