Prescribing pattern of psychotropic drugs in nursing home residents with dementia

2011 ◽  
Vol 23 (8) ◽  
pp. 1249-1259 ◽  
Author(s):  
R. B. Wetzels ◽  
S. U. Zuidema ◽  
J. F. M. de Jonghe ◽  
F. R. J. Verhey ◽  
R. T. C. M. Koopmans
Keyword(s):  
Nursing Home ◽  
Psychotropic Drug ◽  
Anatomical Therapeutic Chemical ◽  
Neuropsychiatric Symptoms ◽  
Nursing Home Residents ◽  
Severe Dementia ◽  
Prescribing Pattern ◽  
Antidementia Drugs ◽  
Utilization Patterns ◽  
To Receive

ABSTRACTBackground: The goal of this study is to determine patterns of psychotropic drug use (PDU), the association with neuropsychiatric symptoms (NPS), and the variability across dementia types in nursing home residents with dementia. In addition, PDU was analyzed across multiple indications.Methods: This was a prospective cohort study over a two-year period from 2006 to 2008, which involved 14 dementia special care units in nine nursing homes. A total of 117 residents with dementia participated in the study, of whom 35% had Alzheimer's dementia (AD) and 11% vascular dementia (VaD). PDU was classified according to anatomical therapeutic chemical-classification as either “present” or “absent”.Results: The majority of residents had moderately severe to severe dementia. At all successive assessments, almost two-thirds of residents received any psychotropic drug (PD) and almost one-third continued to receive any PD. Of all PDs, antipsychotics (APs) were prescribed most frequently. Fewer residents started with antidepressants, but continued to receive antidepressants at higher percentages. Anxiolytics showed an intermittent course, but a subgroup of 9% showed two-year continuation. Once started on PDs at baseline, residents continued to use PDs at high percentages: three-quarters continued to receive APs for at least six months. Half of residents received at least one PD; one-fifth received at least two PDs simultaneously. Residents with AD received more hypnotics and antidementia drugs; residents with VaD received more antipsychotics, antidepressants, anxiolytics and anticonvulsants.Conclusions: PDs have different utilization patterns, but overall, consistently high continuation rates were found. These results warrant scrutiny of continuous PDU.

scholarly journals Associations between Pain and Quality of Life in Severe Dementia: A Norwegian Cross-Sectional Study

2017 ◽  
Vol 7 (1) ◽  
pp. 109-121 ◽  
Author(s):  
Hanne Marie Rostad ◽  
Martine T.E. Puts ◽  
Milada Cvancarova Småstuen ◽  
Ellen Karine Grov ◽  
Inger Utne ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Depressive Symptoms ◽  
Daily Living ◽  
Neuropsychiatric Symptoms ◽  
Nursing Home Residents ◽  
Severe Dementia ◽  
Cross Sectional ◽  
The Relationship

Background/Aims: Many variables influence the quality of life in older adults with dementia. We aim to quantify how the relationship between pain and quality of life in nursing home residents with severe dementia can be explained by neuropsychiatric symptoms, depressive symptoms, and activities of daily living. Methods: This article presents cross-sectional baseline data from a cluster randomised controlled trial. Results: The total and direct effects of pain on quality of life were statistically significant. Both neuropsychiatric and depressive symptoms partially mediated the relationship between pain and quality of life. Activities of daily living acted as a mediator only when modelled together with depressive symptoms. Conclusion: Pain, neuropsychiatric symptoms, and depressive symptoms appear to be important factors that influence the quality of life for nursing home residents with severe dementia. Therefore, multidimensional interventions may be beneficial for maintaining or improving quality of life in this population.

scholarly journals Can the PROPER intervention reduce psychotropic drug prescription in nursing home residents with dementia? Results of a cluster-randomized controlled trial

2020 ◽  
pp. 1-10
Author(s):  
C.H.W. Smeets ◽  
M. Smalbrugge ◽  
R.T.C.M. Koopmans ◽  
M.H.J.M.G. Nelissen-Vrancken ◽  
K. van der Spek ◽  
...  
Keyword(s):  
Nursing Home ◽  
The Netherlands ◽  
Psychotropic Drug ◽  
Psychotropic Drugs ◽  
Neuropsychiatric Symptoms ◽  
Nursing Home Residents ◽  
Term Care ◽  
Randomized Controlled ◽  
Percentage Points ◽  
Cluster Randomized

