Antipsychotic drug use in nursing home residents with and without dementia

Allers, Katharina; Dörks, Michael; Schmiemann, Guido; Hoffmann, Falk

doi:10.1097/yic.0000000000000173

Cited by 20 publications

(20 citation statements)

References 22 publications

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“…Disruption in the responses to legionellosis, influenza A, and Staphylococcus aureus infection, all of which are significant causes of morbidity and mortality in nursing home residents [58][59][60], are also predictable. Off-label antipsychotic drug use in nursing homes has been reported to be as high as 37% of patients (with and without dementia) [61]. Taken together, this suggests that 1 in 3 nursing home residents would be at elevated risk for infections specifically known to cause adverse outcomes in their population.…”

Section: Fig 5 Immune Dysregulation and Infectious Disease Susceptibmentioning

confidence: 99%

The antipsychotic medication, risperidone, causes global immunosuppression in healthy mice

et al. 2019

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Atypical antipsychotic medications such as risperidone are widely prescribed for diverse psychiatric indications including schizophrenia, bipolar disorder and depression. These medications have complex pharmacology and are associated with significant endocrine and metabolic side effects. This class of medications also carries FDA black box warnings due to increased risk of death in elderly patients. Clinical reports indicate that patients treated with these medications are more susceptible to infections; however, the underlying mechanisms/pharmacology are unclear. We have previously reported that risperidone and it's active metabolite distributes to the bone marrow in clinically relevant concentrations in preclinical species, leading us to hypothesize that the hematopoietic system may be impacted by these medications. To test this hypothesis, using proteomic and cytokine array technology, we evaluated the expression of genes involved in inflammatory and immune function following short term (5 days) and longer term (4 weeks) treatment in healthy animals. We report that low-dose risperidone treatment results in global immunosuppression in mice, observed following 5 days of dosing and exacerbated with longer term drug treatment (4 weeks). These data are consistent with increased susceptibility to infection in patients administered these medications and have profound implications for the increasing off-label prescribing to vulnerable patient populations including children and the elderly.

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Section: Fig 5 Immune Dysregulation and Infectious Disease Susceptibmentioning

confidence: 99%

The antipsychotic medication, risperidone, causes global immunosuppression in healthy mice

et al. 2019

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“…The selected studies comprised three studies from Australia [37,43,44], one from the USA [38], one from Norway [39], one from Canada [40], and two from Germany [41,42]. They were all published in English except one that was in Norwegian [39].…”

Section: Description Of the Selected Studiesmentioning

confidence: 99%

“…They were all published in English except one that was in Norwegian [39]. Most studies used quantitative methods, including cross-sectional surveys [37,39,41,42,44], a secondary analysis of a prospective cohort [40], and a prospective longitudinal intervention study [43]. There was one qualitative study of interviews and documentations [38].…”

Section: Description Of the Selected Studiesmentioning

confidence: 99%

“…In addition, variations in reporting PRN medications in terms of percentages and means hindered comparison of the studies' findings and derivation of a single overall figure. Prevalence ranged from 1.1% of prescriptions [39] to 35.9% of prescriptions [42], depending on residents' underlying conditions. Additionally, a few studies provided data on the actual administration of prescribed PRN medications, rather than prescriptions.…”

Section: Prevalence and Type Of Prn Prescription And Administrationmentioning

confidence: 99%

“…While demographic characteristics of residents in terms of age and gender were not associated with PRN prescription and administration, higher numbers of PRN medications were associated with increased use of long-term medications (7.4 ± 3.5) and a longer duration of stay (4.8 ± 4.3 years). Dementia diagnosis and older age were associated with more PRN medication prescription and administration [41,42]. Additionally, a longer stay, above the median of 2.1 years, was associated with 2.38 more PRN medications [41].…”

