Objective: to compare psychotropic prescribing in older people with dementia and the general elderly population.
Design and setting: retrospective population database study in 315 General Practices.
Subjects: there were 271,365 patients aged > or = 65, of which 10,058 (3.7%) recorded as having dementia.
Methods: epidemiology of psychotropic prescribing in older people with and without dementia; multilevel modelling of patient and practice characteristics associated with antipsychotic prescribing.
Results: people with dementia were currently prescribed an antipsychotic drug (17.7%), an antidepressant (28.7%) and a hypnotic/anxiolytic (16.7%). Compared to the general elderly population, antipsychotic prescribing was 17.4 [95% confidence interval (CI) 16.4-18.4], antidepressant prescribing 2.7 (95% CI 2.6-1.8) and hypnotic/anxiolytics 2.2 (95% 2.1-2.3) times more likely in people with dementia. Most antipsychotic prescribing in people with dementia was prolonged (> 16 weeks). Patients living in more deprived areas and registered with larger and more remote practices were more likely to be prescribed prolonged antipsychotics.
Conclusions: over one in six patients are currently prescribed antipsychotic drugs known to be of little benefit and causing significant harm, with other psychotropics equally commonly used. Changing this will require investment in services to support alternative management strategies for people with behavioural and psychological disturbance associated with dementia.