Hostname: page-component-76fb5796d-qxdb6 Total loading time: 0 Render date: 2024-04-26T19:38:01.661Z Has data issue: false hasContentIssue false
  • English
  • Français

Prescribing pattern of psychotropic drugs in nursing home residents with dementia

Published online by Cambridge University Press:  20 June 2011

R. B. Wetzels ,
S. U. Zuidema ,
J. F. M. de Jonghe ,
F. R. J. Verhey  and
R. T. C. M. Koopmans
R. B. Wetzels*
Affiliation:
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands Care Center Rivierenland Foundation, Tiel, the Netherlands
S. U. Zuidema
Affiliation:
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
J. F. M. de Jonghe
Affiliation:
Geriatric Medicine, Medical Center Alkmaar, Alkmaar, the Netherlands
F. R. J. Verhey
Affiliation:
Alzheimer Center Limburg/Institute of Mental Health and Neurosciences, Maastricht UMC, Maastricht, the Netherlands
R. T. C. M. Koopmans
Affiliation:
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
*
Correspondence should be addressed to: Roland B. Wetzels, MD, Radboud University Nijmegen, Medical Centre, Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Code 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands. Phone: +31-24-3618834; Fax: +31-24-3619558. Email: r.wetzels@elg.umcn.nl.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: The goal of this study is to determine patterns of psychotropic drug use (PDU), the association with neuropsychiatric symptoms (NPS), and the variability across dementia types in nursing home residents with dementia. In addition, PDU was analyzed across multiple indications.

Methods: This was a prospective cohort study over a two-year period from 2006 to 2008, which involved 14 dementia special care units in nine nursing homes. A total of 117 residents with dementia participated in the study, of whom 35% had Alzheimer's dementia (AD) and 11% vascular dementia (VaD). PDU was classified according to anatomical therapeutic chemical-classification as either “present” or “absent”.

Results: The majority of residents had moderately severe to severe dementia. At all successive assessments, almost two-thirds of residents received any psychotropic drug (PD) and almost one-third continued to receive any PD. Of all PDs, antipsychotics (APs) were prescribed most frequently. Fewer residents started with antidepressants, but continued to receive antidepressants at higher percentages. Anxiolytics showed an intermittent course, but a subgroup of 9% showed two-year continuation. Once started on PDs at baseline, residents continued to use PDs at high percentages: three-quarters continued to receive APs for at least six months. Half of residents received at least one PD; one-fifth received at least two PDs simultaneously. Residents with AD received more hypnotics and antidementia drugs; residents with VaD received more antipsychotics, antidepressants, anxiolytics and anticonvulsants.

Conclusions: PDs have different utilization patterns, but overall, consistently high continuation rates were found. These results warrant scrutiny of continuous PDU.

