Hostname: page-component-cc8bf7c57-8cnds Total loading time: 0 Render date: 2024-12-12T01:48:57.124Z Has data issue: false hasContentIssue false
  • English
  • Français

Factors associated with appropriate psychotropic drug prescription in nursing home patients with severe dementia

Published online by Cambridge University Press:  21 September 2017

Klaas van der Spek ,
Raymond TCM Koopmans ,
Martin Smalbrugge ,
Marjorie HJMG Nelissen-Vrancken ,
Roland B Wetzels ,
Claudia HW Smeets ,
Steven Teerenstra ,
Sytse U Zuidema  and
Debby L Gerritsen
Klaas van der Spek*
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
Raymond TCM Koopmans
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands Joachim en Anna, center for specialized geriatric care, and Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
Martin Smalbrugge
Affiliation:
Department of General Practice and Elderly Care Medicine and Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
Marjorie HJMG Nelissen-Vrancken
Affiliation:
Dutch Institute for Rational Use of Medicine, Utrecht, The Netherlands
Roland B Wetzels
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
Claudia HW Smeets
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
Steven Teerenstra
Affiliation:
Department for Health Evidence, Group Biostatistics, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
Sytse U Zuidema
Affiliation:
Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
Debby L Gerritsen
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands Radboud Alzheimer Centre, Nijmegen, The Netherlands
*
Correspondence should be addressed to: Klaas van der Spek, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen Huispost 117 ELG, PO box 9101, 6500 HB Nijmegen, The Netherlands. Phone: +31641814811. E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

We studied the patient and non-patients factors of inappropriate psychotropic drug (PD) prescription for neuropsychiatric symptoms (NPS) in nursing home patients with severe dementia.

Methods:

In a cross-sectional study, the appropriateness of prescriptions was explored using the Appropriate Psychotropic drug use In Dementia (APID) index sum score. This index assesses information from medical records on indication, evaluation, dosage, drug–drug interactions, drug–disease interactions, duplications, and therapy duration. Various measurements were carried out to identify the possible patient and non-patient factors. Linear multilevel regression analysis was used to identify factors that are associated with APID index sum scores. Analyses were performed for groups of PDs separately, i.e. antipsychotics, antidepressants, anxiolytics, and hypnotics.

Results:

The sample consisted of 338 patients with a PD prescription that used 147 antipsychotics, 167 antidepressants, 85 anxiolytics, and 76 hypnotics. It was found that older patients and more severe aggression, agitation, apathy, and depression were associated with more appropriate prescriptions. Additionally, less appropriate prescriptions were found to be associated with more severe anxiety, dementia diagnoses other than Alzheimer dementia, more physician time available per patient, more patients per physician, more years of experience of the physician, and higher nurse's workload.

Conclusions:

The association of more pronounced NPS with more appropriate PD prescriptions implies that physicians should pay more attention to the appropriateness of PD prescriptions when NPS are less manifest. Non-patient-related factors are also associated with the appropriateness of PD prescriptions. However, especially considering that some of these findings are counter-intuitive, more research on the topic is recommended.

Keywords

dementiapsychopharmacologyneuropsychiatric symptoms
Type
Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 4: Issue Theme: Delirium , April 2018 , pp. 547 - 556
Copyright
Copyright © International Psychogeriatric Association 2017 

