Effects of a Multidisciplinary Intervention on the Presence of Neuropsychiatric Symptoms and Psychotropic Drug Use in Nursing Home Residents WithYoung-Onset Dementia: Behavior and Evolution of Young-Onset Dementia Part 2 (BEYOND-II) Study

ABSTRACTBackground:Young-onset dementia (YOD) is defined as dementia that develops before the age of 65 years. The prevalence and type of neuropsychiatric symptoms (NPS) in YOD differ from patients with late onset dementia. NPS in dementia patients are often treated with psychotropic drugs. The aim of this study was to investigate psychotropic drug use (PDU) in Dutch community-dwelling YOD patients and the association between age, gender, dementia etiology and severity, symptoms of depression, disease awareness, unmet needs, and type of NPS.Methods:Psychotropic drug use in 196 YOD patients was registered. Drugs were categorized according to the Anatomical Therapeutical Chemical classification. The association between age, gender, dementia type, dementia stage, type of NPS, depressive symptoms, disease awareness, and amount of unmet needs on total PDU was analyzed using binomial logistic regression analysis.Results:Fifty-two percent of the patients were prescribed at least one psychotropic drug; 36.2% of patients used one drug, and 12.2% used two different drugs. Antidepressants (36.2%) and antipsychotic drugs (17.3%) were the most frequently prescribed psychotropic drugs. Anti-dementia drugs were prescribed in 51.5% of the patients. Increasing age and moderate to severe depressive symptoms were positively associated with the total use of psychotropic drugs.Conclusions:Community-dwelling YOD patients have a high prevalence of PDU. More research is needed to study the association between unmet needs, NPS, and PDU, and psychosocial interventions have to be developed to limit the use of psychotropic drugs in YOD.

Download Full-text

Differences in neuropsychiatric symptoms between nursing home residents with young-onset dementia and late-onset dementia

Aging & Mental Health ◽

10.1080/13607863.2018.1428935 ◽

2018 ◽

Vol 23 (5) ◽

pp. 581-586 ◽

Cited By ~ 5

Author(s):

Britt Appelhof ◽

Christian Bakker ◽

Jeannette C. L. Van Duinen-van Den IJssel ◽

Sandra A. Zwijsen ◽

Martin Smalbrugge ◽

...

Keyword(s):

Nursing Home ◽

Late Onset ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents ◽

Young Onset ◽

Young Onset Dementia ◽

Late Onset Dementia

Download Full-text

The Determinants of Quality of Life of Nursing Home Residents with Young-Onset Dementia and the Differences between Dementia Subtypes

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000477087 ◽

2017 ◽

Vol 43 (5-6) ◽

pp. 320-329 ◽

Cited By ~ 18

Author(s):

Britt Appelhof ◽

Christian Bakker ◽

Jeannette C.L. Van Duinen-van den Ijssel ◽

Sandra A. Zwijsen ◽

Martin Smalbrugge ◽

...

Keyword(s):

Quality Of Life ◽

Nursing Home ◽

Frontotemporal Dementia ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents ◽

Young Onset ◽

Alzheimer Dementia ◽

Young Onset Dementia ◽

Dementia Subtype

Aims: The aims of this study are to (1) explore the determinants of quality of life (QoL) in nursing home residents with young-onset dementia (YOD), (2) investigate whether there are differences between dementia subtypes (Alzheimer dementia, vascular/mixed dementia, frontotemporal dementia, other) regarding these determinants, and (3) compare QoL profiles of YOD nursing home residents across dementia subtypes. Methods: This cross-sectional study included 207 nursing home residents. Multilevel modeling was used to determine the relationships between QoL and neuropsychiatric symptoms (NPS), dementia severity, psychotropic drug use (PDU), dementia subtype, age, and gender. Additional multilevel models were used to compare aspects of QoL between dementia subtypes. Results: Residents' QoL was negatively associated with advanced dementia, PDU, and NPS. In general, the relationships between the determinants and QoL were similar across the dementia subtypes. Aspects of QoL differed by dementia subtype. Residents with frontotemporal dementia showed less negative emotions, accepted more help and experienced better quality of relationships with professional caregivers, had a more positive self-image, felt more comfortable in the nursing home environment, and experienced lower quality of social relationships. Conclusions: Considering the high rates of NPS and PDU in YOD residents and their negative associations with QoL, we recommend emphasizing services to manage and reduce NPS and PDU in nursing home residents with YOD. Furthermore, our findings suggest accounting for differences in aspects of QoL by dementia subtype to address specific needs and thereby improve QoL.

