Antipsychotic drug prescription in nursing home residents with dementia : perspectives of staff and proxies in a complex decision process

AbstractPolypharmacy represents a major clinical and public health issue in older persons. We aimed to measure the prevalence of polypharmacy, and the main predictors of drug prescription in nursing home residents. Post hoc analyses of the “Incidence of pNeumonia and related ConseqUences in nursing home Residents” (INCUR) study were conducted. Polypharmacy was defined as the prescription of 5 or more drugs. A frailty index (FI) was computed according to the model proposed by Rockwood and Mitnitski using 36 health deficits, including diseases, signs, symptoms, and disabilities. Linear regression models were performed to identify the main predictors of the number of prescribed drugs. The INCUR study enrolled 800 patients (mean [SD] age 86.2 [4.1] years, 74.1% women). The mean number of medications prescribed at the baseline was 8.5 (SD 4.1). Prevalence of polypharmacy was found 86.4%. The mean FI was 0.38 (SD 0.10). A fully adjusted linear multivariate regression model found an inverse and independent association between age and number of prescribed drugs (beta − 0.07, 95% CI − 0.13, − 0.02; p = 0.005). Conversely, the FI was independently and positively associated with the number of medications (beta 4.73, 95% CI 1.17, 8.29; p = 0.009). The prevalence of polypharmacy is high among older persons living in nursing home. Age and FI are significantly associated with the number of drugs. The number of prescribed drugs tends to decrease with age, whereas a direct association with frailty is reported.

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Inappropriate drug prescription in elderly nursing home residents

European Journal of Public Health ◽

10.1093/eurpub/cku161.133 ◽

2014 ◽

Vol 24 (suppl_2) ◽

Author(s):

A Lafranconi ◽

AM Maestroni ◽

G Diana ◽

P Ferraguti ◽

C Lemma ◽

...

Keyword(s):

Nursing Home ◽

Drug Prescription ◽

Nursing Home Residents ◽

Inappropriate Drug

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Potentially Inappropriate Drug Prescribing in French Nursing Home Residents: An Observational Study

Pharmacy ◽

10.3390/pharmacy8030133 ◽

2020 ◽

Vol 8 (3) ◽

pp. 133

Author(s):

Soraya Qassemi ◽

Arnaud Pagès ◽

Laure Rouch ◽

Serge Bismuth ◽

André Stillmunkes ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Drug Prescription ◽

Nursing Home Residents ◽

Optimization Methods ◽

Inappropriate Drug ◽

Utilization Review ◽

Cross Sectional ◽

Implicit Approach ◽

Explicit Criteria

Purpose: To identify the prevalence of potentially inappropriate drug prescription in a sample of nursing home residents in France, combining explicit criteria and implicit approach and to involve pharmacists in the multi-professional process of therapeutic optimization. Methods: A cross-sectional, observational, multicenter study was conducted during a five-month period in a sample of French nursing homes. Information on drug prescription, diseases, and socio-demographic characteristics of nursing home residents was collected. For each prescription, identification of potentially inappropriate drug prescription was done, based on explicit and implicit criteria. Results: Nursing home residents were administered an average of 8.1 (SD 3.2, range 0–20) drugs per day. Nearly 87% (n = 237) of the residents had polypharmacy with five or more drugs prescribed per day. Among the 274 nursing home residents recruited from five nursing homes, 212 (77.4%) had at least one potentially inappropriate drug prescription. According to the Laroche list, 84 residents (30.7%) had at least one drug with an unfavorable benefit–harm balance. An overdosing was found for 20.1% (n = 55) of the residents. Nearly 30% (n = 82) of the residents had a drug prescribed without valid medical indication. Conclusions: This study shows that potentially inappropriate drug prescriptions are highly prevalent among nursing home residents, nevertheless pharmacists can take part in drug utilization review in collaboration with the nursing home staff.

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Staff Education Reduces Antipsychotic Drug Use in Nursing Home Residents

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/50.7.1318 ◽

1993 ◽

Vol 50 (7) ◽

pp. 1318-1318

Keyword(s):

Nursing Home ◽

Drug Use ◽

Antipsychotic Drug ◽

Nursing Home Residents ◽

Staff Education

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Prevalence of Behavioural and Psychological Symptoms of Dementia in Nursing Homes in Berlin

European Psychiatry ◽

10.1016/s0924-9338(09)70723-0 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

T. Majic ◽

J.-P. Pluta ◽

T. Mell ◽

A. Decker ◽

A. Heinz ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Home Care ◽

Caregiver Burden ◽

Psychological Symptoms ◽

Drug Prescription ◽

Nursing Home Residents ◽

Nursing Home Care ◽

Cross Sectional ◽

Psychiatric Hospitalizations

Background:Behavioral and Psychological Symptoms of Dementia (BPSD) include agitation, apathy, hallucinations, and depression. These symptoms are a challenge to professional nursing care, resulting in frequent psychiatric hospitalization, which incur high costs to the national healthcare systems.Objective:To estimate the prevalence of BPSD in nursing home residents in 16 representative nursing homes in Berlin, Germany.Methods:In a cross-sectional clustered cohort study, BPSD were assessed using the Dementia Mood Assessment Scale (DMAS), the Neuropsychiatric Inventary (NPI) and the Cohen-Mansfield Agitation Inventory (CMAI). Dementia stage severity was measured by Functional Assessment Staging (FAST) and the Mini-Mnetals State Examination (MMSE). Furthermore, the patients" history recording psychotropics and number of psychiatric hospitalizations were registered. The prevalence and incidence rates of BPSD as well the duration of hospitalization and the quantity of drug prescription were estimated.Results:BPSD are common above all in nursing home residents with dementia, exhibiting prevalence rates of above 60% of all nursing home residents suffering from dementia. The severity of BPSD was related to number of psychiatric hospitalizations, the amount of psychotropics prescribed, and caregiver burden (p < .05).Conclusion:The high prevalence rate of BPSD reflects a significant problem in nursing home care, and is related to negative health outcomes and caregiver burden. Thus, nursing home care could be improved by minimizing the severity of BPSD, as well as the amount of drugs prescribed and the frequency of demented patients" hospitalization.

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