ABSTRACT Objectives: To evaluate the effect of the PROPER intervention in nursing home residents with dementia on the prevalence of psychotropic drug use and neuropsychiatric symptoms. Design: A cluster-randomized controlled design with two parallel groups (intervention versus usual care) and assessments at 0, 6, 12, and 18 months. Setting: Thirty-one dementia special care units within 13 long-term care organizations in the Netherlands. Participants: Three hundred eighty nursing home residents with dementia Intervention: The PROPER intervention consisted of a structured and repeated multidisciplinary medication review, supported by education and continuous evaluation. Measurements: Prescriptions of antipsychotics, antidepressants, anxiolytics, and hypnotics, and occurrence of neuropsychiatric symptoms. Results: The prescription of any type of psychotropic drugs increased in the intervention group, and decreased in the control group, with an estimated difference of 3.9 percentage points per 6 months (p = 0.01). Effects for the individual drug groups were minor (differences of 1.6 percentage points and below per 6 months) and not statistically significant. The occurrence of neuropsychiatric symptoms remained stable in both the intervention and control groups during the follow-up of 18 months. Conclusions: The PROPER intervention failed to demonstrate effectiveness in reducing the prevalence of psychotropic drugs. It may be interesting to enrich the intervention with components that address personal attitudes and communication between nursing home professionals, not only with respect to the prescription of psychotropic drugs, but also to neuropsychiatric symptoms. The study has been registered in The Netherlands Trial Register (NTR3569).

Factors Related to Psychotropic Drug Prescription for Neuropsychiatric Symptoms in Nursing Home Residents With Dementia

2014 ◽  
Vol 15 (11) ◽  
pp. 835-840 ◽  
Author(s):  
Claudia H.W. Smeets ◽  
Martin Smalbrugge ◽  
Sytse U. Zuidema ◽  
Els Derksen ◽  
Erica de Vries ◽  
...  
Keyword(s):  
Nursing Home ◽  
Psychotropic Drug ◽  
Neuropsychiatric Symptoms ◽  
Drug Prescription ◽  
Nursing Home Residents

scholarly journals Course of activities of daily living in nursing home residents with dementia from admission to 36-month follow-up

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Reidun Haarr Johansen ◽  
Karoline Olsen ◽  
Sverre Bergh ◽  
Jūratė Šaltytė Benth ◽  
Geir Selbæk ◽  
...  
Keyword(s):  
Nursing Home ◽  
Daily Living ◽  
Neuropsychiatric Symptoms ◽  
Nursing Home Residents ◽  
Severe Dementia ◽  
General Physical ◽  
Severity Of Dementia ◽  
General Physical Health ◽  
Over Time

Abstract Background Dementia is affecting both the person with the disease and the family members. It is associated with nursing home admission, and a reduced ability to perform personal activities of daily living (P-ADL). The aim of this study was to examine the association between the severity of dementia and P-ADL function, and to study if additional factors such as neuropsychiatric symptoms, type of nursing home unit, and use of medication were associated with P-ADL function. Methods A total of 582 nursing home residents with dementia, included at admission to the nursing home, were followed with biannual assessments for 36 months. P-ADL was assessed using the Physical Self-Maintenance scale, and severity of dementia was measured with the Clinical Dementia Rating scale. In addition, neuropsychiatric symptoms, general physical health, and use of medications were assessed at the same time points. Demographic information was collected at baseline. Linear mixed models were estimated. Results There was a significant (p < 0.05) non-linear decline in P-ADL function over time in analysis not adjusting for any characteristics. More severe dementia at baseline and at the follow-up assessments was associated with lower P-ADL function (p < 0.001), with the association being stable over time. A higher level of neuropsychiatric symptoms, not using anti-dementia medication, being in a regular care unit as compared to a special care unit and having poor/fair general physical health as compared to good/excellent, were associated with a lower P-ADL function. Conclusion The association between more severe dementia and lower P-ADL function was stable over a 36-month follow-up period of nursing home residents with dementia. Health care planners and clinicians should be aware of this when planning for and treating nursing home residents.

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

2019 ◽  
Vol 19 (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.

