Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-22T18:38:10.108Z Has data issue: false hasContentIssue false
  • English
  • Français

Dementia, neuropsychiatric symptoms, and the use of psychotropic drugs among older people who receive domiciliary care: a cross-sectional study

Published online by Cambridge University Press:  20 November 2013

Jon N. Wergeland ,
Geir Selbæk ,
Lisbeth D. Høgset ,
Ulrika Söderhamn  and
Øyvind Kirkevold
Jon N. Wergeland*
Affiliation:
Norwegian Centre for Research, Education and Service Development, Vestfold Hospital Trust, Tønsberg, Norway Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
Geir Selbæk
Affiliation:
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway Akershus University Hospital, Lørenskog, Norway
Lisbeth D. Høgset
Affiliation:
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
Ulrika Söderhamn
Affiliation:
Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
Øyvind Kirkevold
Affiliation:
Norwegian Centre for Research, Education and Service Development, Vestfold Hospital Trust, Tønsberg, Norway Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway Faculty of Health, Care and Nursing, Gjøvik University College, Gjøvik, Norway
*
Correspondence should be addressed to: Jon N. Wergeland, PhD, University of Agder, Serviceboks 422, 4604 Kristiansand, Norway. Phone: +4793216030; Fax: +4738141301. Email: [email protected].
Get access

Abstract

Background:

The objective of this study was to (a) determine the prevalence of cognitive impairment, dementia, and neuropsychiatric symptoms (NPSs) among home-dwelling people, 70 years and older (70+ years), who receive domiciliary care, and (b) describe their use of psychotropic drugs. Few studies have investigated dementia among people receiving in-home care.

Methods:

A sample (N = 1,000) representative of people aged 70+ years receiving domiciliary care was randomly recruited for participation. A standardized interview with the participants and their next of kin were performed using well-established assessment scales. Two clinical experts independently diagnosed dementia according to ICD-10 criteria.

Results:

Of the 415 participants (41.5%) with dementia according to ICD-10 criteria, 19.5% had a dementia diagnosis known to the patient themselves, their caregiver, or health workers in the domiciliary care service. In the previous month, 72.1% exhibited NPSs (21.1% rated as clinically significant), with depression (47.5%), apathy (33.7%), anxiety (33.0%), and irritability (31.1%) being the most common. Psychotropic drugs were regularly used by 40.1% of the sample. Antidepressants (p = 0.001) and cognitive enhancers (p < 0.001) were more often given to people with dementia than to those without dementia.

Conclusions:

Dementia and NPSs are highly prevalent among people who receive domiciliary care, and diagnostic disclosure is low. People with dementia constitute a distinct group with respect to NPSs and psychotropic drug use. Early detection and correct diagnosis might increase the understanding of their everyday challenges and enable families to alleviate consequences of dementia and NPSs.

Keywords

BPSDcognitive impairmentcommunity dwellingdomiciliary caremedicationolder people
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 3 , March 2014 , pp. 383 - 391
Copyright
Copyright © International Psychogeriatric Association 2013 

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

Ballard, C. G. et al. (2009). Management of agitation and aggression associated with Alzheimer disease. Nature Reviews Neurology, 5, 245–255.Google Scholar
Barbui, C. and Percudani, M. (2006). Epidemiological impact of antidepressant and antipsychotic drugs on the general population. Current Opinion in Psychiatry, 19, 405–410.Google Scholar
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.Google Scholar
Devanand, D. P., Pelton, G. H., Cunqueiro, K., Sackeim, H. A. and Marder, K. (2011). A 6-month, randomized, double-blind, placebo-controlled pilot discontinuation trial following response to haloperidol treatment of psychosis and agitation in Alzheimer's disease. International Journal of Geriatric Psychiatry, 26, 937–943.Google Scholar
Engedal, K., Haugen, P., Gilje, K. and Laake, P. (1988). Efficacy of short mental tests in the detection of mental impairment in old age. Comprehensive Gerontology A, 2, 87–93.Google Scholar
Ferri, C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112–2117.CrossRefGoogle ScholarPubMed
Finnvold, J. (1997). Receive assistance, but misses social contact (Norwegian). Available at: http://www.ssb.no/helse/artikler-og-publikasjoner/_attachment/69940?_ts=137db1ae938.Google Scholar
Folstein, M. F., Folstein, S. E. and Mchugh, P. R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Geda, Y. E. et al. (2008). Prevalence of neuropsychiatric symptoms in mild cognitive impairment and normal cognitive aging: population-based study. Archives of General Psychiatry, 65, 1193–1198.Google Scholar
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566–572.Google Scholar
Jano, E., Johnson, M., Chen, H. and Aparasu, R. R. (2008). Determinants of atypical antipsychotic use among antipsychotic users in community-dwelling elderly, 1996–2004. Current Medical Research and Opinion, 24, 709–716.Google Scholar
Jorm, A. F. (2004). The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): a review. International Psychogeriatrics, 16, 275–293.Google Scholar
Juncos-Rabadan, O. et al. (2012). Prevalence and correlates of cognitive impairment in adults with subjective memory complaints in primary care centres. Dementia and Geriatric Cognitive Disorders, 33, 226–232.Google Scholar
Lopez, O. L. et al. (2013). The long-term effects of conventional and atypical antipsychotics in patients with probable Alzheimer's disease. American Journal of Psychiatry, 170, 1051–1058.CrossRefGoogle ScholarPubMed
Luppa, M., Luck, T., Brahler, E., Konig, H. H. and Riedel-Heller, S. G. (2008). Prediction of institutionalisation in dementia. A systematic review. Dementia and Geriatric Cognitive Disorders, 26, 65–78.CrossRefGoogle ScholarPubMed
Lyketsos, C. G., Lopez, O., Jones, B., Fitzpatrick, A. L., Breitner, J. and Dekosky, S. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA, 288, 1475–1483.Google Scholar
Martinez, M. F., Flores, J. C., De Las Heras, S. P., Lekumberri, A. M., Menocal, M. G. and Imirizaldu, J. J. Z. (2008). Prevalence of neuropsychiatric symptoms in elderly patients with dementia in Mungialde County (Basque country, Spain). Dementia and Geriatric Cognitive Disorders, 25, 103–108.CrossRefGoogle Scholar
Monastero, R., Palmer, K., Qiu, C., Winblad, B. and Fratiglioni, L. (2007). Heterogeneity in risk factors for cognitive impairment, no dementia: population-based longitudinal study from the Kungsholmen Project. American Journal of Geriatric Psychiatry, 15, 60–69.Google Scholar
Okura, T., Plassman, B. L., Steffens, D. C., Llewellyn, D. J., Potter, G. G. and Langa, K. M. (2010). Prevalence of neuropsychiatric symptoms and their association with functional limitations in older adults in the United States: the aging, demographics, and memory study. Journal of the American Geriatrics Society, 58, 330–337.Google Scholar
Okura, T., Plassman, B. L., Steffens, D. C., Llewellyn, D. J., Potter, G. G. and Langa, K. M. (2011). Neuropsychiatric symptoms and the risk of institutionalization and death: the aging, demographics, and memory study. Journal of the American Geriatrics Society, 59, 473–481.Google Scholar
Otnes, B. (2010). Homeservices at Nursing Home Level: Estimates from Statistics about National Reports on In-Home Care and Social Care 2008 (In Norwegian). Oslo: Statistisk sentralbyrå. (Documents, 2010/13).Google Scholar
Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W. and Ferri, C. P. (2013). The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer's & Dementia, 9, 63–75 e2.CrossRefGoogle ScholarPubMed
Ruths, S., Straand, J. and Nygaard, H. A. (2001). Psychotropic drug use in nursing homes: diagnostic indications and variations between institutions. European Journal of Clinical Pharmacology, 57, 523–528.Google Scholar
Ruths, S. et al. (2013). Trends in psychotropic drug prescribing in Norwegian nursing homes from 1997 to 2009: a comparison of six cohorts. International Journal of Geriatric Psychiatry, 28, 868–876.Google Scholar
Selbaek, G. and Høgset, L. D. (2010). IPLOS and Assessment of the Need for Services among Home-Dwelling Elderly with Cognitive Impairment (In Norwegian). Hamar, Norway: Sykehuset Innlandet HF, AFS.Google Scholar
Selbaek, G., Kirkevold, O. and Engedal, K. (2007). The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 22, 843–849.Google Scholar
Shulman, K. I. (2000). Clock-drawing: is it the ideal cognitive screening test? International Journal of Geriatric Psychiatry, 15, 548–561.Google Scholar
Steinberg, M. et al. (2004). The persistence of neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry, 19, 19–26.Google Scholar
Steinberg, M. et al. (2008). Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry, 23, 170–177.CrossRefGoogle ScholarPubMed
Winblad, B. et al. (2004). Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246.Google Scholar
World Health Organization, W. (2013a). The Anatomical Therapeutic Chemical Classification System [Online]. Available at: http://www.who.int/classifications/atcddd/en/; last accessed 10 April 2012.Google Scholar
World Health Organization, W. (2013b). ICD-10 International Statistical Classification of Diseases and Related Health Problems [Online]. World Health Organization, WHO. Available at: http://apps.who.int/classifications/icd10/browse/2010/en; last accessed 10 April 2013.Google Scholar
Zuidema, S., Koopmans, R. and Verhey, F. (2007). Prevalence and predictors of neuropsychiatric symptoms in cognitively impaired nursing home patients. Journal of Geriatric Psychiatry and Neurology, 20, 41–49.Google Scholar