期刊论文详细信息
BMC Clinical Pharmacology
Psychotropic drug use among people with dementia – a six-month follow-up study
Hugo Lövheim3  Yngve Gustafson3  Stig Karlsson2  Maria Gustafsson1 
[1]Department of Pharmacology and Clinical Neurosciences, Division of Clinical Pharmacology and Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
[2]Department of Nursing, Umeå University, Umeå, Sweden
[3]Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
关键词: Psychotropic prescribing;    BPSD;    Dementia;    Psychotropic drugs;   
Others  :  860506
DOI  :  10.1186/2050-6511-14-56
 received in 2013-08-14, accepted in 2013-11-01,  发布年份 2013
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【 摘 要 】

Background

Psychotropic drugs are widely used among old people with dementia but few studies have described long-term treatment in this group of patients. The purpose of this study was to explore the long-term use of psychotropic drugs in old people with dementia.

Methods

Data on psychotropic drug use, functioning in the activities of daily living (ADL), cognitive function and behavioral and psychological symptoms were collected at baseline and six months later, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The data were collected in 2005–2006. Detailed data about the prescribing of psychotropic drugs were collected from prescription records. This study was conducted in 40 specialized care units in northern Sweden, with a study population of 278 people with dementia.

Results

At the start of the study, 229 of the participants (82%) were prescribed at least one psychotropic drug; 150 (54%) used antidepressants, 43 (16%) used anxiolytics, 107 (38%) used hypnotics and sedatives, and 111 (40%) used antipsychotics. Among the baseline users of antidepressants, anxiolytics, hypnotics and sedatives and antipsychotics, 67%, 44%, 57% and 57% respectively, still used the same dose of the same psychotropic drug after six months. Associations were found between behavioral and psychological symptoms and different psychotropic drugs.

Conclusion

Psychotropic drug use was high among people with dementia living in specialized care units and in many cases the drugs were used for extended periods. It is very important to monitor the effects and adverse effects of the prescribed drug in this frail group of people.