Factors associated with appropriate psychotropic drug prescription in nursing home patients with severe dementia

2017 ◽  
Vol 30 (4) ◽  
pp. 547-556 ◽  
Author(s):  
Klaas van der Spek ◽  
Raymond TCM Koopmans ◽  
Martin Smalbrugge ◽  
Marjorie HJMG Nelissen-Vrancken ◽  
Roland B Wetzels ◽  
...  
Keyword(s):  
Nursing Home ◽  
Psychotropic Drug ◽  
Neuropsychiatric Symptoms ◽  
Drug Prescription ◽  
Multilevel Regression ◽  
Severe Dementia ◽  
Related Factors ◽  
Cross Sectional ◽  
Alzheimer Dementia ◽  
Nursing Home Patients

ABSTRACTBackground:We studied the patient and non-patients factors of inappropriate psychotropic drug (PD) prescription for neuropsychiatric symptoms (NPS) in nursing home patients with severe dementia.Methods:In a cross-sectional study, the appropriateness of prescriptions was explored using the Appropriate Psychotropic drug use In Dementia (APID) index sum score. This index assesses information from medical records on indication, evaluation, dosage, drug–drug interactions, drug–disease interactions, duplications, and therapy duration. Various measurements were carried out to identify the possible patient and non-patient factors. Linear multilevel regression analysis was used to identify factors that are associated with APID index sum scores. Analyses were performed for groups of PDs separately, i.e. antipsychotics, antidepressants, anxiolytics, and hypnotics.Results:The sample consisted of 338 patients with a PD prescription that used 147 antipsychotics, 167 antidepressants, 85 anxiolytics, and 76 hypnotics. It was found that older patients and more severe aggression, agitation, apathy, and depression were associated with more appropriate prescriptions. Additionally, less appropriate prescriptions were found to be associated with more severe anxiety, dementia diagnoses other than Alzheimer dementia, more physician time available per patient, more patients per physician, more years of experience of the physician, and higher nurse's workload.Conclusions:The association of more pronounced NPS with more appropriate PD prescriptions implies that physicians should pay more attention to the appropriateness of PD prescriptions when NPS are less manifest. Non-patient-related factors are also associated with the appropriateness of PD prescriptions. However, especially considering that some of these findings are counter-intuitive, more research on the topic is recommended.

scholarly journals Sequential Dependencies in Solid and Fluid Intake in Nursing Home Residents with Dementia: A Multistate Model

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 915-915
Author(s):  
Wen Liu ◽  
Kristine Williams ◽  
Yong Chen
Keyword(s):  
Nursing Home ◽  
Fluid Intake ◽  
Nursing Home Residents ◽  
Temporal Association ◽  
Negative Consequences ◽  
Severe Dementia ◽  
Assistance Programs ◽  
Sequential Dependencies ◽  
Dementia Severity ◽  
Multinomial Logit Models

Abstract Nursing home (NH) residents with dementia commonly experience low food intake leading to negative consequences. While multilevel factors influence intake, evidence is lacking on how intake is sequentially associated. This study examined the temporal association between previous and current solid and fluid intake in NH residents with dementia. We analyzed 160 mealtime videos involving 27 residents and 36 staff (53 dyads) in 9 NHs. The dependent variable was the current intake state (fluid, solid, no-intake). Independent variables included the prior intake state, technique of current intake state (resident-initiated, staff-facilitated), duration between previous and current intakes. Covariates included resident and staff characteristics. Two-way interactions of duration and technique with the prior intake state, and resident comorbidity and dementia severity were examined using Multinomial Logit Models. Interactions were significant for technique by comorbidity, technique by dementia severity, technique by prior fluid and solid intake, and duration by prior fluid intake. Successful previous intake increased odds of current solid and fluid intake. Staff-facilitation (vs. resident-initiation) reduced odds of solid and fluid intake for residents with moderately severe (vs. severe) dementia. Higher morbidity decreased odds of solid intake (vs. no-intake) for staff-facilitated intake. Resident with severe dementia had smaller odds of solid and fluid intake for resident-initiated intake. Longer duration increased odds of transition from liquid to solid intake. Findings supported strong sequential dependencies in intake, indicating the promise of intervening behaviorally to modify transitions to successful intake during mealtime. Findings inform the development and implementation of innovative mealtime assistance programs to promote intake.

scholarly journals Assessment of Psychotropic Drug Prescribing Among Nursing Home Residents in Ontario, Canada, During the COVID-19 Pandemic

2021 ◽  
Author(s):  
Nathan M. Stall ◽  
Jonathan S. Zipursky ◽  
Jagadish Rangrej ◽  
Aaron Jones ◽  
Andrew P. Costa ◽  
...  
Keyword(s):  
Nursing Home ◽  
Psychotropic Drug ◽  
Nursing Home Residents ◽  
Drug Prescribing
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