Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-10T23:09:30.815Z Has data issue: false hasContentIssue false
  • English
  • Français

Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-study

Published online by Cambridge University Press:  31 May 2016

Klaas van der Spek ,
Debby L. Gerritsen ,
Martin Smalbrugge ,
Marjorie H. J. M. G. Nelissen-Vrancken ,
Roland B. Wetzels ,
Claudia H. W. Smeets ,
Sytse U. Zuidema  and
Raymond T. C. M. Koopmans
Klaas van der Spek*
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands
Debby L. Gerritsen
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands Radboud Alzheimer Center, Nijmegen, the Netherlands
Martin Smalbrugge
Affiliation:
Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, VU Medical Center, Amsterdam, the Netherlands
Marjorie H. J. M. G. Nelissen-Vrancken
Affiliation:
Dutch Institute for Rational Use of Medicine, Utrecht, the Netherlands
Roland B. Wetzels
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands
Claudia H. W. Smeets
Affiliation:
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands
Sytse U. Zuidema
Affiliation:
Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, 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 Medical Centre, Nijmegen, the Netherlands Radboud Alzheimer Center, Nijmegen, the Netherlands Joachim en Anna, Centre for specialised geriatric care, Nijmegen, the Netherlands
*
Correspondence should be addressed to: Klaas van der Spek, Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen Huispost 117 ELG, PO Box 9101, 6500 HB Nijmegen, the Netherlands. Phone: +31641814811. Email: klaas.vanderspek@radboudumc.nl.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

This study explores the appropriateness of psychotropic drug (PD) use for neuropsychiatric symptoms (NPS) in nursing home patients with dementia.

Methods:

A cross-sectional study on 559 patients with dementia residing on dementia special care units in Dutch nursing homes was conducted. Appropriateness of PD use was assessed using the Appropriate Psychotropic drug use In Dementia (APID) index. The APID index score is calculated using information about individual PDs from patients’ medical records. The index encompasses seven (different) domains of appropriateness, i.e. indication, evaluation, dosage, drug-drug interactions, drug-disease interactions, duplications, and therapy duration.

Results:

A total of 578 PDs were used for NPS by 60% of the nursing home patients. Indication, evaluation, and therapy duration contributed the most to inappropriate use. Ten per cent of the PDs scored fully appropriate according to the APID index sum score, 36% scored fully appropriate for indication, 46% scored fully appropriate for evaluation, and 58% scored fully appropriate for therapy duration. Antidepressants were used the most appropriately, and antiepileptics the most inappropriately.

Conclusions:

The minority of the PD use was fully appropriate. The results imply that PD use for NPS in dementia can be improved; the appropriateness should be optimized with a clinical focus on the appropriate indications, evaluations, and therapy duration.

Keywords

behavioral and psychological symptoms of dementia (BPSD)dementiapsychopharmacology
Type
Paper of the Month
Information
International Psychogeriatrics , Volume 28 , Issue 10 , October 2016 , pp. 1589 - 1595
Copyright
Copyright © International Psychogeriatric Association 2016 

