Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-31T16:45:12.644Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychotropic drug prescription in nursing home patients with dementia: influence of environmental correlates and staff distress on physicians’ prescription behavior

Published online by Cambridge University Press:  04 August 2011

Sytse U. Zuidema ,
Jos F. M. de Jonghe ,
Frans R. J. Verhey  and
Raymond T. C. M. Koopmans
Sytse U. Zuidema*
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
Jos F. M. de Jonghe
Affiliation:
Departments of Clinical Psychology and Geriatric Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands
Frans R. J. Verhey
Affiliation:
School of Mental Health and Neuroscience/ Alzheimer Centre Limburg, Maastricht University Medical Centre, Maastricht, The Netherlands
Raymond T. C. M. Koopmans
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
*
Correspondence should be addressed to: S. U. Zuidema, Department of Primary and Community Care, 117 ELG, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Phone: +31 (0)243655324; Fax: +31 (0)243619558. Email: [email protected].
Get access

Abstract

Background: The aim of the study was to examine whether staff distress and aspects of the nursing home environment were associated with psychotropic drug use (PDU) in patients with dementia.

Methods: This was a cross-sectional study of 1289 nursing home patients with dementia from 56 Dementia Special Care Units (SCUs) in the Netherlands. The primary outcome was PDU. Potential correlates of PDU were staff distress, environmental correlates (the number of patients per unit or per living room, staff/patient ratio, and the presence of a walking circuit), and patient factors (gender, age, dementia severity, and neuropsychiatric symptoms (NPS)). Multilevel logistic regression analysis was used to estimate the relative contributions of predictor variables in explaining PDU.

Results: Staff distress, aspects of the physical nursing home environment and patients’ neuropsychiatric symptoms were independently associated with PDU. Staff distress at patients’ agitation was associated with antipsychotic and anxiolytic drug use (OR 1.66, 95% CI (1.16–2.36) and 1.62 (1.00–2.61), respectively). SCUs with more patients per living room had higher hypnotic drug use (OR 1.08, 95% CI (1.02–1.14)). Low staff/patient ratio was associated with high antidepressant drug use (OR 0.13, 95% CI (0.04–0.47)). The effects of nursing home environment on study outcome were smallest for antidepressant use (intra-SCU correlation 0.005) and highest for hypnotic use (intra-SCU correlation 0.171).

Conclusion: Staff distress and other environmental aspects are independently associated with PDU. These findings raise questions about the appropriateness of psychoactive drug prescriptions for nursing home patients with dementia.

Keywords

dementiapsychotropic drug usenursing homeenvironmentstaff distress
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 10 , December 2011 , pp. 1632 - 1639
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

Ballard, C. G. et al. (2009). Management of agitation and aggression associated with Alzheimer disease. Nature Reviews Neurology, 5, 245–255.CrossRefGoogle ScholarPubMed
Banerjee, S. (2009). The Use of Antipsychotic Medication for People with Dementia: Time for Action. A Report for the Minister of State for Care Services. London: The Stationery Office.Google Scholar
Chen, Y., Briesacher, B. A., Field, T. S., Tjia, J., Lau, D. T. and Gurwitz, J. H. (2010). Unexplained variation across US nursing homes in antipsychotic prescribing rates. Archives of Internal Medicine, 170, 89–95.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Everitt, D. E., Fields, D. R., Soumerai, S. S. and Avorn, J. (1991). Resident behavior and staff distress in the nursing home. Journal of the American Geriatrics Society, 39, 792–798.CrossRefGoogle ScholarPubMed
Gauthier, S. et al. (2010) Management of behavioral problems in Alzheimer's disease. International Psychogeriatrics, 22, 346–372.CrossRefGoogle ScholarPubMed
Hughes, C. M., Lapane, K., Watson, M. C. and Davies, H. T. (2007). Does organisational culture influence prescribing in care homes for older people? A new direction for research. Drugs and Aging, 24, 81–93.CrossRefGoogle ScholarPubMed
Jeste, D. V. et al. (2008). ACNP White Paper: update on use of antipsychotic drugs in elderly persons with dementia. Neuropsychopharmacology, 33, 957–970.CrossRefGoogle ScholarPubMed
Kamble, P., Chen, H., Sherer, J. T. and Aparasu, R. R. (2009). Use of antipsychotics among elderly nursing home residents with dementia in the US: an analysis of National Survey Data. Drugs and Aging, 26, 483–492.CrossRefGoogle ScholarPubMed
Kamble, P., Sherer, J., Chen, H. and Aparasu, R. (2010). Off-label use of second-generation antipsychotic agents among elderly nursing home residents. Psychiatric Services, 61, 130–136.CrossRefGoogle ScholarPubMed
Kat, M. G., de Jonghe, J. F. M., Aalten, P., Kalisvaart, C. J., Dröes, R. M. and Verhey, F. R. J. (2002). Neuropsychiatric symptoms of dementia: psychometric aspects of the Dutch Neuropsychiatric Inventory (NPI). Tijdschrift voor Gerontologie en Geriatrie, 33, 150–155 (in Dutch).Google ScholarPubMed
Kim, H. and Whall, A. L. (2006). Factors associated with psychotropic drug usage among nursing home residents with dementia. Nursing Research, 55, 252–258.CrossRefGoogle ScholarPubMed
Lange, R. T., Hopp, G. A. and Kang, N. (2004). Psychometric properties and factor structure of the Neuropsychiatric Inventory Nursing Home version in an elderly neuropsychiatric population. International Journal of Geriatric Psychiatry, 19, 440–448.CrossRefGoogle Scholar
Nijk, R. M., Zuidema, S. U. and Koopmans, R. T. C. M. (2009). Prevalence and correlates of psychotropic drug use in Dutch nursing home patients with dementia. International Psychogeriatrics, 21, 485–493.CrossRefGoogle ScholarPubMed
Nordic Council on Medicines (1990). Guidelines for ATC Classification. Oslo: WHO Collaborating Center for Drugs Statistics Methodology.Google Scholar
Rasbash, J., Healy, M., Browne, W. and Cameron, B. (1998). MLwiN. London: Multilevel Models Project Institute of Education, University of London.Google Scholar
Reisberg, B., Ferris, S., de Leon, M. J. and Crook, T. (1982). The Global Deterioration Scale (GDS) for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.Google Scholar
Schneider, L. S. et al. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 1525–1538.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Selbaek, G., Kirkevold, O. and Engedal, K. (2008). Psychiatric and behavioural symptoms and the use of psychotropic medication in Special Care Units and Regular Units in Norwegian nursing homes. Scandinavian Journal of Caring Sciences, 22, 568–573.CrossRefGoogle ScholarPubMed
Shah, S. M., Carey, I. M., Harris, T., Dewilde, S. and Cook, D. G. (2011). Antipsychotic prescribing to older people living in care homes and the community in England and Wales. International Journal of Geriatric Psychiatry. 26, 423–434.CrossRefGoogle ScholarPubMed
Snijders, T. A. B. and Bosker, R. J. (1999). Multilevel Analysis. An Introduction to Basic and Advanced Multilevel Modelling. London: SAGE Publications.Google Scholar
Stafford, A. C., Alswayan, M. S. and Tenni, P. C. (2011). Inappropriate prescribing in older residents of Australian care homes. Journal of Clinical Pharmacy and Therapeutics, 36, 33–44.CrossRefGoogle ScholarPubMed
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
Wetzels, R. B., Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2010). Course of neuropsychiatric symptoms in residents with dementia in nursing homes over a 2-year period. American Journal of Geriatric Psychiatry, 18, 1054–1065.CrossRefGoogle Scholar
Wood, S. et al. (2000). The use of the Neuropsychiatric Inventory in nursing home residents: characterization and measurement. American Journal of Geriatric Psychiatry, 8, 75–83.CrossRefGoogle ScholarPubMed
Wood-Mitchell, A., James, I. A., Waterworth, A., Swann, A. and Ballard, C. (2008). Factors influencing the prescribing of medications by old age psychiatrists for behavioral and psychological symptoms of dementia: a qualitative study. Age and Ageing, 37, 547–552.CrossRefGoogle ScholarPubMed
Zuidema, S. U., de Jonghe, J. F. M., Verhey, F. R. J. and Koopmans, R. T. C. M. (2007a). Neuropsychiatric symptoms in nursing home patients: factor structure invariance of the Dutch nursing home version of the Neuropsychiatric Inventory in different stages of dementia. Dementia and Geriatric Cognitive Disorders, 24, 169–176.CrossRefGoogle ScholarPubMed
Zuidema, S. U., Verhey, F. R. J., Derksen, E. and Koopmans, R. T. C. M. (2007b). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632–638.CrossRefGoogle Scholar
Zuidema, S. U., de Jonghe, J. F. M., Verhey, F. R. J. and Koopmans, R. T. C. M. (2010). Environmental correlates of neuropsychiatric symptoms in Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 25, 14–22.CrossRefGoogle Scholar