Antipsychotic Prescribing Practices Amongst the Elderly of St. James's Hospital (SJH), Dublin

2017 ◽  
Author(s):  
Clodagh Power
Keyword(s):  
The Elderly ◽  
Prescribing Practices ◽  
Antipsychotic Prescribing

Antipsychotic Prescribing Practices Amongst the Elderly of St. James's Hospital (SJH), Dublin

2017 ◽  
Vol 41 (S1) ◽  
pp. S663-S663
Author(s):  
C. Power ◽  
B. McCarthy ◽  
B.A. Lawlor ◽  
E. Greene
Keyword(s):  
Best Practice ◽  
The Elderly ◽  
Medical Documentation ◽  
Psychotic Symptoms ◽  
Prescribing Practices ◽  
Next Of Kin ◽  
Pharmacological Interventions ◽  
Antipsychotic Medications ◽  
Number Of Patients ◽  
Antipsychotic Prescribing

IntroductionPsychotic symptoms arise commonly in the context of behavioural and psychological symptoms of dementia (BPSD) in the elderly. While non-pharmacological interventions are preferable to manage such symptoms, antipsychotic medications are frequently used. This is largely unlicensed and associated with significant risks, particularly in dementia (1).ObjectivesTo examine antipsychotic prescribing practices in SJH.MethodsOn 23rd February 2016 all inpatients aged over 65 who were prescribed antipsychotic medications were identified. Demographic and medical data were collected from medical and electronic notes and medication kardexes.ResultsComplete data were available for 53 of 59 identified cases. The cohort had a mean age of 80 (range 65–99) and 62% were male. Seventy-four percent (n = 39) had documented cognitive impairment or dementia. Fifty-eight percent (n = 31) were newly prescribed an antipsychotic following admission. The commonest indications for antipsychotics were: delirium (53%) and BPSD (25%). Haloperidol (56%), quetiapine (19%) and risperidone (8%) were prescribed most frequently. Non-pharmacological interventions were documented in 50% however in many cases it is not clear what these interventions were. Antipsychotic use was discussed with patients and/or next of kin in less than 25% of cases. Adverse effects were noted in 6/36 (17%) with equal incidence of falls, EPSEs and ECG changes.ConclusionPositive and negative aspects of current antipsychotic prescribing practices are highlighted. Antipsychotics were prescribed for a small number of patients for appropriate indications. However, there was poor consideration of non-pharmacological interventions and a lack of consultation with the patient/NOK. This may reflect, in part, inadequate medical documentation. A guideline needs to specifically address these areas of concern to improve safety and promote best practice.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Conclusion

2016 ◽  
Author(s):  
Maria A. Sullivan
Keyword(s):  
Older Adults ◽  
Substance Use ◽  
The Elderly ◽  
Social Consequences ◽  
Individual Therapy ◽  
Older Individuals ◽  
Prescribing Practices ◽  
Elderly Age ◽  
Age Related ◽  
The Impact

Addiction in older adults very often goes unrecognized, for several reasons: social biases about the elderly, age-related metabolic changes, and the inappropriate use of prescription benzodiazepines and opioids to address untreated anxiety and mood conditions. Alcohol or substance-use disorders (SUDs) in older individuals may present in subtle and atypical ways. Strategies to overcome such difficulties include systematic screening using validated instruments, patient education regarding the impact of psychoactive substances on health, and cautious prescribing practices. Relying on standard DSM criteria may result in a failure to detect an SUD that presents with cognitive symptoms or physical injury, as well as the absence of work or social consequences. Older individuals can benefit from the application of risk-stratification measures, and they can be referred, e.g., to age-appropriate group therapy and non-confrontational individual therapy focusing on late-life issues of loss and sources of social support, as well as be offered medication management for alcohol or substance use disorder. Although research has been limited in this population, treatment outcomes have been found to be superior in older adults than younger adults.

Assessment of antipsychotic prescribing in Belgian nursing homes

2011 ◽  
Vol 23 (8) ◽  
pp. 1240-1248 ◽  
Author(s):  
Majda Azermai ◽  
Monique Elseviers ◽  
Mirko Petrovic ◽  
Luc van Bortel ◽  
Robert Vander Stichele
Keyword(s):  
Nursing Homes ◽  
Inappropriate Prescribing ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Prescribing Indicators ◽  
Prescribing Quality ◽  
Homes For The Elderly ◽  
Combined Use ◽  
Antipsychotic Prescribing

ABSTRACTBackground: Given the potential adverse effects of antipsychotics, high use in nursing homes creates concern. Our study goal was to explore the use of antipsychotics in relation to resident characteristics, and to assess the appropriateness of antipsychotic prescribing in Belgian nursing homes.Methods: Data were used from a cross-sectional study (Prescribing in Homes for the Elderly; PHEBE) conducted in 76 nursing homes in Belgium. Antipsychotics were classified into typical and atypical, using the anatomical therapeutic and chemical classification. Ten inappropriate antipsychotic prescribing indicators were selected from the updated Beers criteria (2003), Bergen District Nursing Home Study (BEDNURS) indicators, and Screening Tool of Older People's Prescriptions criteria (STOPP).Results: The residents' mean age was 84.8 years, 78.1% of whom were female. The prevalence of antipsychotic utilization was 32.9%. Antipsychotics were mainly indicated for dementia-related agitation, and psychosis with/without dementia. Higher use of antipsychotics was found for dementia (OR: 3.27; 95% CI: 2.61–4.09), insomnia (OR: 1.38; 95% CI: 1.10–1.73), depression (OR: 1.30; 95% CI: 1.03–1.65), and age <80 years (OR: 1.79; 95% CI: 1.38–2.33). Inappropriate antipsychotic prescribing indicators scoring the highest among users were: long-term use (92.6%), use despite risk of falling (45.6%), combined use with other psychotropics (31.8%), and duplicate use (15.1%). Inappropriate prescribing was associated with depression (OR: 3.41) and insomnia (OR: 2.17).Conclusion: The indicator-driven analysis of antipsychotic prescribing quality revealed a need for improvement, with the main prescribing problems relating to duration and combination of therapies. Risks/benefits of off-label use need to be evaluated more consciously at the start of therapy, and at periodic re-evaluations.

scholarly journals "Real World" Atypical Antipsychotic Prescribing Practices in Public Child and Adolescent Inpatient Settings

2002 ◽  
Vol 28 (1) ◽  
pp. 111-121 ◽  
Author(s):  
E. Pappadopulos ◽  
P. S. Jensen ◽  
S. B. Schur ◽  
J. C. MacIntyre ◽  
S. Ketner ◽  
...  
Keyword(s):  
Atypical Antipsychotic ◽  
Real World ◽  
Child And Adolescent ◽  
Prescribing Practices ◽  
Inpatient Settings ◽  
Adolescent Inpatient ◽  
Antipsychotic Prescribing

Combined antipsychotic use in a community rehabilitation psychiatric service

2010 ◽  
Vol 27 (3) ◽  
pp. 138-140
Author(s):  
Tunde Apantaku-Olajide ◽  
Abid Khattak ◽  
Peter Whitty
Keyword(s):  
Psychiatric Rehabilitation ◽  
Psychiatric Service ◽  
Total Sample ◽  
Rehabilitation Service ◽  
Prescribing Practices ◽  
Cross Sectional ◽  
Case Record ◽  
Psychiatric Illnesses ◽  
Community Rehabilitation ◽  
Antipsychotic Prescribing

AbstractObjectives:Despite the clinical guidelines regarding the use of combined antipsychotics and the limited evidence for its benefits, use remains high in psychiatric practice. The aim of this study was to examine prescribing practices and investigate reasons for initiating and continuing combined antipsychotics in stable psychiatric illnesses.Method:A cross-sectional case record survey of antipsychotic prescribing practices in a community psychiatric rehabilitation service. A total sample (n = 75) of patients with chronic and enduring psychiatric illnesses was studied. The age, gender, diagnosis and prescribed antipsychotics were examined. The proportional prevalence and documented reasons for combined antipsychotic prescribing were analysed.Results:Seventy-three of the 75 patients were prescribed antipsychotic mediations. Of these, 44 (60%) received a combination of two or more antipsychotics. The most common reason for combined prescribing was a switch of antipsychotic (n = 18; 41%). No reason was documented in 19 cases (43%).Conclusions:In this study, slow cross-tapering or incomplete switch process of antipsychotics contributed to the prolonged period of combined antipsychotics treatment. Adequate documentation regarding indication and review of medications cannot be overemphasized.

scholarly journals Antipsychotic prescribing patterns in care homes and relationship with dementia

2007 ◽  
Vol 31 (9) ◽  
pp. 329-332 ◽  
Author(s):  
David P. Alldred ◽  
Duncan R. Petty ◽  
Peter Bowie ◽  
Arnold G. Zermansky ◽  
David K. Raynor
Keyword(s):  
Medication Review ◽  
Controlled Trial ◽  
Intervention Group ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
Care Homes ◽  
Cross Sectional ◽  
Antipsychotic Prescribing ◽  
Randomised Controlled

Aims and MethodTo determine the prescribing patterns for antipsychotics in care homes for the elderly, a cross-sectional study was carried out using data from the intervention group of a randomised controlled trial of medication review in care homes.ResultsOf 331 residents studied, 67 (20%) were prescribed an antipsychotic (70% atypical); 57 of these (85%) did not have a diagnosis of a psychotic disorder. The antipsychotic prescribing rate was 32% (46 out of 146) for those with dementia and 10% (17 out of 174) for those without dementia. A quarter (82 out of 331) had received a medication review by the general practitioner in the preceding 12 months.Clinical ImplicationsOne-fifth of residents were prescribed an antipsychotic with little evidence of review. Systems should ensure residents' treatment is reviewed regularly.

Reduction of Concurrent Antipsychotic Prescribing Practices Through the Use of PSYCKES

2006 ◽  
Vol 34 (1) ◽  
pp. 57-61 ◽  
Author(s):  
Thomas Uttaro ◽  
Molly Finnerty ◽  
Thomas White ◽  
Rosanne Gaylor ◽  
Lawrence Shindelman
Keyword(s):  
Prescribing Practices ◽  
Antipsychotic Prescribing
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