Download Full-text

Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-study

International Psychogeriatrics ◽

10.1017/s104161021600082x ◽

2016 ◽

Vol 28 (10) ◽

pp. 1589-1595 ◽

Cited By ~ 30

Author(s):

Klaas van der Spek ◽

Debby L. Gerritsen ◽

Martin Smalbrugge ◽

Marjorie H. J. M. G. Nelissen-Vrancken ◽

Roland B. Wetzels ◽

...

Keyword(s):

Nursing Home ◽

Drug Use ◽

Psychotropic Drug ◽

Neuropsychiatric Symptoms ◽

Cross Sectional Study ◽

Cross Sectional ◽

Inappropriate Use ◽

Psychotropic Drug Use ◽

Nursing Home Patients ◽

Sum Score

ABSTRACTBackground:This study explores the appropriateness of psychotropic drug (PD) use for neuropsychiatric symptoms (NPS) in nursing home patients with dementia.Methods:A cross-sectional study on 559 patients with dementia residing on dementia special care units in Dutch nursing homes was conducted. Appropriateness of PD use was assessed using the Appropriate Psychotropic drug use In Dementia (APID) index. The APID index score is calculated using information about individual PDs from patients’ medical records. The index encompasses seven (different) domains of appropriateness, i.e. indication, evaluation, dosage, drug-drug interactions, drug-disease interactions, duplications, and therapy duration.Results:A total of 578 PDs were used for NPS by 60% of the nursing home patients. Indication, evaluation, and therapy duration contributed the most to inappropriate use. Ten per cent of the PDs scored fully appropriate according to the APID index sum score, 36% scored fully appropriate for indication, 46% scored fully appropriate for evaluation, and 58% scored fully appropriate for therapy duration. Antidepressants were used the most appropriately, and antiepileptics the most inappropriately.Conclusions:The minority of the PD use was fully appropriate. The results imply that PD use for NPS in dementia can be improved; the appropriateness should be optimized with a clinical focus on the appropriate indications, evaluations, and therapy duration.

Download Full-text

Psychotropic drug use in community-dwelling people with young-onset dementia: two-year course and determinants

Aging & Mental Health ◽

10.1080/13607863.2019.1691145 ◽

2019 ◽

Vol 25 (1) ◽

pp. 179-186

Author(s):

Adrie A. J. Gerritsen ◽

Christian Bakker ◽

Esther Bruls ◽

Frans R. J. Verhey ◽

Yolande A. L. Pijnenburg ◽

...

Keyword(s):

Drug Use ◽

Psychotropic Drug ◽

Community Dwelling ◽

Young Onset ◽

Psychotropic Drug Use ◽

Young Onset Dementia

Download Full-text

Process evaluation of a tailored intervention to Reduce Inappropriate psychotropic Drug use in nursing home residents with dementia

BMC Geriatrics ◽

10.1186/s12877-021-02357-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Claudia M. Groot Kormelinck ◽

Charlotte F. van Teunenbroek ◽

Sytse U. Zuidema ◽

Martin Smalbrugge ◽

Debby L. Gerritsen

Keyword(s):