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

Ballard, C. et al. (2009). The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurology, Elsevier Ltd, 8, 151–157. doi: 10.1016/S1474-4422(08)70295-3.CrossRefGoogle ScholarPubMed
Bottiggi, K. A. et al. (2006). Long-term cognitive impact of anticholinergic medications in older adults. The American Journal of Geriatric Psychiatry, 14, 980–984.CrossRefGoogle ScholarPubMed
Chen, Y., Briesacher, B. A., Field, T. S., Tjia, J., Lau, D. T. and Gurwitz, J. H. (2010). Unexplained variation across US nursing homes in antipsychotic prescribing rates. Archives of Internal Medicine, 170, 89–95. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2897009&tool=pmcentrez&rendertype=abstract.CrossRefGoogle ScholarPubMed
Cioltan, H. et al. (2017). Variation in use of antipsychotic medications in nursing homes in the United States: a systematic review. BMC Geriatrics, 17, 32. Available from: http://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-017-0428-1CrossRefGoogle ScholarPubMed
Foebel, A. et al. (2015). A retrospective, longitudinal study of factors associated with new antipsychotic medication use among recently admitted long-term care residents. BMC Geriatrics, 15, 128. doi: 10.1186/s12877-015-0127-8.CrossRefGoogle ScholarPubMed
Gallagher, P., Ryan, C., Byrne, S., Kennedy, J. and O'Mahony, D. (2008). STOPP (screening tool of older Person's prescriptions) and START (screening tool to alert doctors to right treatment). Consensus validation. International Journal of Clinical Pharmacological Therapy, 46, 72–83.CrossRefGoogle ScholarPubMed
Gulla, C., Selbaek, G., Flo, E., Kjome, R., Kirkevold, Ø. and Husebo, B. S. (2016). Multi-psychotropic drug prescription and the association to neuropsychiatric symptoms in three Norwegian nursing home cohorts between 2004 and 2011. BMC Geriatrics, 16, 115. doi: 10.1186/s12877-016-0287-1.CrossRefGoogle ScholarPubMed
Gustafsson, M., Karlsson, S. and Lövheim, H. (2013). Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units. BMC Pharmacology & Toxicology, 14, 10. doi: 10.1186/2050-6511-14-10.CrossRefGoogle ScholarPubMed
Hanlon, J. T. et al. (1992). A method for assessing drug therapy appropriateness. Journal of Clinical Epidemiology, 45, 1045–1051.CrossRefGoogle ScholarPubMed
Harrell, F. E. Jr. (2015). Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis. Springer series in statistics (p. 585). Switzerland: Springer International Publishing AG.CrossRefGoogle Scholar
Holmes, C. and Badrakalimuthu, V. R. (2015). Guidelines: Managing Behaviour Problems in Patients with Dementia Version: 3. NHS Foundation Trust.Google Scholar
Jonge, J. de and Landeweerd, J. A. (1993). Toetsing van de job demand-control benadering bij werknemers demand-control, in de gezondheidszorg: een secundaire data-analyse [Testing of the Job approach among health care workers: a secondary analysis]. Gedrag en Organisatie, 6, 79–92.Google Scholar
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 Aging, Adis International, 26, 483–492. doi: 10.2165/00002512-200926060-00005.CrossRefGoogle ScholarPubMed
Kaufer, D. I. et al. (2000). Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. The Journal of Neuropsychiatry and Clinical Neurosciences, 12, 233–239. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11001602.CrossRefGoogle ScholarPubMed
Kröger, E. et al. (2005). Medication use among nursing home residents with severe dementia: identifying categories of appropriateness and elements of a successful intervention. Journal of the American Medical Directors Association, Elsevier Inc. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1525861015002546Google Scholar
Laffon de Mazières, C., Lapeyre-Mestre, M., Vellas, B., de Souto Barreto, P. and Rolland, Y. (2015). Organizational factors associated with inappropriate neuroleptic drug prescribing in nursing homes: a multilevel approach. Journal of the American Medical Directors Association, Elsevier Inc., 16, 590–597. doi: 10.1016/j.jamda.2015.01.092.CrossRefGoogle ScholarPubMed
Landeweerd, J. A., Boumans, N. P. G. and Nissen, J. M. F. (1996). De Maastrichtse Arbeidssatisfactie Schaal voor de GezondheidsZorg (MAS-GZ) [The Maastricht Work Satisfaction Scale for Healthcare (MAS-GZ)]. In Van Beek, C. C., Van Dorsten, T. G. and Stam, G. J. (eds.), Handboek Verpleegkundige Innovatie (pp. D250-3–D250-6). Houten: Bohn Stafleu.Google Scholar
Lintern, T. (2001). Quality in dementia care: evaluating staff attitudes and behaviour. Alzheimer Disease & Associated Disorders, 20, 15–16.Google Scholar
