Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-30T23:28:21.627Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  16 April 2009

Renate M. Nijk ,
Sytse U. Zuidema  and
Raymond T. C. M. Koopmans
Renate M. Nijk*
Affiliation:
Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands van Neynselgroep, 's Hertogenbosch, The Netherlands
Sytse U. Zuidema
Affiliation:
Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands
Raymond T. C. M. Koopmans
Affiliation:
Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands
*
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: [email protected].
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

dementianeuropsychiatric symptomsnursing homepsychotropic drug useantipsychoticsantidepressantsbehavioral and psychological symptoms of dementia
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 3 , June 2009 , pp. 485 - 493
Copyright
Copyright © International Psychogeriatric Association 2009

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 Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: Amercian Psychiatric Association.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Draper, B. et al. (2001). Use of psychotropics in Sydney nursing homes: associations with depression, psychosis, and behavioral disturbances. International Psychogeriatrics, 3, 107–120.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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).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
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Nordic Council on Medicines. Guideline for ATC Classification (1990). Unpublished manuscript. Oslo: WHO Collaborating Center for Drugs Statistics Methodology.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.Google ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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
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.CrossRefGoogle ScholarPubMed
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).Google ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Ypma-Bakker, M. et al. . (2002). Guideline problem behaviour. Tijdschrift voor verpleeghuisgeneeskunde, 26, 5–31 (in Dutch).Google Scholar
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.Google Scholar
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed