Trends in the prescribing of atypical antipsychotics in elderly patients with dementia in Korea

Objective: In 2005, the Food and Drug Administration warned that atypical antipsychotics (AAPs) increased mortality in elderly patients with dementia. We investigated AAP prescribing in elderly patients with dementia in the ambulatory setting in Korea and the factors affecting AAP prescribing in elderly patients with dementia. Methods: Subjects = 65 years of age with at least one diagnosis of dementia (ICD-10: F00-F03, G30, G31.8) from January 1 to December 31, 2013 were identified from a health insurance database. Using multiple logistic regression analysis to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for AAP prescribing in elderly patients with dementia, AAP user prevalence was estimated and presented by dementia type, individual AAP, medical institution, and region. Results: A total of 61,550 elderly patients with dementia were identified: 6,504 (9.8%) received AAPs, 12.3% of them had Alzheimer's disease; only 2 patients with vascular dementia were prescribed AAPs (0.04%). Female patients were less likely to be prescribed AAPs than male patients. The likelihood of AAP prescribing was higher for patients aged 70 years and older than for those < 70 years. AAP prescribing was higher for patients visiting secondary care institutions (OR, 1.12; 95% CI, 1.65 - 1.74) than for those visiting primary care institutions, and for patients in cities (OR, 1.57; 95% CI, 1.52 - 1.62) than for those in metropolitan regions. Conclusions: Although the prevalence of AAP prescribing has decreased, especially among patients with vascular dementia, it remains high. Efforts to reduce AAP use should focus on secondary care institutions in nonmetropolitan regions.