Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-31T16:49:45.961Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessment of antipsychotic prescribing in Belgian nursing homes

Published online by Cambridge University Press:  22 March 2011

Majda Azermai ,
Monique Elseviers ,
Mirko Petrovic ,
Luc van Bortel  and
Robert Vander Stichele
Majda Azermai*
Affiliation:
Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
Monique Elseviers
Affiliation:
Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium Department of Nursing Science, University of Antwerp, Antwerp, Belgium
Mirko Petrovic
Affiliation:
Geriatric Service, Ghent University Hospital, Ghent, Belgium
Luc van Bortel
Affiliation:
Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
Robert Vander Stichele
Affiliation:
Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
*
Correspondence should be addressed to: Majda Azermai, Ghent University, Heymans Institute of Pharmacology, De Pintelaan 185 (1 Blok B), 9000 Gent, Belgium. Phone: +32 9 332 33 47; Fax: +32 9 332 49 88. Email: [email protected].
Get access

Abstract

Background: Given the potential adverse effects of antipsychotics, high use in nursing homes creates concern. Our study goal was to explore the use of antipsychotics in relation to resident characteristics, and to assess the appropriateness of antipsychotic prescribing in Belgian nursing homes.

Methods: Data were used from a cross-sectional study (Prescribing in Homes for the Elderly; PHEBE) conducted in 76 nursing homes in Belgium. Antipsychotics were classified into typical and atypical, using the anatomical therapeutic and chemical classification. Ten inappropriate antipsychotic prescribing indicators were selected from the updated Beers criteria (2003), Bergen District Nursing Home Study (BEDNURS) indicators, and Screening Tool of Older People's Prescriptions criteria (STOPP).

Results: The residents' mean age was 84.8 years, 78.1% of whom were female. The prevalence of antipsychotic utilization was 32.9%. Antipsychotics were mainly indicated for dementia-related agitation, and psychosis with/without dementia. Higher use of antipsychotics was found for dementia (OR: 3.27; 95% CI: 2.61–4.09), insomnia (OR: 1.38; 95% CI: 1.10–1.73), depression (OR: 1.30; 95% CI: 1.03–1.65), and age <80 years (OR: 1.79; 95% CI: 1.38–2.33). Inappropriate antipsychotic prescribing indicators scoring the highest among users were: long-term use (92.6%), use despite risk of falling (45.6%), combined use with other psychotropics (31.8%), and duplicate use (15.1%). Inappropriate prescribing was associated with depression (OR: 3.41) and insomnia (OR: 2.17).

Conclusion: The indicator-driven analysis of antipsychotic prescribing quality revealed a need for improvement, with the main prescribing problems relating to duration and combination of therapies. Risks/benefits of off-label use need to be evaluated more consciously at the start of therapy, and at periodic re-evaluations.

