Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-26T06:36:54.697Z Has data issue: false hasContentIssue false
  • English
  • Français

A cross-sectional examination of the prevalence of psychotropic medications for people living with dementia in Australian long-term care facilities: issues of concern

Published online by Cambridge University Press:  04 December 2017

Mitchell McMaster ,
Elaine Fielding ,
David Lim ,
Wendy Moyle Open the ORCID record for Wendy Moyle [Opens in a new window] ,
Elizabeth Beattie  and
The AusQoL Group
Mitchell McMaster*
Affiliation:
Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia
Elaine Fielding
Affiliation:
Dementia Collaborative Research Centre: Carers and Consumers, Queensland University of Technology, Brisbane, Australia
David Lim
Affiliation:
Flinders Rural Health SA, Flinders University, Victor Harbor, Australia
Wendy Moyle
Affiliation:
Menzies Health Institute Queensland, Griffith University, Nathan, Australia
Elizabeth Beattie
Affiliation:
Dementia Collaborative Research Centre: Carers and Consumers, Queensland University of Technology, Brisbane, Australia
The AusQoL Group
Affiliation:
Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia Dementia Collaborative Research Centre: Carers and Consumers, Queensland University of Technology, Brisbane, Australia Flinders Rural Health SA, Flinders University, Victor Harbor, Australia Menzies Health Institute Queensland, Griffith University, Nathan, Australia
*
Correspondence should be addressed to: Mitchell McMaster, Centre for Research on Ageing, Health and Wellbeing, Florey Building #54, Mills Rd, Acton, ACT, 2602. Phone: +61-2-61256351; Fax: +61-2-61251558. Email: mitchell.mcmaster@anu.edu.au.
Get access

Abstract

Background:

Behavioral and psychological symptoms of dementia (BPSD) are a common problem in long-term care facilities (LTC). Clinical guidelines dictate that first-line treatments for BPSD are psychosocial and behavioral interventions; if these are unsuccessful, psychotropic medications may be trialed at low doses and their effects can be monitored.

Methods:

There have previously been no studies with nationally representative samples to investigate psychotropic administration in LTCs in Australia. This study determines the prevalence of psychotropic administration in a representative stratified random sample of 446 residents living with dementia from 53 Australian LTCs. Questionnaire and medical chart data in this study is drawn from a larger cross-sectional, mixed methods study on quality of life in Australian LTCs.

Results:

It was found that 257 (58%) residents were prescribed psychotropic medications including: antipsychotics (n = 160, 36%), benzodiazepines (n = 136, 31%), antidepressants (n = 117, 26%), and anti-dementia medications (n = 9, 2%). BPSD were found to be very common in the sample, with 82% (n = 364) of participants experiencing at least one BPSD. The most prevalent BPSD were depression (n = 286, 70%) and agitation (n = 299, 67%).

Conclusions:

Although detailed background information was not collected on individual cases, the prevalence found is indicative of systematic industry-wide, over-prescription of psychotropic medications as a first-line treatment for BPSD. This study highlights a clear need for further research and interventions in this area.

Keywords

dementiaBPSDpsychotropic medicationantipsychoticsbenzodiazepinesantidepressants
Type
Original Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 7: Issue Theme: Benzodiazepines and Hypnotics , July 2018 , pp. 1019 - 1026
Copyright
Copyright © International Psychogeriatric Association 2017 

