[en] OBJECTIVES: Dementia is the most common reason for nursing home admission and is increasingly prevalent. Behavioral and psychiatric symptoms are common in dementia and are commonly treated with psychotropic medications. However, nursing home residents are especially vulnerable to the adverse effects of potentially inappropriate medication. This observational study aimed to determine the rate of psychotropic drug use and psychotropic polypharmacy among Belgian nursing home residents with mild to moderate dementia.
DESIGN: This is a cross-sectional study examining the prevalence of psychotropic medication use.
SETTING AND PARTICIPANTS: Data were collected from the charts of 494 residents with dementia in 23 Belgian nursing homes.
METHODS: Medications were categorized according to the Belgian Centre for Pharmacotherapeutic Information. The total number of psychotropic medications and prevalence of psychotropic polypharmacy (≥2 daily psychotropic medications) were calculated, and the effects of age, sex, duration of nursing home stay, dementia severity, and severity of neuropsychiatric symptoms were examined.
RESULTS: A total of 68.6% of residents used at least 1 kind of psychotropic medication, 40.3% used ≥2, and 14% used ≥3. Hypnotics, sedatives, and anxiolytics were the most prescribed category (45.3%), followed by antidepressants (33.0%) and antipsychotics (29.6%). Younger age and female sex were associated with a higher number of psychotropic medications used. More severe polypharmacy was also associated with higher severity of neuropsychiatric symptoms.
CONCLUSIONS AND IMPLICATIONS: There is a high prevalence of psychotropic drug use among Belgian nursing home residents with dementia. This is comparable with findings in other countries. Considering the risk of adverse effects, we advise further efforts to review the use of potentially inappropriate medications.
Disciplines :
Psychiatry Pharmacy, pharmacology & toxicology
Author, co-author :
Maex, Jonathan ; Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, Antwerp University, Campus Drie Eiken, Wilrijk, Belgium. Electronic address: jonathan.maex@icloud.com
Van Diermen, Linda; Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, Antwerp University, Campus Drie Eiken, Wilrijk, Belgium, Psychiatric Center Bethanië, Zoersel, Belgium
Gillis, Katrin; Centre for Health for Older People, Odisee University College, Sint-Niklaas, Belgium, Centre for Research and Innovation in Care, University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Belgium
Lahaye, Hilde; Centre for Health for Older People, Odisee University College, Sint-Niklaas, Belgium
De Witte, Marianne; vzw Curando, Ruiselede, Belgium
Nichols, E., Steinmetz, J.D., Vollset, S.E., et al. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health 7 (2022), 105–125.
Janus, S.I.M., van Manen, J.G., IJzerman, M.J., Zuidema, S.U., Psychotropic drug prescriptions in Western European nursing homes. Int Psychogeriatr 28 (2016), 1775–1790.
Campbell-Enns, H.J., Campbell, M., Rieger, K.L., Thompson, G.N., Doupe, M.B., No other safe care option: nursing home admission as a last resort strategy. Gerontologist 60 (2020), 1504–1514.
NSW Health. Assessment and management of behaviours and psychological symptoms associated with dementia (BPSD) a handbook. 2022, NSW Health.
Bunn, F., Burn, A.M., Goodman, C., et al. Comorbidity and dementia: a scoping review of the literature. BMC Med, 12, 2014, 192.
Xiao, X., Xiang, S., Xu, Q., Li, J., Xiao, J., Si, Y., Comorbidity among inpatients with dementia: a preliminary cross-sectional study in West China. Aging Clin Exp Res 35 (2023), 659–667.
Clague, F., Mercer, S.W., McLean, G., Reynish, E., Guthrie, B., Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data. Age Ageing 46 (2017), 33–39.
Jokanovic, N., Tan, E.C.K., Dooley, M.J., Kirkpatrick, C.M., Bell, J.S., Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc 16 (2015), 5351–53512.
Leelakanok, N., D'Cunha, R.R., Association between polypharmacy and dementia – a systematic review and metaanalysis. Aging Ment Health 23 (2019), 932–941.
Morin, L., Laroche, M.-L., Texier, G., Johnell, K., Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. J Am Med Dir Assoc 17 (2016), 862.e1–862.e9.
Davies, E.A., O'Mahony, M.S., Adverse drug reactions in special populations - the elderly. Br J Clin Pharmacol 80 (2015), 796–807.
Field, T.S., Gurwitz, J.H., Avorn, J., et al. Risk factors for adverse drug events among nursing home residents. Arch Intern Med 161 (2001), 1629–1634.
Franceschi, M., Scarcelli, C., Niro, V., et al. Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit: a prospective study of 1756 patients. Drug Saf 31 (2008), 545–556.
Gustafsson, M., Sjölander, M., Pfister, B., Jonsson, J., Schneede, J., Lövheim, H., Drug-related hospital admissions among old people with dementia. Eur J Clin Pharmacol 72 (2016), 1143–1153.
Mannesse, C.K., Derkx, F.H., de Ridder, M.A., Man in ’t Veld, A.J., van der Cammen, T.J., Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing 29 (2000), 35–39.
Wang, K.N., Bell, J.S., Chen, E.Y.H., Gilmartin-Thomas, J.F.M., Ilomäki, J., Medications and prescribing patterns as factors associated with hospitalizations from long-term care facilities: a systematic review. Drugs Aging 35 (2018), 423–457.
Oya, N., Ayani, N., Kuwahara, A., et al. Over half of falls were associated with psychotropic medication use in four nursing homes in Japan: a retrospective cohort study. Int J Environ Res Public Health, 19, 2022, 3123.
Richardson, K., Loke, Y.K., Fox, C., et al. Adverse effects of Z-drugs for sleep disturbance in people living with dementia: a population-based cohort study. BMC Med, 18, 2020, 351.
Azermai, M., Dealing with behavioral and psychological symptoms of dementia: a general overview. Psychol Res Behav Manag 8 (2015), 181–185.
Koponen, M., Rajamaki, B., Lavikainen, P., et al. Antipsychotic use and risk of stroke among community-dwelling people with Alzheimer's disease. J Am Med Dir Assoc 23 (2022), 1059–1065.e4.
Trifirò, G., Spina, E., Gambassi, G., Use of antipsychotics in elderly patients with dementia: do atypical and conventional agents have a similar safety profile?. Pharmacol Res 59 (2009), 1–12.
May, S., Greiner, T., Thoma, S., et al. Psychopharmaceutical medication in Brandenburgian nursing homes - an exploratory study. Psychiatr Prax 46 (2019), 388–393.
Bathena, S.P.R., Leppik, I.E., Kanner, A.M., Birnbaum, A.K., Antiseizure, antidepressant, and antipsychotic medication prescribing in elderly nursing home residents. Epilepsy Behav 69 (2017), 116–120.
Terada, S., Yamakawa, M., Kang, Y., et al. Variations and factors associated with psychotropic use in cognitively impaired elderly residing in long-term care facilities in East Asia: a cross-sectional study. Psychogeriatrics 19 (2019), 291–299.
Vasudev, A., Shariff, S.Z., Liu, K., et al. Trends in psychotropic dispensing among older adults with dementia living in long-term care facilities: 2004-2013. Am J Geriatr Psychiatry 23 (2015), 1259–1269.
Azab, M., Novella, A., Ianes, A., Pasina, L., Potentially inappropriate psychotropic drugs in nursing homes: an Italian observational study. Drugs Aging 41 (2023), 187–197.
Schjøtt, J., Aßmus, J., A retrospective comparison of inappropriate prescribing of psychotropics in three Norwegian nursing homes in 2000 and 2016 with prescribing quality indicators. BMC Med Inform Decis Making, 19, 2019, 102.
Jester, D.J., Molinari, V., Zgibor, J.C., Volicer, L., Prevalence of psychotropic polypharmacy in nursing home residents with dementia: a meta-analysis. Int Psychogeriatr 33 (2021), 1083–1098.
Tombaugh, T.N., McIntyre, N.J., The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 40 (1992), 922–935.
Gillis, K., van Diermen, L., Lahaye, H., et al. Effect of need-based care on behavioural and psychological symptoms in residents with dementia and formal caregivers’ distress in nursing homes: a three-arm cluster randomized controlled trial. Eur Geriatr Med 14 (2023), 1083–1096.
Katz, S., Downs, T.D., Cash, H.R., Grotz, R.C., Progress in development of the index of ADL. Gerontologist 10 (1970), 20–30.
Zuidema, S.U., Jonghe, J.F.M., Verhey, F.R.J., Koopmans, R.T.C.M., Agitation in Dutch institutionalized patients with dementia: factor analysis of the Dutch version of the cohen-mansfield agitation inventory. Demen Geriatr Cogn Disord 23 (2007), 35–41.
Kat, M.G., Jonghe, J.F.M., Aalten, P., Kalisvaart, C.J., Dröes, R.M., Verhey, F.R.J., Neuropsychiatric symptoms of dementia: psychometric aspects of the Dutch Neuropsychiatric Inventory (NPI). Tijdschr Gerontol Geriatr 33 (2002), 150–155.