Keywords

inappropriate prescribingprescribing quality indicatorsantipsychoticsolder adultshomes for the aged
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 8 , October 2011 , pp. 1240 - 1248
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Azermai, M., Elseviers, M., Petrovic, M. and Vander Stichele, R. (in press). Geriatric drug utilisation of psychotropics in Belgian nursing homes. Human Psychopharmacology: Clinical and Experimental.Google Scholar
Ballard, C. and Waite, J. (2006). The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer's disease. Cochrane Database of Systematic Reviews, CD003476.CrossRefGoogle Scholar
Ballard, C. et al. (2008). A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD trial). PLoS Medicine, 5, e76.CrossRefGoogle ScholarPubMed
Ballard, C. et al. (2009). The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurology, 8, 151–157.CrossRefGoogle ScholarPubMed
Berdot, S. et al. (2009). Inappropriate medication use and risk of falls: a prospective study in a large community-dwelling elderly cohort. BMC Geriatrics, 9, 30.CrossRefGoogle Scholar
Briesacher, B. A. et al. (2005). The quality of antipsychotic drug prescribing in nursing homes. Archives of Internal Medicine, 165, 1280–1285.CrossRefGoogle ScholarPubMed
Castle, N. G., Hanlon, J. T. and Handler, S. M. (2009). Results of a longitudinal analysis of national data to examine relationships between organizational and market characteristics and changes in antipsychotic prescribing in US nursing homes from 1996 through 2006. American Journal of Geriatric Pharmacotherapy, 7, 143–150.CrossRefGoogle ScholarPubMed
Elseviers, M., Vander Stichele, R., Soenen, K., Gobert, M., van Bortel, L. and van de Voorde, C. (2010). Drug utilization in Belgian nursing homes: impact of residents’ and institutional characteristics. Pharmacoepidemiology and Drug Safety, 19, 1041–1048.CrossRefGoogle ScholarPubMed
Fick, D. M., Cooper, J. W., Wade, W. E., Waller, J. L., Maclean, J. R. and Beers, M. H. (2003). Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Archives of Interal Medicine, 163, 2716–2724.CrossRefGoogle ScholarPubMed
Gallagher, P., Ryan, C., Byrne, S., Kennedy, J. and O'Mahony, D. (2008). STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. International Journal of Clinical Pharmacology and Therapeutics, 46, 72–83.CrossRefGoogle ScholarPubMed
Glick, I. D., Murray, S. R., Vasudevan, P., Marder, S. R. and Hu, R. J. (2001). Treatment with atypical antipsychotics: new indications and new populations. Journal of Psychiatric Research, 35, 187–191.CrossRefGoogle ScholarPubMed
Hanlon, J. T. et al. (1992). A method for assessing drug therapy appropriateness. Journal of Clinical Epidemiology, 45, 1045–1051.CrossRefGoogle ScholarPubMed
Hughes, C.M. and Lapane, K.L. (2005). Administrative initiatives for reducing inappropriate prescribing of psychotropic drugs in nursing homes. How successful have they been? Drugs and Aging, 22, 339–351.CrossRefGoogle Scholar
Kamble, P., Chen, H., Sherer, J. and Aparasu, R. R. (2008). Antipsychotic drug use among elderly nursing home residents in the United States. American Journal of Geriatric Pharmacotherapy, 6, 187–197.CrossRefGoogle ScholarPubMed
Katz, S. and Akpom, C. A. (1976). A measure of primary sociobiological functions. International Journal of Health Services, 6, 493–508.CrossRefGoogle ScholarPubMed
Landi, F., Onder, G., Cesari, M., Barillaro, C., Russo, A. and Bernabei, R. (2005). Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study. Journals of Gerontology, Series A: Biological Sciences and Medical Science, 60, 622–626.CrossRefGoogle ScholarPubMed
Liperoti, R., Pedone, C. and Corsonello, A. (2008). Antipsychotics for the treatment of behavioral and psychological symptoms of dementia (BPSD). Current Neuropharmacology, 6, 117–124.CrossRefGoogle ScholarPubMed
Mann, E., Kopke, S., Haastert, B., Pitkala, K. and Meyer, G. (2009). Psychotropic medication use among nursing home residents in Austria: a cross-sectional study. BMC Geriatrics, 9, 18.CrossRefGoogle ScholarPubMed
Muench, J. and Hamer, A. M. (2010). Adverse effects of antipsychotic medications. American Family Physician, 81, 617–622.Google ScholarPubMed
Naugler, C. T., Brymer, C., Stolee, P. and Arcese, Z. A. (2000). Development and validation of an improving prescribing in the elderly tool. Canadian Journal of Clinical Pharmacology, 7, 103–107.Google ScholarPubMed
National Institute for Health and Clinical Excellence (2006). The NICE-SCIE guideline on Supporting People with Dementia and their Carers. Available at http://www.nice.org.uk/nicemedia/live/10998/30318/30318.pdf; last accessed September 2010.Google Scholar
Ruths, S. (2008). Evaluation of prescribing quality in nursing homes based on drug-specific indicators: the Bergen district nursing home (BEDNURS) study. Norsk Epidemiologi, 18, 173–178.Google Scholar
Ruths, S., Straand, J. and Nygaard, H. A. (2003). Multidisciplinary medication review in nursing home residents: what are the most significant drug-related problems? The Bergen District Nursing Home (BEDNURS) study. Quality and Safety in Health Care, 12, 176–180.CrossRefGoogle ScholarPubMed
Schneider, L. S., Dagerman, K. S. and Insel, P. (2005). Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA, 294, 1934–1943.CrossRefGoogle ScholarPubMed
Shekelle, P. G., MacLean, C. H., Morton, S. C. and Wenger, N. S. (2001). Assessing care of vulnerable elders: methods for developing quality indicators. Annals of Internal Medicine, 135, 647–652.CrossRefGoogle ScholarPubMed
Scottish Intercollegiate Guidelines Network (2006). Guideline for the Management of Patients with Dementia. Available at: http://www.sign.ac.uk/pdf/sign86.pdf; last accessed September 2010.Google Scholar
Testad, I. et al. (2010). Nursing home structure and association with agitation and use of psychotropic drugs in nursing home residents in three countries: Norway, Austria and England. International Journal of Geriatric Psychiatry, 25, 725–731.CrossRefGoogle ScholarPubMed
Trifiro, G., Verhamme, K. M., Ziere, G., Caputi, A. P., Stricker, B. H. and Sturkenboom, M. C. (2007). All-cause mortality associated with atypical and typical antipsychotics in demented outpatients. Pharmacoepidemiology and Drug Safety, 16, 538–544.CrossRefGoogle ScholarPubMed
US Food and Drug Administration (2005). Public Health Advisory: Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/UCM053171; last accessed June 2010.Google Scholar
US Food and Drug Administration (2008). Information for Healthcare Professionals: Conventional Antipsychotics. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124830.htm; last accessed June 2010.Google Scholar