Section: Factors Affecting Prn Medicines Managementmentioning

confidence: 99%

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PRN Medicines Management for Psychotropic Medicines in Long-Term Care Settings: A Systematic Review

et al. 2019

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Many medications are prescribed and administered PRN (pro re nata, as needed). However, there are few integrative reviews to inform PRN psychotropic medication use in long-term care facilities and nursing or care homes. Accordingly, this integrative systematic review aimed to improve our understanding of PRN medicines management with a focus on psychotropic medications (antipsychotics, sedatives, anxiolytics, and hypnotics) in long-term care settings. Keywords relating to PRN in English, Norwegian, and Spanish were used, and articles published between 2009 and 2019 were retrieved. Based on the inclusion criteria, eight articles were used for data analysis and synthesis. This review offers a description of PRN prescription and administration of psychotropic medications in long-term care. Variations were observed in the management of PRN psychotropic medications based on residents’ underlying health conditions and needs, duration of use, and changes between medications and doses. Neither the reasons for PRN prescription and administration nor the steps taken to identify and manage any associated adverse reactions or adverse drug events were reported. Further initiatives are needed to improve PRN medicines management to explore factors that affect PRN prescription and administration and to develop appropriate PRN guidelines to prevent harm and improve the safety of people living in long-term care facilities.

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Krankenhausaufenthalte von Pflegeheimbewohnern in der letzten Lebensphase: eine Analyse von Krankenkassenroutinedaten

Hoffmann

Allers

2020

Z Gerontol Geriat

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Zusammenfassung Hintergrund Im internationalen Vergleich versterben Pflegeheimbewohner in Deutschland häufig im Krankenhaus. Daten zu längeren Zeiträumen vor dem Tod und zu regionalen Unterschieden fehlen. Ziel der Arbeit Es werden Häufigkeiten von Krankenhausaufenthalten bei Pflegeheimbewohnern in verschiedenen Perioden vor dem Tod analysiert. Zudem werden Unterschiede nach Alter, Geschlecht, Pflegestufe, Demenz und Bundesländern untersucht. Material und Methoden Wir verwendeten Daten einer großen Krankenkasse und schlossen Pflegeheimbewohner im Mindestalter von 65 Jahren ein, die zwischen dem 01.01.2010 und dem 31. 12.2014 verstarben. Outcome war mindestens ein Krankenhausaufenthalt nach Heimeintritt in verschiedenen Phasen des letzten Lebensjahres. Vertiefende Analysen wurden für die Zeiträume 0 (entspricht Versterben im Krankenhaus), 28 und 365 Tage vor Tod durchgeführt. Ergebnisse Von den insgesamt 67.328 verstorbenen Bewohnern (mittleres Alter: 85,3 Jahre; 69,8 % weiblich), verstarben 29,5 % im Krankenhaus. In den letzten 28 bzw. 365 Tagen vor Tod hatten 51,5 % bzw. 74,3 % mindestens einen Krankenhausaufenthalt. Diese Werte waren in ostdeutschen Bundesländern höher. In allen Zeiträumen wurden Männer häufiger hospitalisiert. Bewohner mit höherer Pflegestufe wurden seltener stationär behandelt, besonders unmittelbar vor dem Tod. Demenz hatte keinen nennenswerten Einfluss auf die Hospitalisierungshäufigkeiten. Diskussion Etwa die Hälfte der Pflegeheimbewohner wird im letzten Lebensmonat stationär behandelt, und ein Drittel verstirbt im Krankenhaus, was, international betrachtet, hoch ist. Dass wir keine Unterschiede bei Bewohnern mit und ohne Demenz fanden, widerspricht ebenso internationalen Befunden. Somit besteht erheblicher Handlungsbedarf, die palliative Versorgung von Pflegeheimbewohnern zu optimieren.

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Antipsychotic drug use in nursing home residents with and without dementia

Cited by 20 publications

References 22 publications

The antipsychotic medication, risperidone, causes global immunosuppression in healthy mice

The antipsychotic medication, risperidone, causes global immunosuppression in healthy mice

PRN Medicines Management for Psychotropic Medicines in Long-Term Care Settings: A Systematic Review

Krankenhausaufenthalte von Pflegeheimbewohnern in der letzten Lebensphase: eine Analyse von Krankenkassenroutinedaten

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