Anrys, P.M.S., Strauven, G.C., Foulon, V., Degryse, J.M., Henrard, S., Spinewine, A., Potentially inappropriate prescribing in Belgian nursing homes: prevalence and associated factors. J Am Med Dir Assoc 19 (2018), 884–890.
Bourgeois, J., Elseviers, M.M., Azermai, M., Van Bortel, L., Petrovic, M., Vander Stichele, R.R., Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages. Eur J Clin Pharmacol 68 (2012), 833–844.
Nørgaard, A., Jensen-Dahm, C., Gasse, C., Hansen, E.S., Waldemar, G., Psychotropic polypharmacy in patients with dementia: prevalence and predictors. J Alzheimers Dis 56 (2017), 707–716.
Johnell, K., Inappropriate drug use in people with cognitive impairment and dementia: a systematic review. Curr Clin Pharmacol 10 (2015), 178–184.
Vetrano, D.L., Tosato, M., Colloca, G., et al. Polypharmacy in nursing home residents with severe cognitive impairment: results from the SHELTER Study. Alzheimers Dement 9 (2013), 587–593.
Nijk, R.M., Zuidema, S.U., Koopmans, R.T.C.M., Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia. Int Psychogeriatr 21 (2009), 485–493.
Bronskill, S.E., Gill, S.S., Paterson, J.M., Bell, C.M., Anderson, G.M., Rochon, P.A., Exploring variation in rates of polypharmacy across long term care homes. J Am Med Dir Assoc, 13, 2012, 309.e15-e21.
Growdon, M.E., Gan, S., Yaffe, K., Steinman, M.A., Polypharmacy among older adults with dementia compared with those without dementia in the United States. J Am Geriatr Soc 69 (2021), 2464–2475.
Moyle, W., El Saifi, N., Draper, B., et al. Pharmacotherapy of persons with dementia in long-term care in Australia: a descriptive audit of central nervous system medications. Curr Drug Saf 12 (2017), 95–102.
Esumi, S., Ushio, S., Zamami, Y., Polypharmacy in older adults with Alzheimer's disease. Medicina (Kaunas), 58, 2022, 1445.
Park, H.-Y., Park, J.-W., Song, H.J., Sohn, H.S., Kwon, J.-W., The association between polypharmacy and dementia: a nested case-control study based on a 12-year longitudinal cohort database in South Korea. PLoS One, 12, 2017, 0169463.
Riedl, L., Kiesel, E., Hartmann, J., et al. A bitter pill to swallow - polypharmacy and psychotropic treatment in people with advanced dementia. BMC Geriatr, 22, 2022, 214.
Zhou, D., Chen, Z., Tian, F., Deprescribing interventions for older patients: a systematic review and meta-analysis. J Am Med Dir Assoc 24 (2023), 1718–1725.
American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 71 (2023), 2052–2081.
O'Mahony, D., Cherubini, A., Guiteras, A.R., et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med 14 (2023), 625–632.
Wauters, M., Elseviers, M., Vander Stichele, R., Dilles, T., Thienpont, G., Christiaens, T., Efficacy, feasibility and acceptability of the OptiMEDs tool for multidisciplinary medication review in nursing homes. Arch Gerontol Geriatr, 95, 2021, 104391.
Raza, A., Piekarz, H., Jawad, S., Langran, T., Donyai, P., A systematic review of quantitative studies exploring staff views on antipsychotic use in residents with dementia in care homes. Int J Clin Pharm 45 (2023), 1050–1061.
Gedde, M.H., Husebo, B.S., Mannseth, J., Kjome, R.L.S., Naik, M., Berge, L.I., Less is more: the impact of deprescribing psychotropic drugs on behavioral and psychological symptoms and daily functioning in nursing home patients. Results from the cluster-randomized controlled COSMOS trial. Am J Geriatr Psychiatry 29 (2021), 304–315.
Dyer, S.M., Harrison, S.L., Laver, K., Whitehead, C., Crotty, M., An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioral and psychological symptoms of dementia. Int Psychogeriatr 30 (2018), 295–309.
Oliveira, A.M.D., Radanovic, M., Mello, P.C.H.D., et al. Nonpharmacological interventions to reduce behavioral and psychological symptoms of dementia: a systematic review. Biomed Res Int, 2015, 2015, 218980.
Jiang, W., Wu, Z., Wen, L., et al. The efficacy of high- or low-frequency transcranial magnetic stimulation in Alzheimer's disease patients with behavioral and psychological symptoms of dementia. Adv Ther 39 (2022), 286–295.
Creighton, A.S., Davison, T.E., Kissane, D.W., The prevalence, reporting, and treatment of anxiety among older adults in nursing homes and other residential aged care facilities. J Affect Disord 227 (2018), 416–423.