Nursing Home ◽

Drug Use ◽

Nursing Homes ◽

Process Evaluation ◽

Psychotropic Drug ◽

Readiness To Change ◽

Nursing Home Residents ◽

Barriers And Facilitators ◽

Psychotropic Drug Use ◽

Barriers To Implementation

Abstract Background Research suggests that collaborative and tailored approaches with external expertise are important to process implementations. We therefore performed a process evaluation of an intervention using participatory action research, tailored information provision, and external coaching to reduce inappropriate psychotropic drug use among nursing home residents with dementia. The process evaluation was conducted alongside a randomized controlled trial assessing the utility of this approach. Methods We used Leontjevas’ model of process evaluation to guide data collection and analysis, focusing on the relevance and feasibility, extent of performance, and barriers and facilitators to implementation. Data on the relevance and feasibility and on the extent of performance were collected using a questionnaire targeting internal project leaders at nursing homes and our external coaches. Implementation barriers and facilitators were identified by individual semi-structured interviews. The Consolidated Framework for Implementation Research was used to structure and describe the identified barriers and facilitators. Results The intervention was viewed positively, but it was also considered time consuming due to the involvement of many people and designing a tailored action and implementation plan was viewed as complex. The extent of performance differed between nursing homes. Delays in implementation and suboptimal execution of actions may have reduced effectiveness of the RID intervention in some nursing homes. Barriers to implementation were reorganizations, staff turnover, communication issues, unclear expectations, and perceived time pressures. Implementation also depended on the involvement and skills of key stakeholders, and organizations’ readiness to change. Although external coaches stimulated implementation, their additional value was rated variably across organizations. Conclusions Barriers to implementation occurred on several levels and some barriers appear to be inherent to the nursing home environment and could be points of leverage of future implementation trajectories. This underlines the importance of assessing and supporting organizations in their readiness to change. Sensitivity analyses, taking into account the week in which nursing homes started with implementation and the degree to which actions were implemented as intended, will be appropriate in the effect analyses of the trial.

Download Full-text

Psychotropic drug use reduced in US nursing-home residents

PharmacoEconomics & Outcomes News ◽

10.1007/bf03275608 ◽

2000 ◽

Vol 286 (1) ◽

pp. 8-8

Keyword(s):

Nursing Home ◽

Drug Use ◽

Psychotropic Drug ◽

Nursing Home Residents ◽

Psychotropic Drug Use

Download Full-text

Reducing inappropriate psychotropic drug use in nursing home residents with dementia: protocol for participatory action research in a stepped-wedge cluster randomized trial

BMC Psychiatry ◽

10.1186/s12888-019-2291-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Claudia M. Groot Kormelinck ◽

Charlotte F. van Teunenbroek ◽

Boudewijn J. Kollen ◽

Margreet Reitsma ◽

Debby L. Gerritsen ◽

...

Keyword(s):

Nursing Home ◽

Drug Use ◽

Nursing Homes ◽

Participatory Action Research ◽

Psychotropic Drug ◽

Neuropsychiatric Symptoms ◽

Nursing Home Residents ◽

Drug Prescribing ◽

Tailored Intervention ◽

Participatory Action

Abstract Background Psychotropic drugs are often prescribed to treat neuropsychiatric symptoms in nursing home residents with dementia, despite having limited efficacy and considerable side effects. To reduce the inappropriate prescribing of these psychotropic drugs, various non-pharmacological, psychosocial, person-centered, or multidisciplinary interventions are advocated. However, existing multidisciplinary interventions have shown variable effects, with limited effectiveness often resulting from suboptimal implementation. We hypothesize that an effective intervention needs to fit the local situation of a nursing home and that support should be offered during implementation. Methods We will embed participatory action research within a stepped-wedge cluster randomized controlled trial to study the effects of a tailored intervention and implementation plan to reduce inappropriate psychotropic drug prescribing. Nursing homes will be provided with tailored information about the perceived problems of managing neuropsychiatric symptoms and we will offer coaching support throughout. Alongside the participatory action research, we will perform a process evaluation to examine the quality of the study, the intervention, and the implementation. Our aim is to recruit 600 residents from 16 nursing homes throughout the Netherlands, with measurements taken at baseline, 8 months, and 16 months. Nursing homes will be randomly allocated to an intervention or a deferred intervention group. During each intervention stage, we will provide information about inappropriate psychotropic drug prescribing, neuropsychiatric symptoms, and difficulties in managing neuropsychiatric symptoms through collaboration with each nursing home. After this, a tailored intervention and implementation plan will be written and implemented, guided by a coach. The primary outcome will be the reduction of inappropriate prescribing, as measured by the Appropriate Psychotropic drug use In Dementia index. Secondary outcomes will be the frequency of psychotropic drug use and neuropsychiatric symptoms, plus quality of life. A mixed methods design will be used for the process evaluation. Effects will be assessed using multilevel analyses. The project leader of the nursing home and the coach will complete questionnaires and in-depth interviews. Discussion We anticipate that the proposed tailored intervention with coaching will reduce inappropriate psychotropic drug prescribing for nursing home residents with neuropsychiatric symptoms. This study should also provide insights into the barriers to, and facilitators of, implementation. Trial registration NTR5872, registered on July 2, 2016.

Download Full-text