Multi-psychotropic drug prescription and the association to neuropsychiatric symptoms in three Norwegian nursing home cohorts between 2004 and 2011

BMC Geriatrics

Research Article

Elisabeth Flo¹  Christine Gulla¹  Bettina S. Husebo²  Øyvind Kirkevold³  Geir Selbaek⁴  Reidun Kjome⁵ 

[1] Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5018, Bergen, Norway;Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5018, Bergen, Norway;Municipality of Bergen, Bergen, Norway;Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, PO Box 2136, N-3103, Tonsberg, Ottestad, Norway;Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway;Faculty of Health, Care and Nursing, Gjovik University College, Gjovik, Norway;Faculty of Health, Care and Nursing, Norwegian University of Science and Technology (NTNU) in Gjøvik, N-2821, Gjøvik, Norway;Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, PO Box 2136, N-3103, Tonsberg, Ottestad, Norway;Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway;Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway;Research group in Social Pharmacy, Department of Global Public Health and Primary Care, and Centre for Pharmacy, University of Bergen, Bergen, Norway;Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5018, Bergen, Norway;

关键词: Dementia;    Nursing homes;    Neuropsychiatric symptoms;    Psychotropic drugs;    Antidepressants;    Antipsychotics;    Hypnotics;    Anxiolytics;    Anti-dementia drugs;   

DOI  :  10.1186/s12877-016-0287-1

 received in 2015-12-29, accepted in 2016-05-23,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundNeuropsychiatric symptoms, such as affective symptoms, psychosis, agitation, and apathy are common among nursing home patients with and without dementia. Treatment with one or more psychotropic drug is often without explicit clinical indication, despite low treatment efficacy, and potential side effects. We aim to investigate the multi-psychotropic drug use to identify factors and patient characteristics associated with multi-use.MethodsWe analysed three cohorts from 129 Norwegian nursing homes, collected between 2004 and 2011. Patients (N = 4739) were assessed with the Neuropsychiatric Inventory – Nursing Home version (NPI-NH), Clinical Dementia Rating scale, and Physical Self Maintenance Scale. We used ordinal logistic regression to analyse associations between psychotropics (antidepressants, antipsychotics, anxiolytics, hypnotics, and anti-dementia drugs), patient characteristics, and neuropsychiatric symptoms.ResultsPatients used on average 6.6 drugs; 27 % used no psychotropics, 32 % one, and 41 % multiple psychotropic drugs (24 % two, 17 % ≥3). Thirty-nine percent were prescribed antidepressants, 30 % sedatives, 24 % anxiolytics, and 20 % antipsychotics. The total NPI-NH score was associated with multi-use (OR 1.02, 95 % CI 1.02–1.03), and increased from a mean of 13.5 (SD 16.3) for patients using none, to 25.5 (21.8) for patients using ≥3 psychotropics. Affective symptoms (depression and anxiety) were most strongly associated with multi-psychotropic drug use (OR 1.10, 95 % CI: 1.09–1.12). Female gender, independency in daily living, younger age, dementia, and many regular drugs were also associated with multi-use.ConclusionForty-one percent were exposed to multi-psychotropic drug prescriptions. Contrary to current evidence and guidelines, there is an extensive use of multiple psychotropic drugs in patients with severe NPS and dementia.

【 授权许可】

CC BY   
© The Author(s). 2016