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Change in sedative burden after dementia onset using difference-in-difference estimations
BACKGROUND: Sedative agents are avoided in older adults because of potential risks including cognitive impairment, fall, frailty, and mortality. However, no studies addressing both prediagnostic and postdiagnostic period of dementia have evaluated sedative agent usage over an extended period. OBJECT...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677315/ https://www.ncbi.nlm.nih.gov/pubmed/31374112 http://dx.doi.org/10.1371/journal.pone.0220582 |
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author | Ah, Young-Mi Han, Euna Jun, Kwanghee Yu, Yun Mi Lee, Ju-Yeun |
author_facet | Ah, Young-Mi Han, Euna Jun, Kwanghee Yu, Yun Mi Lee, Ju-Yeun |
author_sort | Ah, Young-Mi |
collection | PubMed |
description | BACKGROUND: Sedative agents are avoided in older adults because of potential risks including cognitive impairment, fall, frailty, and mortality. However, no studies addressing both prediagnostic and postdiagnostic period of dementia have evaluated sedative agent usage over an extended period. OBJECTIVES: To describe a longitudinal change in sedative medication use before and after the diagnosis with dementia over 10 years compared to patients without dementia. METHODS: We conducted a retrospective cohort study using longitudinal claims data for senior national health insurance beneficiaries. After 1:4 propensity score matching, 54,165 older patients (≥60 years) were included. Difference-in-difference (DID) of sedative burden and use of sedative agents pre- and post-dementia diagnosis were estimated, and compared to those of patients without dementia. The yearly average daily sedative load (adSL) for each individual was calculated after applying duration, dose, and sedative score of medications from the sedative load model. The medication use for each sedative category was calculated using the defined daily dose (DDD) per 1000 patient-days. RESULTS: The adSL in patients with dementia was consistently high before and after diagnosis and significantly increased after diagnosis, compared to those of patients without dementia (DID 0.123 unit/day, 95% confidence interval 0.117–0.129). DID of medication use was the highest for antidepressants (64.764 DDD/1000 patient-days) followed by Z-drugs and antipsychotics. Atypical antipsychotic and antidepressant usage steeply increased after dementia diagnosis. CONCLUSION: Sedative burden in patients with dementia before and after dementia diagnosis was higher than that in patients without dementia, and was further increased after dementia diagnosis. |
format | Online Article Text |
id | pubmed-6677315 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-66773152019-08-06 Change in sedative burden after dementia onset using difference-in-difference estimations Ah, Young-Mi Han, Euna Jun, Kwanghee Yu, Yun Mi Lee, Ju-Yeun PLoS One Research Article BACKGROUND: Sedative agents are avoided in older adults because of potential risks including cognitive impairment, fall, frailty, and mortality. However, no studies addressing both prediagnostic and postdiagnostic period of dementia have evaluated sedative agent usage over an extended period. OBJECTIVES: To describe a longitudinal change in sedative medication use before and after the diagnosis with dementia over 10 years compared to patients without dementia. METHODS: We conducted a retrospective cohort study using longitudinal claims data for senior national health insurance beneficiaries. After 1:4 propensity score matching, 54,165 older patients (≥60 years) were included. Difference-in-difference (DID) of sedative burden and use of sedative agents pre- and post-dementia diagnosis were estimated, and compared to those of patients without dementia. The yearly average daily sedative load (adSL) for each individual was calculated after applying duration, dose, and sedative score of medications from the sedative load model. The medication use for each sedative category was calculated using the defined daily dose (DDD) per 1000 patient-days. RESULTS: The adSL in patients with dementia was consistently high before and after diagnosis and significantly increased after diagnosis, compared to those of patients without dementia (DID 0.123 unit/day, 95% confidence interval 0.117–0.129). DID of medication use was the highest for antidepressants (64.764 DDD/1000 patient-days) followed by Z-drugs and antipsychotics. Atypical antipsychotic and antidepressant usage steeply increased after dementia diagnosis. CONCLUSION: Sedative burden in patients with dementia before and after dementia diagnosis was higher than that in patients without dementia, and was further increased after dementia diagnosis. Public Library of Science 2019-08-02 /pmc/articles/PMC6677315/ /pubmed/31374112 http://dx.doi.org/10.1371/journal.pone.0220582 Text en © 2019 Ah et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Ah, Young-Mi Han, Euna Jun, Kwanghee Yu, Yun Mi Lee, Ju-Yeun Change in sedative burden after dementia onset using difference-in-difference estimations |
title | Change in sedative burden after dementia onset using difference-in-difference estimations |
title_full | Change in sedative burden after dementia onset using difference-in-difference estimations |
title_fullStr | Change in sedative burden after dementia onset using difference-in-difference estimations |
title_full_unstemmed | Change in sedative burden after dementia onset using difference-in-difference estimations |
title_short | Change in sedative burden after dementia onset using difference-in-difference estimations |
title_sort | change in sedative burden after dementia onset using difference-in-difference estimations |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677315/ https://www.ncbi.nlm.nih.gov/pubmed/31374112 http://dx.doi.org/10.1371/journal.pone.0220582 |
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