Behavioral symptoms and the administration of psychotropic drugs to aged patients with dementia in nursing homes and in acute geriatric wards

Abstract

Objectives:To describe the prevalence of various psychiatric and behavioral symptoms among patients with dementia in nursing homes and acute geriatric wards and to investigate the administration of psychotropic medications to these patients.Methods: 425 consecutive patients (>70 years) in six acute geriatric wards in two city hospitals and seven nursing homes in Helsinki, Finland, were assessed with an extensive interview, cognitive tests, and attention tests. Of these, 255 were judged to have dementia according to the following information: previous dementia diagnoses and their adequacy, results of CT scans, Mini-mental State Examination (MMSE) tests, Clinical Dementia Scale (CDR) tests, and DSM-IV criteria. Psychiatric and behavioral symptoms were recorded over two weeks for each patient.Results: Psychiatric and behavioral symptoms were very common among patients with dementia in both settings. In all, 48% presented with psychotic symptoms (delusions, visual or auditory hallucinations, misidentifications or paranoid symptoms), 43% with depression, 26% agitation, and 26% apathy. Use of psychotropic drugs was also common: 87% were on at least one psychotropic drug, 66% took at least two, 36% at least three, and 11% four or more psychotropic drugs. Of the patients with dementia, 42% were on conventional antipsychotics, and 34% on anxiolytics despite their known side-effects. Only 13% were on atypical antipsychotics and 3% on cholinesterase inhibitors. The K. H. Pitkala et al.use of selective serotonin reuptake inhibitors (SSRIs) was common (31%) among the patients. A surprising finding was that drugs with anticholinergic effects were also frequently (20%) used. Conclusion:Both behavioural symptoms and use of psychotropic drugs are very common among dementia patients in institutional settings. The frequent use of potentially harmful drugs implies a need for education among physicians taking care of these patients.

Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care

“…The prevalence of antipsychotic medication in this study is in line with, or somewhat lower than, that reported previously (Craig et al, 2003;Pitkala et al, 2004;Sørensen et al, 2001). Different population characteristics and methodology make closer comparisons impossible.…”

“…These behaviors and psychological symptoms are very common in populations of old people with dementia and the prevalence of BPSD in different studies varies between 79% and approximately 92% (Brodaty et al, 2001;Margallo-Lana et al, 2001;Pitkala et al, 2004). Some of the symptoms increase the difficulty of caring for the person with dementia, and there is a correlation between BPSD and burden of care, and even with caregiver depression (Black and Almeida, 2004).…”

“…It is not uncommon in clinical practice for people with BPSD to be treated pharmacologically, often with antipsychotics (Margallo-Lana et al, 2001;Pitkala et al, 2004). The introduction of atypical antipsychotics, such as risperidone and olanzapine, has changed the treatment for this population, as they are more effective in controlling BPSD and have fewer and milder extrapyramidal side-effects (EPS) than conventional antipsychotics (Brodaty et al, 2003;De Deyn et al, 1999).…”

Fatores associados ao uso de psicofármacos em idosos asilados

“…O encontro frequente de prescrições com neurolépticos também foi observado em outros estudos 16,17 , havendo predomínio do uso de neurolépticos atípicos, como observado na presente casuística. A relação entre demência e consumo de neurolépticos, fato usual em ILPI, é dado relatado com constância [18][19][20][21] . Estudos demonstram que os institucionalizados cursam com maior prevalência de depressão, levando a uma maior utilização de antidepressivos, podendo chegar a 31,0% em algumas casuísticas, número maior se comparado ao presente estudo 20,22 .…”

“…A relação entre demência e consumo de neurolépticos, fato usual em ILPI, é dado relatado com constância [18][19][20][21] . Estudos demonstram que os institucionalizados cursam com maior prevalência de depressão, levando a uma maior utilização de antidepressivos, podendo chegar a 31,0% em algumas casuísticas, número maior se comparado ao presente estudo 20,22 . Deve-se, porém, enfatizar que o encontro de 17,7% de prescrições com fármacos antidepressivos nesta casuística não deve ser considerado como menor, visto que praticamente um em cada cinco institucionalizados utilizava esse grupo medicamentoso.…”