Keywords

persistencehigh prescription ratedifferent patterns of prescription
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 8 , October 2011 , pp. 1249 - 1259
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Geriatrics Society and American Association for Geriatric Psychiatry (2003). Consensus statement of improving the quality of mental health care in U.S. nursing homes: management of depression and behavioral symptoms associated with dementia. Journal of the American Geriatrics Society, 51, 1287–1298.CrossRefGoogle Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.Google Scholar
Ayalon, L., Gum, A. M., Feliciano, L. and Arean, P. A. (2006). Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review. Archives of Internal Medicine, 166, 2182–2188.CrossRefGoogle ScholarPubMed
Ayalon, L., Arean, P., Bornfeld, H. and Beard, R. (2009). Long-term care staff beliefs about evidence based practices for the management of dementia and agitation. International Journal of Geriatric Psychiatry, 24, 118–124.CrossRefGoogle ScholarPubMed
Ballard, C. et al. (2001). A one-year follow-up study of behavioral and psychological symptoms in dementia among people in care environments. Journal of Clinical Psychiatry, 62, 631–636.CrossRefGoogle Scholar
Ballard, C. G. et al. (2009). Management of agitation and aggression associated with Alzheimer disease. Nature Reviews: Neurology, 5, 245–255.Google ScholarPubMed
CBO (2005). Guideline Diagnosis and Pharmacological Treatment of Dementia. Utrecht: Nederlandse Vereniging voor Klinische Geriatrie. Available at: http://www.cbo.nl/Downloads/387/rl_dement_2005.pdf; last accessed January 2010.Google Scholar
Chen, Y. et al. (2010). Unexplained variation across US nursing homes in antipsychotic prescribing rates. Archives of Internal Medicine, 170, 89–95.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. and Jensen, B. (2008). Nursing home physicians’ knowledge of and attitudes toward nonpharmacological interventions for treatment of behavioral disturbances associated with dementia. Journal of the American Medical Directors Association, 9, 491–498.CrossRefGoogle ScholarPubMed
CSM (2004). Atypical Antipsychotic Drugs and Stroke. London: Committee for Safety of Medicines.Google Scholar
Cummings, J. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, S10–S16.CrossRefGoogle ScholarPubMed
Cummings, J. et al. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
de Jonghe, J. F., Wetzels, R. B., Mulders, A., Zuidema, S. U. and Koopmans, R. T. (2009). Validity of the Severe Impairment Battery short version. Journal of Neurology, Neurosurgery and Psychiatry, 80, 954–959.CrossRefGoogle ScholarPubMed
Dorsey, E. R., Rabbani, A., Gallagher, S. A., Conti, R. M. and Alexander, G. C. (2010). Impact of FDA black box advisory on antipsychotic medication use. Archives of Internal Medicine, 170, 96–103.CrossRefGoogle ScholarPubMed
Eggermont, L. H., de Vries, K. and Scherder, E. J. (2009). Psychotropic medication use and cognition in institutionalized older adults with mild to moderate dementia. International Psychogeriatrics, 21, 286–294.CrossRefGoogle ScholarPubMed
FDA (2008). FDA Requests Boxed Warnings on Older Class of Antipsychotic Drugs. FDA Alert 16 June. Washington, DC: Food and Drug Administration. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116912.htm.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Furniss, L., Craig, S. K. and Burns, A. (1998). Medication use in nursing homes for elderly people. International Journal of Geriatric Psychiatry, 13, 433–439.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
Howard, R., Ballard, C., O'Brien, J. and Burns, A. (2001). Guidelines for the management of agitation in dementia. International Journal of Geriatric Psychiatry, 16, 714–717.CrossRefGoogle ScholarPubMed
Kamble, P., Chen, H., Sherer, J. T. and Aparasu, R. R. (2009). Use of antipsychotics among elderly nursing home residents with dementia in the US: an analysis of national survey data. Drugs and Aging, 26, 483–492.CrossRefGoogle ScholarPubMed
Kamble, P., Sherer, J., Chen, H. and Aparasu, R. (2010). Off-label use of second-generation antipsychotic agents among elderly nursing home residents. Psychiatric Services, 61, 130–136.CrossRefGoogle ScholarPubMed
Kat, M. G. et al. (2002). [Neuropsychiatric symptoms of dementia: psychometric aspects of the Dutch Neuropsychiatric Inventory (NPI)]. Tijdschrift voor Gerontologie en Geriatrie, 33, 150–155.Google ScholarPubMed
Kim, H. and Whall, A. L. (2006). Factors associated with psychotropic drug usage among nursing home residents with dementia. Nursing Research, 55, 252–258.CrossRefGoogle ScholarPubMed
Kim, J. M., Lyons, D., Shin, I. S. and Yoon, J. S. (2003). Differences in the behavioral and psychological symptoms between Alzheimer's disease and vascular dementia: are the different pharmacologic treatment strategies justifiable? Human Psychopharmacology, 18, 215–220.CrossRefGoogle ScholarPubMed
Koopmans, R. T. et al. (1996). Psychotropic drug use in a group of Dutch nursing home patients with dementia: many users, long-term use, but low doses. Pharmarcy World and Science, 18, 42–47.CrossRefGoogle Scholar
Lee, P. et al. (2004). Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review. BMJ, 329, 75.CrossRefGoogle ScholarPubMed
Lovheim, H., Sandman, P. O., Kallin, K., Karlsson, S. and Gustafson, Y. (2006). Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care. International Psychogeriatrics, 18, 713–726.CrossRefGoogle ScholarPubMed
Margallo-Lana, M. et al. (2001). Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments. International Journal of Geriatric Psychiatry, 16, 39–44.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Marshall, M. (2001). The challenge of looking after people with dementia. BMJ, 323, 410–411.CrossRefGoogle ScholarPubMed
McGrath, A. M. and Jackson, G. A. (1996). Survey of neuroleptic prescribing in residents of nursing homes in Glasgow. BMJ, 312, 611–612.CrossRefGoogle ScholarPubMed
McKhann, G. et al. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Nijk, R. M., Zuidema, S. U. and Koopmans, R. T. (2009). Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia. International Psychogeriatrics, 21, 485–493.CrossRefGoogle ScholarPubMed
Nordic Council on Medicines (1990). Guidelines for ATC Classification. WHO Collaborating Center for Drugs Statistics Methodology. Oslo: Nordic Council on Medicines.Google Scholar
Pitkala, K. H., Laurila, J. V., Strandberg, T. E. and Tilvis, R. S. (2004). Behavioral symptoms and the administration of psychotropic drugs to aged patients with dementia in nursing homes and in acute geriatric wards. International Psychogeriatrics, 16, 61–74.CrossRefGoogle ScholarPubMed
Pollock, B. G. et al. (2007). A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia. American Journal of Geriatric Psychiatry, 15, 942–952.CrossRefGoogle ScholarPubMed
Reisberg, B., Ferris, S., de Leon, M. and Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.Google ScholarPubMed
Román, G. C. et al. (1993). Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology, 43, 250–260.CrossRefGoogle ScholarPubMed
Ruths, S., Straand, J. and Nygaard, H. A. (2001). Psychotropic drug use in nursing homes–diagnostic indications and variations between institutions. European Journal of Clinical Pharmacology, 57, 523–528.Google ScholarPubMed
Salzman, C. et al. (2008). Elderly patients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy. Journal of Clinical Psychiatry, 69, 889–898.CrossRefGoogle ScholarPubMed
Sanfelix-Gimeno, G. et al. (2009). Effectiveness of safety warnings in atypical antipsychotic drugs: an interrupted time-series analysis in Spain. Drug Safety, 32, 1075–1087.CrossRefGoogle ScholarPubMed
Saxton, J. et al. (2005). Development of a short form of the Severe Impairment Battery. American Journal of Geriatric Psychiatry, 13, 999–1005.CrossRefGoogle Scholar
Selbaek, G., Kirkevold, O. and Engedal, K. (2007). The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 22, 843–849.CrossRefGoogle ScholarPubMed
Selbaek, G., Kirkevold, O. and Engedal, K. (2008). 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. American Journal of Geriatric Psychiatry, 16, 528–536.CrossRefGoogle ScholarPubMed
Smalbrugge, M. et al. (2008). Guideline Problem Behavior. Utrecht: NVVA.Google Scholar
Trifiro, G. et al. (2010). Prescribing pattern of antipsychotic drugs in the Italian general population, 2000–2005: a focus on elderly with dementia. International Clinical Psychopharmacology, 25, 22–28.CrossRefGoogle ScholarPubMed
Wang, L. Y. et al. (2009). Prazosin for the treatment of behavioral symptoms in patients with Alzheimer disease with agitation and aggression. American Journal of Geriatric Psychiatry, 17, 744–751.CrossRefGoogle ScholarPubMed
Wetzels, R. B., Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2010). Course of neuropsychiatric symptoms in residents with dementia in nursing homes over 2-year period. American Journal of Geriatric Psychiatry, 18, 1054–1065.CrossRefGoogle ScholarPubMed
Wilcock, G. K., Ballard, C. G., Cooper, J. A. and Loft, H. (2008). Memantine for agitation/aggression and psychosis in moderately severe to severe Alzheimer's disease: a pooled analysis of 3 studies. Journal of Clinical Psychiatry, 69, 341–348.CrossRefGoogle ScholarPubMed
Wood, S. et al. (2000). The use of the neuropsychiatric inventory in nursing home residents: characterization and measurement. American Journal of Geriatric Psychiatry, 8, 75–83.CrossRefGoogle ScholarPubMed
Woolcott, J. C. et al. (2009). Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Archives of Internal Medicine, 169, 1952–1960.CrossRefGoogle ScholarPubMed
Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2007a). Agitation in Dutch institutionalized patients with dementia: factor analysis of the Dutch version of the Cohen-Mansfield Agitation Inventory. Dementia and Geriatric Cognitive Disorders, 23, 35–41.CrossRefGoogle ScholarPubMed
Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2007b). Neuropsychiatric symptoms in nursing home patients: factor structure invariance of the Dutch nursing home version of the Neuropsychiatric Inventory in different stages of dementia. Dementia and Geriatric Cognitive Disorders, 24, 169–176.CrossRefGoogle ScholarPubMed
Zuidema, S. U., Derksen, E., Verhey, F. R. and Koopmans, R. T. (2007c). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632–638.CrossRefGoogle Scholar