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Comparison of behavioral and psychological symptoms of dementia and psychotropic drug treatments among old people in geriatric care in 2000 and 2007

Published online by Cambridge University Press:  09 September 2011

Hugo Lövheim ,
Yngve Gustafson ,
Stig Karlsson  and
Per-Olof Sandman
Hugo Lövheim*
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Yngve Gustafson
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Stig Karlsson
Affiliation:
Department of Nursing, Umeå University, Umeå, Sweden
Per-Olof Sandman
Affiliation:
Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
*
Correspondence should be addressed to: H. Lövheim, Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 85 Umeå, Sweden. Phone: +46 90 785 88 59; Fax: +46 90 13 06 23. Email: hugo.lovheim@germed.umu.se.
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Abstract

Background: Behavioral and psychological symptoms, such as verbal or physical aggression, aberrant motor behaviors, psychotic symptoms, anxiety, depressive symptoms and apathy are common among people with dementia. The aim of the present study was to compare the one-week prevalence of behavioral and psychological symptoms and psychotropic drug treatment among people with cognitive impairment living in institutional care, in two large, comparable samples from 2000 and 2007.

Methods: A comparison was made between two cross-sectional samples, collected in 2000 and 2007, comprising 4054 participants with cognitive impairment living in geriatric care units in the county of Västerbotten, Sweden. The Multi-Dimensional Dementia Assessment Scale (MDDAS) was used to assess cognitive impairment and behavioral and psychological symptoms. The use of psychotropic drugs was recorded.

Results: Between 2000 and 2007, 15 out of 39 behavioral or psychological symptoms had become less common and no symptoms had become more common, after controlling for demographic changes. Four out of six behaviors within the cluster of aggressive behaviors had declined in prevalence. Patients prescribed anti-dementia drugs increased from 5.1% to 18.0% and antidepressant drug use increased from 43.2% to 49.1%, while anxiolytic, hypnotic, sedative and antipsychotic drug use remained largely unchanged.

Conclusion: The prevalence of many behavioral symptoms had declined from 2000 to 2007, and among these changes, the decline in aggressive behaviors probably has the greatest clinical impact.

Keywords

dementianursing homeBPSDAlzheimer's diseaseanti-dementia drugscholinesterase inhibitors
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 10 , December 2011 , pp. 1616 - 1622
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Adolfsson, R., Gottfries, C. G., Nyström, L. and Winblad, B. (1981). Prevalence of dementia disorders in institutionalized Swedish old people: the work load imposed by caring for these patients. Acta Psychiatrica Scandinavica, 63, 225–244.CrossRefGoogle ScholarPubMed
Black, W. and Almeida, O. P. (2004). A systematic review of the association between the behavioral and psychological symptoms of dementia and burden of care. International Psychogeriatrics, 16, 295–315. doi: 10.1017/S1041610204000468.CrossRefGoogle ScholarPubMed
Burns, A., O'Brien, J. and Ames, D. (2010). Dementia. Oxford: Oxford University Press.Google ScholarPubMed
Coehlo, D. P., Hooker, K. and Bowman, S. (2007). Institutional placement of persons with dementia: what predicts occurrence and timing? Journal of Family Nursing, 13, 253–277. doi: 10.1177/1074840707300947.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Hosia-Randell, H. and Pitkälä, K. (2005). Use of psychotropic drugs in elderly nursing home residents with and without dementia in Helsinki, Finland. Drugs and Aging, 22, 793–800.CrossRefGoogle ScholarPubMed
Lobo, A. et al. (2000). Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology, 54, S4–9.Google ScholarPubMed
Lövheim, H., Sandman, P. O., Kallin, K., Karlsson, S. and Gustafson, Y. (2006). Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care. International Psychogeriatrics, 18, 713–726. doi: 10.1017/S1041610206003930.CrossRefGoogle ScholarPubMed
Lövheim, H., Sandman, P., Kallin, K., Karlsson, S. and Gustafson, Y. (2008a). Symptoms of mental health and psychotropic drug use among old people living in geriatric care: changes between 1982 and 2000. International Journal of Geriatric Psychiatry, 23, 289–294. doi: 10.1002/gps.1876.CrossRefGoogle ScholarPubMed
Lövheim, H., Sandman, P. O., Karlsson, S. and Gustafson, Y. (2008b). Behavioral and psychological symptoms of dementia in relation to level of cognitive impairment. International Psychogeriatrics, 20, 777–789. doi: 10.1017/S1041610208006777.CrossRefGoogle ScholarPubMed
Lövheim, H., Sandman, P. O., Karlsson, S. and Gustafson, Y. (2009). Changes between 1982 and 2000 in the prevalence of behavioral symptoms and psychotropic drug treatment among old people with cognitive impairment in geriatric care. International Psychogeriatrics, 21, 941–948. doi: 10.1017/S1041610209990329.CrossRefGoogle ScholarPubMed
Lövheim, H., Bergdahl, E., Sandman, P., Karlsson, S. and Gustafson, Y. (2010). One-week prevalence of depressive symptoms and psychotropic drug treatments among old people with different levels of cognitive impairment living in institutional care: changes between 1982 and 2000. International Psychogeriatrics, 22, 1154–1160. doi: 10.1017/S104161021000061X.CrossRefGoogle ScholarPubMed
Rapoport, M., Mamdani, M., Shulman, K. I., Herrmann, N. and Rochon, P. A. (2005). Antipsychotic use in the elderly: shifting trends and increasing costs. International Journal of Geriatric Psychiatry, 20, 749–753. doi: 10.1002/gps.1358.CrossRefGoogle ScholarPubMed
Rochon, P. A. et al. (2008). Antipsychotic therapy and short-term serious events in older adults with dementia. Archives of Internal Medicine, 168, 1090–1096.CrossRefGoogle ScholarPubMed
Sandman, P. O., Adolfsson, R., Norberg, A., Nyström, L. and Winblad, B. (1988). Long-term care of the elderly: a descriptive study of 3600 institutionalized patients in the county of Vasterbotten, Sweden. Comprehensive Gerontology A, 2, 120–132.Google 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. doi: 10.1001/jama.294.15.1934.CrossRefGoogle ScholarPubMed
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, 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. doi: 10.1002/gps.1749.CrossRefGoogle ScholarPubMed
Shin, I. S., Carter, M., Masterman, D., Fairbanks, L. and Cummings, J. L. (2005). Neuropsychiatric symptoms and quality of life in Alzheimer disease. American Journal of Geriatric Psychiatry, 13, 469–474.CrossRefGoogle ScholarPubMed
Sink, K. M., Holden, K. F. and Yaffe, K. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA, 293, 596–608. doi: 10.1001/jama.293.5.596.CrossRefGoogle ScholarPubMed
Statistics Sweden (2010). Population Statistics. Population by Region, Marital Status, Age and Sex. Year 1968–2009. Örebro: Statistics Sweden.Google Scholar
Zuidema, S. U., Derksen, E., Verhey, F. R. and Koopmans, R. T. (2007). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632–638. doi: 10.1002/gps.1722.CrossRefGoogle Scholar
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