Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Home
  • Home
Article
  • Cited by 55

  • Get access
    Add to cart £25.00
    Check if you have access via personal or institutional login
    Log in Register

Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia

  • Renate M. Nijk (a1) (a2), Sytse U. Zuidema (a1) and Raymond T. C. M. Koopmans (a1)

Abstract

Background: Neuropsychiatric symptoms in dementia patients are common and are often treated with psychotropic drugs. The aim of this study was to determine the prevalence and correlates of psychotropic drug use in Dutch nursing home patients with dementia.

Methods: Psychotropic drug use of 1322 patients on 59 dementia special care units (SCUs) in 25 nursing homes was registered. Drugs were categorized according to the Anatomical Therapeutical Chemical classification (ATC). The influence of age, gender, dementia stage measured by the Global Deterioration Scale (GDS), and type of neuropsychiatric symptoms on psychotropic drug use was analyzed using binomial logistic regression analysis.

Results: 63% of the patients used at least one psychotropic drug. Psychotropics in general and antipsychotics in particular were most frequently prescribed in GDS stage 6, and in patients aged between 65 and 75 years. Psychotropics in general were positively associated with depression, night-time behavior and agitation. Antipsychotic drug use was positively associated with psychosis, agitation and night-time behavior and was negatively associated with apathy. Anxiolytics were associated with age, psychosis, agitation and night-time behavior. Antidepressants were most frequently prescribed in GDS stage 6 and associated with female gender, agitation and depression. Sedatives were only associated with night-time behavior.

Conclusion: Nursing home patients with dementia have a high prevalence of psychotropic drug use. In particular, the association with neuropsychiatric symptoms raises questions of efficacy of these drugs and the risk of chronic use.

Copyright

COPYRIGHT: © International Psychogeriatric Association 2009

Corresponding author

Correspondence should be addressed to: R. M. Nijk, van Neynselgroep, P.O Box 90112, 5200 MA, 's Hertogenbosch, The Netherlands. Phone: +31 (0)73 658 3000, Fax: +31 (0)73 680 3060. Email: r.nijk@vanneynsel.nl.

References

Hide All
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: Amercian Psychiatric Association.
Ballard, C. et al. (2008). A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD Trial). PLoS Medicine, 5, 587–599.
Brodaty, H., Draper, B., Saab, D., Low, L. F., Richards, V., Paton, H. and Lie, D. (2001). Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. International Journal of Geriatric Psychiatry, 16, 504–512.
Cohen-Mansfield, J. and Billig, N. (1986). Agitated behaviors in the elderly. I. A conceptual review. Journal of the American Geriatrics Society, 34, 711–721.
de Jonghe, J. F. and Kat, M. G. (1996). Factor structure and validity of the Dutch version of the Cohen-Mansfield Agitation Inventory (CMAI-D). Journal of the American Geriatrics Society, 44, 888–889.
Draper, B. et al. (2001). Use of psychotropics in Sydney nursing homes: associations with depression, psychosis, and behavioral disturbances. International Psychogeriatrics, 3, 107–120.
Fossey, J. et al. (2006). Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial. BMJ, 332, 756–761.
Kat, M. G., de Jonghe, J. F., Aalten, P., Kalisvaart, C. J., Droes, R. M. and Verhey, F. R. (2002). Neuropsychiatric symptoms of dementia: psychometric aspects of the Dutch Neuropsychiatric Inventory (NPI). Tijdschrift voor Gerontologie en Geriatrie, 33, 150–155 (in Dutch).
Kim, H. and Whall, A. L. (2006). Factors associated with psychotropic drug usage among nursing home residents with dementia. Nursing Research, 55, 252–258.
Lindesay, J., Matthews, R. and Jagger, C. (2003). Factors associated with antipsychotic drug use in residential care: changes between 1990 and 1997. International Journal of Geriatric Psychiatry, 18, 511–519.
Lövheim, 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.
Lyketsos, C. G., Steinberg, M., Tschanz, J. T., Norton, M. C., Steffens, D. C. and Breitner, J. C. (2000). Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging, American Journal of Psychiatry, 157, 708–714.
Macdonald, A. J., Carpenter, G. I., Box, O., Roberts, A. and Sahu, S. (2002). Dementia and use of psychotropic medication in non-“Elderly Mentally Infirm” nursing homes in South East England. Age and Ageing, 31, 58–64.
Nordic Council on Medicines. Guideline for ATC Classification (1990). Unpublished manuscript. Oslo: WHO Collaborating Center for Drugs Statistics Methodology.
Pitkälä, 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.
Ramadan, F. H., Naughton, B. J. and Prior, R. (2003). Correlates of behavioral disturbances and pattern of psychotropic medication use in five skilled nursing facilities. Journal of Geriatric Psychiatry and Neurology, 16, 8–14.
Reisberg, B., Ferris, S. H., de Leon, M. J. and Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.
Rochon, P. A. et al. (2008). Antipsychotic therapy and short-term serious events in older adults with dementia. Archives of Internal Medicine, 168, 1090–1096.
Schneider, L. S., Dagerman, K. S. and Insel, P. (2005). Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA, 294, 1934–1943.
Schneider, L. S. et al. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 1525–1538.
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.
Sink, K. M., Holden, K. F. and Yaffe, K. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA, 293, 596–608.
van Gool, W. A., Stam, C. J., Steenhoek, A. and Hagemeijer, A. (2006). The practice guideline “Diagnosis and pharmaceutical treatment of dementia”. Nederlands Tijdschrift van Geneeskunde, 150, 839–843 (in Dutch).
van Iersel, M. B., Zuidema, S. U., Koopmans, R. T. C. M., Verhey, F. R. J. and Olde Rikkert, M. G. M. (2005). Antipsychotics for behavioural and psychological problems in elderly people with dementia: a systematic review of adverse events. Drugs and Aging, 22, 845–858.
Ypma-Bakker, M. et al. . (2002). Guideline problem behaviour. Tijdschrift voor verpleeghuisgeneeskunde, 26, 5–31 (in Dutch).
World Health Organization (2005). Anatomical Therapeutical Chemical (ATC), Classification Index Including Daily Doses (DDD) for Plain Substances. Oslo: World Health Organization Collaborating Center for Drug Statistics Methodology.
Zuidema, S. U., Derksen, E., Verhey, F. R. J. and Koopmans, R. T. (2007a). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry. 22, 632–238.
Zuidema, S., Koopmans, R. and Verhey, F. (2007b). Prevalence and predictors of neuropsychiatric symptoms in cognitively impaired nursing home patients. Journal of Geriatric Psychiatry and Neurology, 20, 41–49.
Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2007c). 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.
Zuidema, S. U., de Jonghe, J. F., Verhey, F. R., and Koopmans, R. T. (2007d). 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.

Keywords

  • Cited by 55

  • Get access
    Add to cart £25.00
    Check if you have access via personal or institutional login
    Log in Register

Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia

  • Renate M. Nijk (a1) (a2), Sytse U. Zuidema (a1) and Raymond T. C. M. Koopmans (a1)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed