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Change in psychotropic drug use in Norwegian nursing homes between 2004 and 2011

Published online by Cambridge University Press:  09 October 2017

G. Selbæk ,
S. I.M. Janus ,
S. Bergh ,
K. Engedal ,
S. Ruths ,
A. S. Helvik ,
J. Šaltyte Benth  and
S. U. Zuidema
G. Selbæk
Affiliation:
Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
S. I.M. Janus*
Affiliation:
Department of Health Technology & Services Research, University of Twente, Enschede, the Netherlands Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
S. Bergh
Affiliation:
Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
K. Engedal
Affiliation:
Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
S. Ruths
Affiliation:
Research Unit for General Practice, Uni Health/Uni Research, Bergen, Norway Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
A. S. Helvik
Affiliation:
Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway St. Olav's University Hospital, Trondheim, Norway
J. Šaltyte Benth
Affiliation:
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway
S. U. Zuidema
Affiliation:
Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
*
Correspondence should be addressed to: Sarah Janus, University of Twente, Department of Health Technology and Services Research, PO Box 217, 7500 AE Enschede, the Netherlands. Phone +31 53 489 3915. Email: s.i.m.janus@utwente.nl.
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Abstract

Background:

We aimed to assess whether there were any changes in the use of psychotropic drugs in Norwegian nursing homes between 2004 and 2011. Also, we investigated whether the predictors of use of specific psychotropic drug groups have changed.

Methods:

We conducted a secondary analysis of two cohort studies of two Norwegian nursing home samples (2004/05 and 2010/11). Multivariate models were applied.

Results:

We found a significant decrease in the prescription of antipsychotic drugs between 2004 and 2011 (0.63 OR, 95%CI = 0.49–0.82, p < 0.001) even after adjusting for relevant demographic and clinical variables. There are only minor changes for the other psychotropic drugs. We found that (1) the use of specific psychotropic drug groups as well as the number of psychotropic drugs used was associated with more affective symptoms and (2) the use of specific psychotropic drug groups as well as the number of psychotropic drugs used was associated with lower scores on the Physical Self-Maintenance scale.

Conclusion:

This is the first study to show a robust decrease in antipsychotic drug use in nursing home patients with dementia unrelated to possible changes in case mix. The change might be explained by treatment recommendations against its use except in the most severe conditions of aggression or psychosis. Our findings indicate that it takes several years to implement scientific knowledge in clinical practice in nursing homes.

Keywords

Neuropsychiatric symptomsnursing homepsychotropic drugs
Type
Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 3: Issue Theme: Psychosocial Interventions for Dementia , March 2018 , pp. 385 - 394
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