【 授权许可】

   
2013 Gustafsson et al.; licensee BioMed Central Ltd.

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【 参考文献 】
  • [1]Olsson J, Bergman A, Carlsten A, Oké T, Bernsten C, Schmidt IK, Fastbom J: Quality of drug prescribing in elderly people in nursing homes and special care units for dementia: a cross-sectional computerized pharmacy register analysis. Clin Drug Investig 2010, 30:289-300.
  • [2]Bergman A, Olsson J, Carlsten A, Waern M, Fastbom J: Evaluation of the quality of drug therapy among elderly patients in nursing homes. Scand J Prim Health Care 2007, 25:9-14.
  • [3]Lau DT, Kasper JD, Potter DEB, Lyles A, Bennett RG: Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med 2005, 165:68-74.
  • [4]Col N, Fanale JE, Kronholm P: The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med 1990, 150:841-845.
  • [5]Mannesse CK, Derkx FH, de Ridder MA, Man in ’t Veld AJ, van der Cammen TJ: Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing 2000, 29:35-39.
  • [6]Hajjar ER, Hanlon JT, Artz MB, Lindblad CI, Pieper CF, Sloane RJ, Ruby CM, Schmader KE: Adverse drug reaction risk factors in older outpatients. Am J Geriatr Pharmacother 2003, 1:82-89.
  • [7]Gustafsson M, Sandman P-O, Karlsson S, Gustafson Y, Lövheim H: Association between behavioral and psychological symptoms and psychotropic drug use among old people with cognitive impairment living in geriatric care settings. Int Psychogeriatr 2013, 25:1415-1423.
  • [8]Moore AR, O’Keeffe ST: Drug-induced cognitive impairment in the elderly. Drugs Aging 1999, 15:15-28.
  • [9]Cancelli I, Beltrame M, Gigli GL, Valente M: Drugs with anticholinergic properties: cognitive and neuropsychiatric side-effects in elderly patients. Neurol Sci 2009, 30:87-92.
  • [10]Rochon PA, Normand S-L, Gomes T, Gill SS, Anderson GM, Melo M, Sykora K, Lipscombe L, Bell CM, Gurwitz JH: Antipsychotic therapy and short-term serious events in older adults with dementia. Arch Intern Med 2008, 168:1090-1096.
  • [11]Declercq T, Petrovic M, Azermai M, Vander Stichele R, De Sutter AIM, van Driel ML, Christiaens T: Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. Cochrane Database Syst Rev 2013, 28:CD007726.
  • [12]Hanlon JT, Horner RD, Schmader KE, Fillenbaum GG, Lewis IK, Wall WE Jr, Landerman LR, Pieper CF, Blazer DG, Cohen HJ: Benzodiazepine use and cognitive function among community-dwelling elderly. Clin Pharmacol Ther 1998, 64:684-692.
  • [13]Gray SL, LaCroix AZ, Hanlon JT, Penninx BWJH, Blough DK, Leveille SG, Artz MB, Guralnik JM, Buchner DM: Benzodiazepine use and physical disability in community-dwelling older adults. J Am Geriatr Soc 2006, 54:224-230.
  • [14]Hetta J, Schwan A: Läkemedelsboken 2011–2012. Uppsala: Läkemedelsverket; 2011:1005-1015. [Sömnstörningar [In English: Sleep Disturbances]]
  • [15]Gehrman PR, Martin JL, Shochat T, Nolan S, Corey-Bloom J, Ancoli-Israel S: Sleep-disordered breathing and agitation in institutionalized adults with Alzheimer disease. Am J Geriatr Psychiatry 2003, 11:426-433.
  • [16]Ancoli-Israel S, Klauber MR, Butters N, Parker L, Kripke DF: Dementia in institutionalized elderly: relation to sleep apnea. J Am Geriatr Soc 1991, 39:258-263.
  • [17]Richards JB, Papaioannou A, Adachi JD, Joseph L, Whitson HE, Prior JC, Goltzman D, Canadian Multicentre Osteoporosis Study Research Group: Effect of selective serotonin reuptake inhibitors on the risk of fracture. Arch Intern Med 2007, 167:188-194.
  • [18]Coupland CAC, Dhiman P, Barton G, Morriss R, Arthur A, Sach T, Hippisley-Cox J: A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database. Health Technol Assess 2011, 15:1-202. iii–iv
  • [19]Socialstyrelsen: Indikatorer för god läkemedelsterapi hos äldre [In English: Indicators of good drug therapy in old people. Information from the National Board of Health and Welfare]. Retrieved April 10, 2013 from http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/18085/2010-6-29.pdf webcite
  • [20]Zuidema SU, Derksen E, Verhey FRJ, Koopmans RTCM: Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. Int J Geriatr Psychiatry 2007, 22:632-638.
  • [21]Selbaek G, Kirkevold Ø, Engedal K: The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes–a 12-month follow-up study. Am J Geriatr Psychiatry 2008, 16:528-536.
  • [22]Gauthier S, Cummings J, Ballard C, Brodaty H, Grossberg G, Robert P, Lyketsos C: Management of behavioral problems in Alzheimer’s disease. Int Psychogeriatr 2010, 22:346-372.
  • [23]Cerejeira J, Lagarto L, Mukaetova-Ladinska EB: Behavioral and psychological symptoms of dementia. Front Neurol 2012, 3:73.
  • [24]O’Connor DW, Griffith J, McSweeney K: Changes to psychotropic medications in the six months after admission to nursing homes in Melbourne, Australia. Int Psychogeriatr 2010, 22:1149-1153.
  • [25]Gustafsson M, Karlsson S, Lövheim H: Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units. BMC Pharmacol Toxicol 2013, 14:10. BioMed Central Full Text
  • [26]Pellfolk TJ-E, Gustafson Y, Bucht G, Karlsson S: Effects of a restraint minimization program on staff knowledge, attitudes, and practice: a cluster randomized trial. J Am Geriatr Soc 2010, 58:62-69.
  • [27]Sandman PO, Adolfsson R, Norberg A, Nyström L, Winblad B: Long-term care of the elderly. A descriptive study of 3600 institutionalized patients in the county of Västerbotten, Sweden. Compr Gerontol A 1988, 2:120-132.
  • [28]Adolfsson R, Gottfries CG, Nyström L, Winblad B: Prevalence of dementia disorders in institutionalized Swedish old people. The work load imposed by caring for these patients. Acta Psychiatr Scand 1981, 63:225-244.
  • [29]Folstein MF, Folstein SE, McHugh PR: ”Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975, 12:189-198.
  • [30]Lövheim H, Sandman P-O, Karlsson S, Gustafson Y: Behavioral and psychological symptoms of dementia in relation to level of cognitive impairment. Int Psychogeriatr 2008, 20:777-789.
  • [31]Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM: Psychotropic drug prescription in nursing home patients with dementia: influence of environmental correlates and staff distress on physicians’ prescription behavior. Int Psychogeriatr 2011, 23:1632-1639.
  • [32]Läkemedelsverket: Läkemedelsbehandling och bemötande vid Beteendemässiga och Psykiska Symtom vid Demenssjukdom - BPSD. [In English: Drug therapy and treatment for Behavioral and Psychological Symptoms of dementia - BPSD. Information from the Medical Products Agency]. Retrieved April 10, 2013 from http://www.lakemedelsverket.se/malgrupp/Halso---sjukvard/Behandlings--rekommendationer/Behandlingsrekommendation---listan/Beteendemassiga-och-psykiska-symtom-vid-demenssjukdom--BPSD/ webcite
  • [33]Banerjee S, Hellier J, Dewey M, Romeo R, Ballard C, Baldwin R, Bentham P, Fox C, Holmes C, Katona C, Knapp M, Lawton C, Lindesay J, Livingston G, McCrae N, Moniz-Cook E, Murray J, Nurock S, Orrell M, O’Brien J, Poppe M, Thomas A, Walwyn R, Wilson K, Burns A: Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. Lancet 2011, 378:403-411.
  • [34]Simon GE, Ludman EJ: Outcome of new benzodiazepine prescriptions to older adults in primary care. Gen Hosp Psychiatry 2006, 28:374-378.
  • [35]Ashton H: The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry 2005, 18:249-255.
  • [36]Nijk RM, Zuidema SU, Koopmans RTCM: Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia. Int Psychogeriatr 2009, 21:485-493.
  • [37]Chiu M-J, Chen T-F, Yip P-K, Hua M-S, Tang L-Y: Behavioral and psychologic symptoms in different types of dementia. J Formos Med Assoc 2006, 105:556-562.
  • [38]Ballard C, Waite J: The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer’s disease. Cochrane Database Syst Rev 2006, 25:CD003476.
  • [39]Lövheim H, Sandman PO, Kallin K, Karlsson S, Gustafson Y: Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care. Int Psychogeriatr 2006, 18:713-726.
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