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

Algase, D., Beattie, E., Song, J. A., Milke, D., Duffield, C. and Cowan, B. (2004). Validation of the Algase wandering scale (version 2) in a cross cultural sample. Aging & Mental Health, 8, 133–142.Google Scholar
Beattie, E. et al. (2015). Multiple perspectives on quality of life for residents with dementia in long term care facilities: protocol for a comprehensive Australian study. International Psychogeriatrics, 27, 1739–1747.Google Scholar
Beck, C. R. et al. (2011). Factors associated with problematic vocalizations in nursing home residents with dementia. The Gerontologist, 51, 389–405.Google Scholar
Brandt, N. J. and Turner, T. (2014). Potentially inappropriate medications in older adults: a review of the 2012 Beers criteria and the implications in persons with dementia. Mental Health Clinician, 4, 166–169.Google Scholar
Cerejeira, J., Lagarto, L. and Mukaetova-Ladinska, E. B. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, 1–21.Google Scholar
Cohen-Mansfield, J. (1991). Instruction Manual of for the Cohen-Mansfield Agitation Inventory (CMAI). Rockville, Maryland: The Research Institute of the Hebrew Home of Greater Washington.Google Scholar
Cummings, J. L. (2003). Use of cholinesterase inhibitors in clinical practice: evidence-based recommendations. The American Journal of Geriatric Psychiatry, 11, 131–145.Google Scholar
De Mauleon, A. et al. (2014). Associated factors with antipsychotic use in long-term institutional care in eight European countries: results from the right time place care study. Journal of the American Medical Directors Association, 15, 812–818.Google Scholar
Defrancesco, M., Marksteiner, J., Fleischhacker, W. W. and Blasko, I. (2015). Use of benzodiazepines in Alzheimer's disease: a systematic review of literature. International Journal of Neuropsychopharmacology, 18, 1–11.Google Scholar
Fielding, E., Beattie, E., O'Reilly, M., McMaster, M. and AUSQOL GROUP (2016). Achieving a national sample of nursing homes: balancing probability techniques and practicalities. Research in Gerontological Nursing, 9, 58–65.Google Scholar
Gauthier, S. et al. (2010). Review: management of behavioral problems in Alzheimer's disease. International Psychogeriatrics, 22, 346–372.Google Scholar
Guideline Adaptation Committee (2016). Clinical Practice Guidelines and Principles of Care for People with Dementia. Sydney: Guideline Adaptation Committee.Google Scholar
Jennum, P., Baandrup, L., Ibsen, R. and Kjellberg, J. (2015). Increased all-cause mortality with use of psychotropic medication in dementia patients and controls: a population-based register study. European Neuropsychopharmacology, 25, 1906–1913.Google Scholar
Kleijer, B. C., Van Marum, R. J., Egberts, A. C., Jansen, P. A., Knol, W. and Heerdink, E. R. (2009). Risk of cerebrovascular events in elderly users of antipsychotics. Journal of Psychopharmacology, 23, 909–914.Google Scholar
Langballe, E. M., Engdahl, B., Nordeng, H., Ballard, C., Aarsland, D. and Selbaek, G. (2014). Short- and long-term mortality risk associated with the use of antipsychotics among 26,940 dementia outpatients: a population-based study. The American Journal of Geriatric Psychiatry, 22, 321–331.Google Scholar
Lonergan, E., Luxenberg, J., Colford, J. M. and Birks, J. (2002). Haloperidol for agitation in dementia. Cochrane Database of Systematic Reviews, 2, Art No. CD002852.Google Scholar
Moyle, W. et al. (2017). Pharmacotherapy of persons with dementia in long-term care in Australia : a descriptive audit of central nervous system medications. Current Drug Safety, 12, 95–102.Google Scholar
Raina, P. et al. (2008). Effectiveness of cholinesterase inhibitors and memantine for treating dementia: evidence review for a clinical practice guideline. Annals of Internal Medicine, 148, 379–397.Google Scholar
Rodda, J., Morgan, S. and Walker, Z. (2009). Are cholinesterase inhibitors effective in the management of the behavioral and psychological symptoms of dementia in Alzheimer's disease? A systematic review of randomized, placebo-controlled trials of donepezil, rivastigmine and galantamine. International Psychogeriatrics, 21, 813–824.Google Scholar
Rosenberg, P. B. et al. (2012). The association of psychotropic medication use with the cognitive, functional, and neuropsychiatric trajectory of Alzheimer's disease. International Journal of Geriatric Psychiatry, 27, 1248–1257.Google Scholar
Rossom, R. C., Rector, T. S., Lederle, F. A. and Dysken, M. W. (2010). Are all commonly prescribed antipsychotics associated with greater mortality in elderly male veterans with dementia?. Journal of the American Geriatrics Society, 58, 1027–1034.Google Scholar
Seitz, D. P. et al. (2013). Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review. International Psychogeriatrics, 25, 185–203.Google Scholar
Seitz, D., Purandare, N. and Conn, D. (2010). Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. International Psychogeriatrics, 22, 1025–1039.Google Scholar
Snowdon, J., Galanos, D. and Vaswani, D. (2011). Patterns of psychotropic medication use in nursing homes: surveys in Sydney, allowing comparisons over time and between countries. International Psychogeriatrics, 23, 1520–1525.Google Scholar
Starkstein, S. E., Mizrahi, R. and Power, B. D. (2008). Depression in Alzheimer's disease: phenomenology, clinical correlates and treatment. International Review of Psychiatry, 20, 382–388.Google Scholar
Therapeutic Goods Administration (2015). Risperidone and risk of cerebrovascular adverse events in dementia patients (Vol. 4, No. 6), Department of Health, Australian Government https://www.tga.gov.au/publication-issue/medicines-safety-update-volume-6-number-4-august-2015.Google Scholar
Westbury, J., Jackson, S. and Peterson, G. (2010). Psycholeptic use in aged care homes in Tasmania, Australia. Journal of Clinical Pharmacy and Therapeutics, 35, 189–193.Google Scholar
Wilkins, J. M. and Forester, B. P. (2016). Update on SSRI treatment for neuropsychiatric symptoms of dementia. Current Psychiatry Reports, 18, 1–7.Google Scholar
World Health Organization (2006). The Anatomical Therapeutic Chemical Classification System with Defined Daily Doses (ATC/DDD). Norway: WHO.Google Scholar
Yesavage, J. A. et al. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 37–49.Google Scholar