Azermai, M. et al. (2012). Systematic appraisal of dementia guidelines for the management of behavioural and psychological symptoms. Ageing Research Reviews, 11, 78–86.CrossRefGoogle ScholarPubMed
Ballard, C. and Corbett, A. (2013). Agitation and aggression in people with Alzheimer's disease. Current Opinion in Psychiatry, 26, 252–259.Google Scholar
Barnes, T. R., Banerjee, S., Collins, N., Treloar, A., McIntyre, S. M. and Paton, C. (2012). Antipsychotics in dementia: prevalence and quality of antipsychotic drug prescribing in UK mental health services. British Journal of Psychiatry, 201, 221–226.Google Scholar
Dorsey, E. R. et al. (2010). Impact of FDA black box advisory on antipsychotic medication use. Archives of Internal Medicine, 170, 96–103.Google Scholar
Gallini, A. et al. (2014). Trends in use of antipsychotics in elderly patients with dementia: impact of national safety warnings. European Neuropsychopharmacology, 24, 95–104.Google Scholar
Hosia-Randell, H. and Pitkala, K. (2005). Use of psychotropic drugs in elderly nursing home residents with and without dementia in Helsinki, Finland. Drugs and Aging, 22, 793–800.Google Scholar
Hughes, C. P. et al. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566–572.Google Scholar
Johnell, K. and Fastbom, J. (2012). Comparison of prescription drug use between community-dwelling and institutionalized elderly in Sweden. Drugs and Aging, 29, 751–758.Google Scholar
Kales, H. C. et al. (2011). Trends in antipsychotic use in dementia 1999–2007. Archives of General Psychiatry, 68, 190–197.Google Scholar
Lawton, M. and Brody, E. M. (1970). Assessment of older people: self-maintaining and instrumental activities of daily living. Nursing Research, 19, 278.Google Scholar
Lyketsos, C. G. et al. (1999). The general medical health rating: a bedside global rating of medical comorbidity in patients with dementia. Journal of the American Geriatrics Society, 47, 487–491.Google Scholar
Mittal, V. et al. (2011). Review: risk of cerebrovascular adverse events and death in elderly patients with dementia when treated with antipsychotic medications: a literature review of evidence. American Journal of Alzheimer's Disease and other Dementias, 26, 10–17.Google Scholar
Mjørud, M. et al. (2014). Variables associated to quality of life among nursing home patients with dementia. Aging & Mental Health, 18, 1013–1021.Google Scholar
National Institute for Health and Clinical Excellence (NICE). Dementia: Supporting People With Dementia And Their Carers in Health And Social Care (Clinical Guidelines, CG42). NICE, 2006.Google Scholar
Nijk, R. M. et al. (2009). Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia. International Psychogeriatrics, 21, 485–493.Google Scholar
Nørgaard, A. et al. (2015). Time trends in antipsychotic drug use in patients with dementia: a nationwide study. Journal of Alzheimer's Disease, 49, 211–220.Google Scholar
Nygaard, H. A. et al. (2004). Not less but different: psychotropic drug utilization trends in Norwegian nursing homes during a 12-year period. The Bergen District Nursing Home (BEDNURS) study. Aging Clinical and Experimental Research, 16, 277–282.Google Scholar
O'Bryant, S. E. et al. (2008). Staging dementia using clinical dementia rating scale sum of boxes scores: a Texas Alzheimer's research consortium study. Archives of Neurology, 65, 1091–1095.Google Scholar
Pitkala, K. et al. (2015). Eight-year trends in the use of opioids, other analgesics, and psychotropic medications among institutionalized older people in finland. Journal of the American Medical Directors Association, 10, 009.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
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. Journal of the American Medical Association, 294, 1934–1943.Google Scholar
Selbaek, G. and Engedal, K. (2012). Stability of the factor structure of the neuropsychiatric inventory in a 31-month follow-up study of a large sample of nursing-home patients with dementia. International Psychogeriatrics, 24, 62–73.Google Scholar
Selbaek, G. et al. (2014). The course of neuropsychiatric symptoms in nursing-home patients with dementia over a 53-month follow-up period. International Psychogeriatrics, 26, 81–91.Google Scholar
Selbeak, G., Kirkevold, Ø. 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
Steinberg, M. and Lyketsos, C. G. (2012). Atypical antipsychotic use in patients with dementia: managing safety concerns. American Journal of Psychiatry, 169, 900–906.Google Scholar
The Information Centre for Health and Social Care. National Dementia and Antipsychotic Prescribing Audit 2012 [Online]. Available at: http://www.ic.nhs.uk/services/national-clinical-audit-support-programme-ncasp/national-dementia-and-antipsychotic-prescribing-audit; last accessed 14 January 2017].Google Scholar
Thomas, S. K. et al. (2013). The impact of direct healthcare professional communication on prescribing practice in the UK hospital setting: an interrupted time series analysis. Drug Safety, 36, 557–564.Google Scholar
Wang, P. S. et al. (2005). Risk of death in elderly users of conventional vs. atypical antipsychotic medications. New England Journal of Medicine, 353, 2335–2341.Google Scholar
Wetzels, R. et al. (2010). Course of neuropsychiatric symptoms in residents with dementia in nursing homes over 2-year period. American Journal of Geriatric Psychiatry, 18, 1054–1065.Google 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.Google Scholar
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