Factors Related to Psychotropic Drug Prescription for Neuropsychiatric Symptoms in Nursing Home Residents With Dementia

Is an unhealthy work environment in nursing home care for people with dementia associated with the prescription of psychotropic drugs and physical restraints?

“…Staff's mindset and knowledge have indeed been found to be of influence on the prescription of psychotropic drugs according to nurses and physicians. 13 For example, it was found in this qualitative study that nurses can have unfounded high expectations of the effectiveness of psychotropic drugs for neuropsychiatric symptoms which induces psychotropic drug description. In line with this finding, a recent review focusing on attitudes of nurses towards the use of physical restraints in geriatric care concluded that, even now that the use is restricted by law in many countries, nurses attitudes seem to be unchanged and they still have insufficient knowledge of its effectiveness, alternatives and reasons for not using them.…”

“…10,11 Consequently, the use of psychotropic drugs and physical restraints can only be justified when no alternatives are available and there is a presence or expectancy of danger. 12 Findings from earlier studies, however, show that psychotropic drugs are still frequently used in 52% to 80% of nursing home residents with dementia 13 , and physical restraints in 6% to 31% of nursing home residents in general. 14 Great differences have been found in the use of psychotropic drugs and physical restraints among nursing home facilities, even when controlled for resident characteristics.…”

General practitioners' knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia: A mixed‐methods systematic review

“…Other models of care, such as that in The Netherlands where specially trained elderly care physicians provide care to nursing home residents, were excluded from this review. However, it was reassuring to find that many of the findings from studies conducted with physicians working in the Dutch model of nursing home care concurred with our review findings …”

Psychotropic drug prescription for nursing home residents with dementia: prevalence and associations with non-resident-related factors

“…Selection of measures. For operationalization of non-resident-related factors, we used results of the previously conducted qualitative analysis of the PROPER I study (Smeets et al, 2014). We opted to analyze specifically those (sub)scales among the quantitative data, fitting in the four themes contributing to PD prescription, after critical review and consensus among the co-authors: (1) Mindset, e.g.…”

“…Higher staff distress due to residents' agitation (Zuidema et al, 2011) and factors such as a larger facility (Kleijer et al, 2014), lower staff/resident ratio (Kim & Whall, 2006;Testad et al, 2010;Zuidema et al, 2011), and lower resident satisfaction of the number of staff, of personal care, and of recreational activities (Kleijer et al, 2014) are related to higher PD prescription. Also, qualitative studies have sought to elucidate additional factors (Cohen-Mansfield et al, 2005;Cornege-Blokland, Kleijer, Hertogh, & Van Marum, 2012;Smeets et al, 2014;Wood-Mitchell, James, Waterworth, Swann, & Ballard, 2008) and underpinned the need to explore the prescribing culture (Bonner et al, 2015). These studies point at an important share of psychosocial nonresident-related factors, including feeling powerless toward NPS, previous prescribing experiences of physicians, communication among professionals and with family, educational level of nurses, nursing home staffing, and continuity in care.…”