Alanen Hanna-Mari, Finne-Soveri Harriet, Noro Anja, Leinonen Esa
University of Tampere Medical School, University of Tampere, FIN-33014 Tampere, Finland.
Age Ageing. 2006 Sep;35(5):508-13. doi: 10.1093/ageing/afl065. Epub 2006 Jun 28.
There is a paucity of information about the use of antipsychotic medication in long-term care, especially among the oldest-old residents.
To analyse the factors associated with the use of antipsychotic medication among nonagenarian residents in long-term institutional care.
A retrospective study was designed from cross-sectional data, gathered in the period 1 January 2003 to 30 June 2003, in Finland. Data were extracted from the Resident Assessment Instrument database, based on Minimum Data Set 2.0 assessments.
Data were provided by 23 hospital-based institutions and 43 residential homes.
Residents aged >or=90 years were included, consisting of 1,334 resident assessments.
Almost a third of the residents received one or more antipsychotic medication. In the logistic regression analysis, factors associated with the use of antipsychotics among nonagenarian residents were as follows: socially inappropriate or disruptive behavioural symptoms [odds ratio (OR) 1.86, 95% confidence interval (CI) 1.36-2.54], concomitant anxiolytic medication (OR 1.83, 95% CI 1.39-2.42), recurring anxious complaints (OR 1.61, 95% CI 1.17-2.22), recurring physical movements (OR 1.43, 95% CI 1.08-1.91) and unsettled relationships (OR 1.35, 95% CI 1.15-1.57). A good sense of initiative or involvement was significantly less likely to be associated with antipsychotics (OR 0.86, 95% CI 0.80-0.94). There were no associations between any psychiatric diagnoses or symptoms and the use of antipsychotics.
Antipsychotic medication use in nonagenarians in long-term institutions was common and seemed in many cases to be associated with residents' negative attitudes to others. Querulous residents received antipsychotics more commonly than those with good social skills. Clearly defined indications may not be fulfilled in many cases, and an evaluation of treatment may be lacking. These may indicate that in Finland, there could be a considerable gap between antipsychotic medication recommendations and actual clinical practice.
关于抗精神病药物在长期护理中的使用情况，尤其是在年龄最大的老年居民中的使用情况，信息匮乏。
分析长期机构护理中百岁老人使用抗精神病药物的相关因素。
基于2003年1月1日至2003年6月30日期间在芬兰收集的横断面数据进行回顾性研究。数据从居民评估工具数据库中提取，基于最低数据集2.0评估。
数据由23家医院机构和43家养老院提供。
纳入年龄≥90岁的居民，共1334份居民评估。
近三分之一的居民接受了一种或多种抗精神病药物治疗。在逻辑回归分析中，百岁老人使用抗精神病药物的相关因素如下：社交不适当或破坏性行为症状[比值比（OR）1.86，95%置信区间（CI）1.36 - 2.54]、同时使用抗焦虑药物（OR 1.83，95% CI 1.39 - 2.42）、反复出现焦虑主诉（OR 1.61，95% CI 1.17 - 2.22）、反复出现身体动作（OR 1.43，95% CI 1.08 - 1.91）以及关系不稳定（OR 1.35，95% CI 1.15 - 1.57）。主动性或参与感良好与使用抗精神病药物的关联显著较低（OR 0.86，95% CI 0.80 - 0.94）。任何精神科诊断或症状与抗精神病药物的使用之间均无关联。
长期机构中百岁老人使用抗精神病药物的情况很常见，在许多情况下似乎与居民对他人的负面态度有关。爱抱怨的居民比社交技能良好的居民更常接受抗精神病药物治疗。在许多情况下可能未满足明确界定的用药指征，且可能缺乏治疗评估。这可能表明在芬兰，抗精神病药物的用药建议与实际临床实践之间可能存在相当大的差距。