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

Anon (1990). Nordic Council on Medicines: Guidelines for ATC Classification. Oslo: WHO Collaborating Center for Drugs Statistics Methodology.Google Scholar
Ballard, C. et al. (2009). The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurology, 8, 151–157.Google Scholar
Bustin, J. (2009). Atypical antipsychotics and CATIE-AD. Is this a turning point? Vertex Buenos Aires Argentina, 20, 136–143.Google Scholar
Eggermont, L. H. P., de Vries, K. and Scherder, E. J. A. (2009). Psychotropic medication use and cognition in institutionalized older adults with mild to moderate dementia. International psychogeriatrics/IPA, 21, 286–294.CrossRefGoogle ScholarPubMed
Finkers, F., Maring, J. G., Boersma, F. and Taxis, K. (2007). A study of medication reviews to identify drug-related problems of polypharmacy patients in the Dutch nursing home setting. Journal of Clinical Pharmacy and Therapeutics, 32, 469–476.CrossRefGoogle ScholarPubMed
Gustafsson, M., Karlsson, S. and Lövheim, H. (2013). Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units. BMC Pharmacology & Toxicology, 14, 10.Google Scholar
Hanlon, J. T. et al. (1992). A method for assessing drug therapy appropriateness. Journal of Clinical Epidemiology, 45, 1045–1051.Google Scholar
Koopmans, R. T. C. M. (2007). Are psychotropic drugs too frequently prescribed in Dutch nursing homes? Tijdschrift voor Gerontologie en Geriatrie, 38, 270–273.Google ScholarPubMed
Lemmers, O., Kremer, J. A. M. and Borm, G. F. (2007). Incorporating natural variation into IVF clinic league tables. Human Reproduction, 22, 1359–1362.CrossRefGoogle ScholarPubMed
Lucas, J. et al. (2014). Antipsychotic medication use in nursing homes: a proposed measure of quality. International Journal of Geriatric Psychiatry, 29, 1049–1061.Google Scholar
Lustenberger, I., Schüpbach, B., von Gunten, A. and Mosimann, U. (2011). Psychotropic medication use in Swiss nursing homes. Swiss Medical Weekly, 141, 13254.Google Scholar
Oborne, C. A., Hooper, R., Li, K. C., Swift, C. G. and Jackson, S. H. (2002). An indicator of appropriate neuroleptic prescribing in nursing homes. Age and Ageing, 31, 435–439.Google Scholar
Ruths, S., Straand, J. and Nygaard, H. (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., Straand, J., Nygaard, H. A. and Aarsland, D. (2008). Stopping antipsychotic drug therapy in demented nursing home patients: a randomized, placebo-controlled study-the bergen district nursing home study (BEDNURS). International Journal of Geriatric Psychiatry, 23, 889–895.Google Scholar
Schneider, L. S., Dagerman, K. and Insel, P. S. (2006). Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. The American Journal of Geriatric Psychiatry, 14, 191–210.Google Scholar
Seitz, D. P. et al. (2013). Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review. International Psychogeriatrics/IPA, 25, 185–203.Google Scholar
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.Google Scholar
Smalbrugge, M. et al. (2008). Probleemgerdag. [Guideline]Google Scholar
Smeets, C. H. et al. (2014). Factors related to psychotropic drug prescription for neuropsychiatric symptoms in nursing home residents with dementia. Journal of the American Medical Directors Association, 15, 835–840.Google Scholar
Uzun, S., Kozumplik, O., Jakovljević, M. and Sedić, B. (2010). Side effects of treatment with benzodiazepines. Psychiatr Danub, 22, 90–93.Google Scholar
van der Spek, K. et al. (2013). PROPER I: frequency and appropriateness of psychotropic drugs use in nursing home patients and its associations: a study protocol. BMC Psychiatry, 13, 307.Google Scholar
van der Spek, K. et al. (2015). A reliable and valid index was developed to measure appropriate psychotropic drug use in dementia. Journal of Clinical Epidemiology, 68, 903–912.Google Scholar
van Iersel, M. B., Zuidema, S. U., Koopmans, R. T., Verhey, F. R. and Olde Rikkert, M. (2005). Antipsychotics for behavioural and psychological problems in elderly people with dementia: a systematic review of adverse events. Drugs Aging, 22, 845–858.Google Scholar
Wei, Y.-J. et al. (2014). Quality of psychopharmacological medication prescribing and mortality in medicare beneficiaries in nursing homes. Journal of the American Geriatrics Society, 62, 1490–1504.Google Scholar
Wetzels, R. B., Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2011). Prescribing pattern of psychotropic drugs in nursing home residents with dementia. International Psychogeriatrics IPA, 23, 1249–1259.CrossRefGoogle ScholarPubMed
Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (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.Google Scholar
Zuidema, S. U., Derksen, E., Verhey, F. R. and Koopmans, R. T. (2007b). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632–638.Google Scholar
Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2011). Psychotropic drug prescription in nursing home patients with dementia: influence of environmental correlates and staff distress on physicians’ prescription behavior. International Psychogeriatrics/IPA, 23, 1632–1639.Google Scholar
Zwijsen, S. A. et al. (2014). Coming to grips with challenging behavior: a cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in dementia. Journal of the American Medical Directors Association, 15, 531.e1–531.e10.Google Scholar
Supplementary material: File

van der Spek supplementary material

Appendix

Download van der Spek supplementary material(File)
File 53.2 KB