Older adults with Alzheimer disease, comorbid arthritis and prescription of psychotropic medications

OBJECTIVES: It is assumed that analgesia is underutilized among those with Alzheimer disease and that these patients may be inappropriately prescribed neuroleptics and benzodiazepines. The current study examines this assertion. DESIGN: For this study, prescription levels of analgesics and psychotropic medications for Alzheimer disease patients with (n=245) and without (n=215) musculoskeletal conditions (ie, arthritis or rheumatism) are compared. SETTING: A national sample of community dwelling and institutionalized older adults was identified from the Canadian Study of Health and Aging* (CSHA). PARTICIPANTS: Persons from 36 cities and surrounding rural areas over 64 years of age were randomly identified for the CSHA from government health records in all but one province. MEASUREMENTS: Prescribed analgesic and psychotropic medications were examined, as well as dementia severity and dementia related behavioural disturbance. RESULTS: Less than half of Alzheimer patients with arthritis or rheumatism were treated for pain (ie, 109 of 245 patients); they were also more likely to be prescribed benzodiazepines compared with Alzheimer patients without musculoskeletal conditions (subsequent to initial consideration for analgesia, dementia severity and dementia-related behaviours; Δχ²[Δdf = 1] =3.97, P=0.046). CONCLUSIONS: These findings are in accord with prior research attesting to the undertreatment of pain among older adults. These results can be generalized with greater confidence, given the random composition of the patient sample.