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.

Does the Context Matter? Utilization of Sedative Drugs in Nursing Homes - A Multilevel Analysis

“…Reduced subjectively perceived competence' of the staff, more non-professionals (in relation to the number of beds) and an average high level of residents' disturbing behavior are associated with the regular use of sedative drugs. These findings indicate that the regular use of sedative drugs is part of an approach to the problem of managing the disturbing behavior of residents [28]. Contrary to what has been suggested by other studies [24,29], we cannot confirm that the use of psychotropic drugs is associated with a lower staff-resident ratio in general.…”

Does the Context Matter? Utilization of Sedative Drugs in Nursing Homes - A Multilevel Analysis

“…Reduced subjectively perceived competence' of the staff, more non-professionals (in relation to the number of beds) and an average high level of residents' disturbing behavior are associated with the regular use of sedative drugs. These findings indicate that the regular use of sedative drugs is part of an approach to the problem of managing the disturbing behavior of residents [28]. Contrary to what has been suggested by other studies [24,29], we cannot confirm that the use of psychotropic drugs is associated with a lower staff-resident ratio in general.…”

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

“…16,17 This fi nding appears to be counterintuitive, since some authors have reported a higher prevalence of mental disorders in the elderly. 5 This might be explained by the fact that mental disorders are often underdiagnosed and, consequently, undertreated among older people. 18 Alternatively, overconcern regarding the use of psychotropics among older residents and possible interactions involving psychotropics could at least in part account for this fi nding.…”

“…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.…”

Associations between conflictual relationships, psychopathology, and the use of psychotropic drugs among older people living in residential facilities

“…Although psychiatric symptoms rather than diagnoses were assessed in our survey, the prescription of psychotropic medications seemed to be relatively consistent with the psychiatric morbidity. This contrasts with previous studies that found only a minority of those prescribed psychotropic medications displayed specific mental disorders . Specifically, the use of antidepressants was associated with both clinical and subclinical depression.…”

Does the Context Matter? Utilization of Sedative Drugs in Nursing Homes - A Multilevel Analysis

“…Reduced subjectively perceived competence' of the staff, more non-professionals (in relation to the number of beds) and an average high level of residents' disturbing behavior are associated with the regular use of sedative drugs. These findings indicate that the regular use of sedative drugs is part of an approach to the problem of managing the disturbing behavior of residents [28]. Contrary to what has been suggested by other studies [24,29], we cannot confirm that the use of psychotropic drugs is associated with a lower staff-resident ratio in general.…”

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

“…16,17 This fi nding appears to be counterintuitive, since some authors have reported a higher prevalence of mental disorders in the elderly. 5 This might be explained by the fact that mental disorders are often underdiagnosed and, consequently, undertreated among older people. 18 Alternatively, overconcern regarding the use of psychotropics among older residents and possible interactions involving psychotropics could at least in part account for this fi nding.…”

“…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.…”

Associations between conflictual relationships, psychopathology, and the use of psychotropic drugs among older people living in residential facilities

“…Although psychiatric symptoms rather than diagnoses were assessed in our survey, the prescription of psychotropic medications seemed to be relatively consistent with the psychiatric morbidity. This contrasts with previous studies that found only a minority of those prescribed psychotropic medications displayed specific mental disorders . Specifically, the use of antidepressants was associated with both clinical and subclinical depression.…”

Does the Context Matter? Utilization of Sedative Drugs in Nursing Homes - A Multilevel Analysis

“…Reduced subjectively perceived competence' of the staff, more non-professionals (in relation to the number of beds) and an average high level of residents' disturbing behavior are associated with the regular use of sedative drugs. These findings indicate that the regular use of sedative drugs is part of an approach to the problem of managing the disturbing behavior of residents [28]. Contrary to what has been suggested by other studies [24,29], we cannot confirm that the use of psychotropic drugs is associated with a lower staff-resident ratio in general.…”

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

“…16,17 This fi nding appears to be counterintuitive, since some authors have reported a higher prevalence of mental disorders in the elderly. 5 This might be explained by the fact that mental disorders are often underdiagnosed and, consequently, undertreated among older people. 18 Alternatively, overconcern regarding the use of psychotropics among older residents and possible interactions involving psychotropics could at least in part account for this fi nding.…”

“…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.…”

Associations between conflictual relationships, psychopathology, and the use of psychotropic drugs among older people living in residential facilities

“…Although psychiatric symptoms rather than diagnoses were assessed in our survey, the prescription of psychotropic medications seemed to be relatively consistent with the psychiatric morbidity. This contrasts with previous studies that found only a minority of those prescribed psychotropic medications displayed specific mental disorders . Specifically, the use of antidepressants was associated with both clinical and subclinical depression.…”