Lucas, J. A. et al. (2014). Antipsychotic medication use in nursing homes: a proposed measure of quality. International Journal of Geriatric Psychiatry, 29, 1049–1061. doi: 10.1002/gps.4098.CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence (2016) Dementia: supporting people with dementia and their carers in health and social care. Clinical Guideline (CG42). Available at: http://nice.org.uk/guidance/cg42; last accessed 11 September 2017.Google Scholar
Nordic Council on Medicines: Guidelines for ATC classification (1990). WHO Collaborating Center for Drugs Statistics Methodology, Oslo.Google Scholar
Orrung Wallin, A., Edberg, A. K., Beck, I. and Jakobsson, U. (2013). Psychometric properties concerning four instruments measuring job satisfaction, strain, and stress of conscience in a residential care context. Archives of Gerontology and Geriatrics, 57, 162–171.CrossRefGoogle Scholar
Seitz, D. P. et al. (2012). Efficacy and feasibility of nonpharmacological interventions for neuropsychiatric symptoms of dementia in long term care: a systematic review. Journal of the American Medical Directors Association, 13, 503–506 e2. doi: 10.1016/j.jamda.2011.12.059.CrossRefGoogle ScholarPubMed
Selbaek, G., Kirkevold, Ø. 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
Smalbrugge, M. et al. (2008). “Probleemgedrag” Guideline. Available at: verenso.nl/assets/Uploads/Downloads/Richtlijnen/VER00316Probleemgedragherzien02.pdf; last accessed 11 September 2017.Google Scholar
Smeets, C. H. et al. (2014). Factors related to psychotropic drug prescription for neuropsychiatric symptoms in nursing home residents with dementia. JAMDA, 15, 835–840.Google ScholarPubMed
Smeets, C. H. et al. (2017). Psychotropic drug prescription for nursing home residents with dementia: prevalence and associations with non-resident-related factors. Aging & Mental Health. Epublished ahead of print. doi: 10.1080/13607863.2017.1348469.Google ScholarPubMed
Stevenson, D. G. et al. (2011). Antipsychotic and benzodiazepine use among nursing home residents: findings from the 2004 national nursing home survey. The American Journal of Geriatric Psychiatry, 18, 1078–1092. doi: 10.1097/JGP.0b013e3181d6c0c6.Antipsychotic.CrossRefGoogle Scholar
van der Spek, K. et al. (2013). PROPER I: frequency and appropriateness of psychotropic drugs use in nursing home patients and its associations: a study protocol. BMC Psychiatry, 13, 307. doi: 10.1186/1471-244X-13-307.CrossRefGoogle ScholarPubMed
van der Spek, K. et al. (2015). A reliable and valid index was developed to measure appropriate psychotropic drug use in dementia. Journal of Clinical Epidemiology, Elsevier Inc., 68, 903–912. doi: 10.1016/j.jclinepi.2015.03.012.CrossRefGoogle ScholarPubMed
van der Spek, K. et al. (2016). Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-study. International Psychogeriatrics, 28, 1589–1595.CrossRefGoogle ScholarPubMed
Wetzels, R. B., Zuidema, S. U., De Jonghe, J. F. M., Verhey, F. R. J. and Koopmans, R. T. C. M. (2011). Prescribing pattern of psychotropic drugs in nursing home residents with dementia. International Psychogeriatrics, 23, 1249–1259. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21682938.CrossRefGoogle ScholarPubMed
Wood-Mitchell, A., James, I. A., Waterworth, A., Swann, A. and Ballard, C. (2008). Factors influencing the prescribing of medications by old age psychiatrists for behavioural and psychological symptoms of dementia: a qualitative study. Age and Ageing, 37, 547–552. doi: 10.1093/ageing/afn135.CrossRefGoogle ScholarPubMed
Zuidema, S. U. et al. (2011). Assessing neuropsychiatric symptoms in nursing home patients with dementia: reliability and reliable change index of the neuropsychiatric inventory and the Cohen-Mansfield agitation inventory. International Journal of Geriatric Psychiatry, 26, 127–134. doi: 10.1002/gps.2499.CrossRefGoogle ScholarPubMed
Zuidema, S. U., De Jonghe, J. F. M., Verhey, F. R. J. and Koopmans, R. T. C. M. (2007). 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. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17641527.CrossRefGoogle ScholarPubMed
Zuidema, S. U., de Jonghe, J. F. M., Verhey, F. R. J. and Koopmans, R. T. C. M. (2010). Environmental correlates of neuropsychiatric symptoms in nursing home patients with dementia. International Journal of Geriatric Psychiatry, 25, 14–22. doi: 10.1002/gps.2292.CrossRefGoogle ScholarPubMed
Zuidema, S. U., De Jonghe, J. F. M., Verhey, F. R. J. and Koopmans, R. T. C. M. (2011). Psychotropic drug prescription in nursing home patients with dementia: influence of environmental correlates and staff distress on physicians’ prescription behavior. International Psychogeriatrics, 1–8. doi: 10.1017/S1041610211001438.Google ScholarPubMed
Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2007). 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. doi: 96681 [pii].CrossRefGoogle ScholarPubMed