Trends in psychotropic drug prescribing in Norwegian nursing homes from 1997 to 2009: a comparison of six cohorts

Background: Psychotropic drugs are extensively prescribed for the treatment of neuropsychiatric symptoms, despite modest efficacy and severe side effects.

Aims: We examined trends in psychotropic drug prescribing in Norwegian nursing homes from 1997 to 2009, in order to gain insight in practice development.

Methods: The study is a secondary data analysis of six cross-sectional nursing home studies conducted between 1997 and 2009. Patients aged >65 years were included. We compared the prevalence of psychotropic drugs (antipsychotics, anxiolytics, hypnotics, and antidepressants). Associations between prescription of psychotropics, and patients' age, gender, type of ward, and year of data collection were examined by univariate analysis and logistic regression.

Results: Altogether, 7 661 patients (mean age 85.2 years, 72.6% women) were included. Prevalence of all psychotropic drugs combined increased from 57.6% to 70.5%, anxiolytics from 14.9% to 21.9%, hypnotics from 14.5% to 22.9%, and antidepressants from 31.5% to 50.9%. Prevalence of antipsychotics varied between extremes 21.1% and 25.6%. Less prescribing of older drugs was exceeded by an increase in newer drug types. Concomitant prescribing of two or more psychotropic drugs increased from 21% to 33%. Predictors of psychotropic drugs were female gender (except antipsychotics), as well as age <80 years, and residency in special care units (except hypnotics).

Conclusions: Prescribing of psychotropic drugs in nursing homes has increased considerably, especially regarding antidepressants. Explanations for this trend need to be further explored.