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

2016 ◽  
Vol 28 (10) ◽  
pp. 1589-1595 ◽  
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.

scholarly journals A cross-sectional study of psychotropic drug use in the elderly: Consuming patterns, risk factors and potentially inappropriate use

2019 ◽  
pp. ejhpharm-2019-001927
Author(s):  
María Isabel Santos-Pérez ◽  
Inmaculada Fierro ◽  
M Esther Salgueiro-Vázquez ◽  
María Sáinz-Gil ◽  
Luis H Martín-Arias
Keyword(s):  
Risk Factors ◽  
Drug Use ◽  
Psychotropic Drug ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
Psychotropic Drug Use

scholarly journals Prevalence and correlates of psychotropic drug use in Dutch nursing home patients with young‐onset dementia

2019 ◽  
Vol 34 (8) ◽  
pp. 1185-1193 ◽  
Author(s):  
Ans J.M.J. Mulders ◽  
Sytse U. Zuidema ◽  
Renée Leeuwis ◽  
Hans Bor ◽  
Frans R.J. Verhey ◽  
...  
Keyword(s):  
Nursing Home ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Young Onset ◽  
Psychotropic Drug Use ◽  
Nursing Home Patients ◽  
Young Onset Dementia

scholarly journals Psychotropic drug use in a group of Dutch nursing home patients with dementia: many users, long-term use, but low doses

1996 ◽  
Vol 18 (1) ◽  
pp. 42-47 ◽  
Author(s):  
R. T. C. M. Koopmans ◽  
M. A. J. H. Willekens-Bogaers ◽  
J. M. Rossum ◽  
H. J. M. Hoogen ◽  
C. Weel ◽  
...  
Keyword(s):  
Nursing Home ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Low Doses ◽  
Psychotropic Drug Use ◽  
Nursing Home Patients

Psychotropic drug prescription in nursing home patients with dementia: influence of environmental correlates and staff distress on physicians’ prescription behavior

2011 ◽  
Vol 23 (10) ◽  
pp. 1632-1639 ◽  
Author(s):  
Sytse U. Zuidema ◽  
Jos F. M. de Jonghe ◽  
Frans R. J. Verhey ◽  
Raymond T. C. M. Koopmans
Keyword(s):  
Nursing Home ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Home Environment ◽  
Neuropsychiatric Symptoms ◽  
Living Room ◽  
Environmental Correlates ◽  
Nursing Home Patients ◽  
Number Of Patients ◽  
Antidepressant Use

ABSTRACTBackground: The aim of the study was to examine whether staff distress and aspects of the nursing home environment were associated with psychotropic drug use (PDU) in patients with dementia.Methods: This was a cross-sectional study of 1289 nursing home patients with dementia from 56 Dementia Special Care Units (SCUs) in the Netherlands. The primary outcome was PDU. Potential correlates of PDU were staff distress, environmental correlates (the number of patients per unit or per living room, staff/patient ratio, and the presence of a walking circuit), and patient factors (gender, age, dementia severity, and neuropsychiatric symptoms (NPS)). Multilevel logistic regression analysis was used to estimate the relative contributions of predictor variables in explaining PDU.Results: Staff distress, aspects of the physical nursing home environment and patients’ neuropsychiatric symptoms were independently associated with PDU. Staff distress at patients’ agitation was associated with antipsychotic and anxiolytic drug use (OR 1.66, 95% CI (1.16–2.36) and 1.62 (1.00–2.61), respectively). SCUs with more patients per living room had higher hypnotic drug use (OR 1.08, 95% CI (1.02–1.14)). Low staff/patient ratio was associated with high antidepressant drug use (OR 0.13, 95% CI (0.04–0.47)). The effects of nursing home environment on study outcome were smallest for antidepressant use (intra-SCU correlation 0.005) and highest for hypnotic use (intra-SCU correlation 0.171).Conclusion: Staff distress and other environmental aspects are independently associated with PDU. These findings raise questions about the appropriateness of psychoactive drug prescriptions for nursing home patients with dementia.

Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia

2009 ◽  
Vol 21 (03) ◽  
pp. 485 ◽  
Author(s):  
Renate M. Nijk ◽  
Sytse U. Zuidema ◽  
Raymond T. C. M. Koopmans
Keyword(s):  
Nursing Home ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Psychotropic Drug Use ◽  
Nursing Home Patients

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 Change in psychotropic drug use among community-dwelling people aged 75 years and older in Finland: repeated cross-sectional population studies

2011 ◽  
Vol 23 (8) ◽  
pp. 1278-1284 ◽  
Author(s):  
Franciska Desplenter ◽  
Charlotte Caenen ◽  
Jolein Meelberghs ◽  
Sirpa Hartikainen ◽  
Raimo Sulkava ◽  
...  
Keyword(s):  
Drug Use ◽  
Psychotropic Drug ◽  
Adverse Drug Events ◽  
Community Dwelling ◽  
Cross Sectional ◽  
Psychotropic Drug Use ◽  
Random Samples ◽  
Antidepressant Use ◽  
Status Differences ◽  
Compare And Contrast

ABSTRACTBackground: Older people are at high risk of experiencing psychotropic-related adverse drug events. The objective of this study was to compare and contrast the use of psychotropic drugs among community-dwelling people aged ≥75 years in 1998 and 2004.Methods: Comparable random samples of people aged ≥75 years were extracted from the population register in Kuopio, Finland, in 1998 (n = 700) and 2003 (n = 1000). In 1998 and 2004, 523 and 700 community-dwelling people respectively participated in nurse interviews, during which demographic, diagnostic and drug use data were elicited. Logistic regression was used to compute unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the prevalence of psychotropic drug use in 2004 compared to 1998.Results: The unadjusted prevalence of total psychotropic (37.3% and 38.4%, OR 1.05; 95% CI 0.83–1.33), anxiolytic, hypnotic and sedative (29.6% and 31.3%, OR 1.08, 95% CI 0.85–1.38), and antidepressant (10.7% and 11.9%, OR 1.12, 95% CI 0.78–1.61) use were similar in 1998 and 2004. There was a decrease in the unadjusted prevalence of antipsychotic use (9.2% and 5.7%, OR 0.60; 95% CI 0.39–0.93). After adjusting for socioeconomic and health status differences, there was an increase in the prevalence of total psychotropic (adjusted OR 1.31, 95% CI 1.01–1.70) and antidepressant (OR 1.59, 95% CI 1.06–2.40) use.Conclusion: The unadjusted prevalence of psychotropic drug use remained stable between 1998 and 2004. However, in adjusted analyses there was a small increase in the prevalence of any psychotropic drug use and antidepressant use specifically.

scholarly journals Potentially avoidable hospitalisations of German nursing home patients? A cross-sectional study on utilisation patterns and potential consequences for healthcare

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e025269 ◽  
Author(s):  
Rüdiger Leutgeb ◽  
Sarah Jane Berger ◽  
Joachim Szecsenyi ◽  
Gunter Laux
Keyword(s):  
Nursing Home ◽  
Medical Care ◽  
International Classification Of Diseases ◽  
Cross Sectional Study ◽  
Federal State ◽  
Level Of Care ◽  
Insurance Company ◽  
Sectional Study ◽  
Cross Sectional ◽  
Nursing Home Patients

ObjectivesDemand for nursing home (NH) care is soaring due to gains in life expectancy and people living longer with chronic illness and disability. This is dovetailing with workforce shortages across the healthcare profession. Access to timely and appropriate medical care for NH residents is becoming increasingly challenging and can result in potentially avoidable hospitalisations (PAHs). In light of these factors, we analysed PAHs comparing NH patients with non-NH patients.DesignCross-sectional study with claims data from 2015 supplied by a large German health insurance company within the federal state of Baden-Wuerttemberg.SettingOne-year observation of hospitalisation patterns for NH and non-NH patients.Participants3 872 245 of the 10.5million inhabitants of Baden-Wuerttemberg were covered.MethodsPatient data about hospitalisation date, sex, age, nationality, level of care and diagnoses were available. PAHs were defined based on international classification of diseases (ICD-10) diagnoses belonging to ambulatory care sensitive conditions (ACSCs). Adjusted ORs for PAHs for NH patients in comparison with non-NH patients were calculated with multivariable regression models.ResultsOf the 933 242 hospitalisations in 2015, there were 23 982 for 13 478 NH patients and 909 260 for 560 998 non-NH patients. Mean age of hospitalised NH patients and level of care were significantly higher than those of non-NH patients. 6449 PAHs (29.6%) for NH patients and 136 543 PAHs (15.02%) for non-NH patients were identified. The adjusted OR for PAHs was significantly heightened for NH patients in comparison with non-NH patients (OR: 1.22, CI (1.18 to 1.26), p<0.0001). Moreover, we could observe that more than 90% of PAHs with ACSCs were unplanned hospitalisations (UHs).ConclusionsLarge numbers of PAHs for NH patients calls for improved coordination of medical care, especially general practitioner service provision. Introduction of targeted training programmes for physicians and NH staff on health problem management for NH patients could perhaps contribute to reduction of PAHs, predominantly UHs.

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