COPH grad studies psychotropic drug use in nursing home residents with dementia

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Dylan Jester, an epidemiologist who received his MPH from the USF College of Public Health (COPH) in the fall, is the lead author of the article “Prevalence of psychotropic polypharmacy in nursing home residents with dementia: A meta-analysis.” 

The article was published in the journal International Psychogeriatrics in January and was co-authored by COPH professor Dr. Janice Zgibor and faculty from USF’s School of Aging Studies, where Jester is pursuing his doctorate. 

“I strongly believe that excellent gerontological research relies on public health principles and methodologies, and that a competent public health system must consider the health and well-being of older adults,” said Jester, who expects to receive his PhD in summer 2021. “My training in epidemiology helps me ask and analyze questions at a population level to make policy and public health recommendations.”

Jester and his colleagues analyzed medication data from 92,370 nursing home residents with dementia living in 12 countries. They found that one in three of these residents are prescribed two or more psychotropic medications, and one in eight are prescribed three or more psychotropic medications. This is known as psychotropic polypharmacy. Psychotropic drugs include antidepressants, anti-anxiety medications, antipsychotics and/or sedative hypnotics.

Jester says he wasn’t so much surprised by the number of psychotropic drugs prescribed but by the lack of research on the topic. 

Photo by Myriam Zilles on Unsplash

Much of the academic literature on medications in nursing home residents with dementia focuses on specific classes of medications—e.g., antipsychotics, sedative-hypnotics. Few have looked at the combinations of these drugs and if specific combinations carry an increased risk of adverse effects, such as falls, stroke, or death,” he noted. “That is where we attempted to fill a gap in the literature and spur future interest. More work is needed to better understand if a ‘substitution effect’ exists, where antipsychotics, for example, are traded out for other medications, and whether this ‘substitution effect’ has an impact on health.”

In addition to more study on how drug combinations and interactions can affect this population, Jester sees the need for the exploration of nonpharmacological treatments of dementia.

“In many cases, these prescriptions are clinically appropriate. Compared to the alternative—which is no medication—they may not present an increased risk to the health and well-being of a resident,” explained Jester. “But another avenue must be prioritizing the use of nonpharmacological treatments—e.g., psychotherapy and adjusting the environment to improve mood and quality of life—when and where appropriate.”

Story by Donna Campisano, USF College of Public Health