Determinants for the use of psychotropics among nursing home residents

Abstract

Purpose To characterise the prescription pattern of psychotropics in Danish nursing homes and to identify diagnostic, behavioural, cognitive and performance characteristics associated with prevalent psychotropic drug use. Methods Prescribed daily medication was recorded from nurses' files. Based on the Anatomical Therapeutical Chemical (ATC) classification index, psychotropics were categorised into neuroleptics, benzodiazepines and antidepressants. Two hundred and eight‐eight residents were diagnosed using the GMS–AGECAT. One hundred and eighteen staff members were interviewed about the residents's Activities of Daily Living (ADL), behavioural problems (Nursing Home Behavior Problem Scale), orientation, communication skills and if the resident had any psychiatric disorder. Multiple logistic regression was used to select the items that determined the use of psychotropics. Results Fifty‐six percent of the residents received a psychotropic, 21% received neuroleptics, 38% received benzodiazepines and 24% received antidepressants. In the multivariate analysis, staff assessment of the resident's mental health was a determinant for the use of all types of specific psychotropics, whereas a GMS–AGECAT diagnosis only determined the use of neuroleptics. Behavioural problems were a determinant for the use of neuroleptics and the use of benzodiazepines irrespective of the psychiatric diagnosis of the resident. Use of antidepressants was associated with male gender and increasing age. Conclusions Staff perceptions of psychiatric morbidity and norms have a greater impact on the prescription of psychotropics than standardised clinical criteria. Copyright © 2001 John Wiley & Sons, Ltd.

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.…”

“…Psychotic features, agitation, offensive behavior, nocturnal disturbances, better mobility, lower age and higher body mass index have all been found to correlate with an increased risk of being treated with antipsychotics in various studies. Cognitive function and activities of daily living (ADL) dependency correlated negatively in some and positively in others (Craig et al, 2003;Lindesay et al, 2003;Robertson et al, 2000;Sørensen et al, 2001). The complex process that leads to an old person with dementia being given antipsychotic treatment, however, remains far from being fully understood.…”

Factors influencing psychotropic prescription by non-psychiatrist physicians in a nursing home for the elderly in Brazil

“…These studies have reported a wide range of prevalence of psychotropic prescription (10-60%) and have mainly focused on the classes of psychotropics and prevalence of psychiatric morbidity among residents. 5 Moreover, although the presence of medical illness seems to negatively affect the identifi cation of psychiatric morbidity by general practitioners, 6 there is to our knowledge no systematic study examining how the prescription of non-psychotropic drugs may infl uence the non-psychiatrist physician's decision-making process for prescribing psychotropics for the elderly in developing countries.…”

“…This is in agreement with studies 3,5 examining the prevalence of the use of psychotropics among nursing home residents. These studies have reported rates ranging from 27% to 60%, which are higher than the rates of 9.3 to 30.6% found in community studies.…”

“…14 Prescribing decisions in nursing homes have raised concerns since evidence supporting them is generally absent. 15 In the present study, there was a signifi cant negative correlation between the number of prescribed psychotropics and age, which is in line with some previous studies, 5 but not all. 16,17 This fi nding appears to be counterintuitive, since some authors have reported a higher prevalence of mental disorders in the elderly.…”