Summary

Data from residents in 109 facilities belonging to six long-term care provider systems were used to compare outcomes between monotherapy and combination therapy in the treatment of agitation in dementia.  Agitation is a common complication of dementia that is often treated with antipsychotics, antidepressants, or antianxiety agents.  However, randomized trials show only modest effect sizes of treatment when compared to placebo and are limited to studies of monotherapy, neglecting the common practice of combining agents from different classes.  We found that combination therapy was associated with better outcomes.

Primary Objective

Compare outcomes between monotherapy and combination therapy for treatment of agitation in dementia in frail LTC residents.

Data were collected on 803 physically frail (at risk for pressure ulcers) older (mean age 82)  residents with dementia complicated by agitation.  Three-month outcomes were compared for hospitalizations, emergency department visits, urinary incontinence, and pressure ulcers.  Multivariate analyses were performed on all data.

Results

1. Combination therapy was used in 42% of residents with agitation in dementia treated with psychiatric medications.

2. Pressure ulcers were common with typical antipsychotic monotherapy (47.7%) or no psychiatric medication (52.1%), compared to combination therapy that included SSRIs (16.8%).

3. Overall, the best outcomes (lowest rates of hospitalizations or emergency department visits, urinary incontinence, and pressure ulcers) were found with combination therapy (SSRIs and antianxiety).
   

Impact

Although contrary to a national guideline, combination therapy was used in 42% of our study population and was associated with better outcomes.  Future randomized trials and practice guidelines should include evaluations of the effectiveness and safety of combination therapy in the treatment of agitation in dementia.