Kim Hyojeong, Whall Ann L
University of Michigan School of Nursing, Ann Arbor, MI 48109-0482, USA.
Nurs Res. 2006 Jul-Aug;55(4):252-8. doi: 10.1097/00006199-200607000-00005.
Although federal regulations hold nursing homes responsible for monitoring psychotropic drug (PD) usage, there is a high prevalence of PD usage and significant variation in use across nursing homes.
The aims of study were to (a) describe current PD usage in nursing homes and (b) examine resident and nursing home factors associated with PD usage in nursing home residents with dementia.
A multivariate, multisite, cross-sectional descriptive study was used on data from 107 dementia patients residing in nine randomly selected nursing homes in southeastern Michigan. The PD usage of interest included antipsychotics, antidepressants, anxiolytics or sedatives, and mood stabilizers. Regression analysis tested resident factors, including cognitive ability, functional ability, presence of depressive symptoms, and demographic characteristics, and three facility factors (nursing home size, type of ownership, and level of registered nurse [RN] staffing) in comparison with PD usage.
In this study, 67.3% of the participants received at least one PD. The most frequently prescribed PDs were antidepressants (41.1%) and antipsychotics (37.4%). Newly developed antipsychotics such as risperidone were given more frequently to residents than were conventional drugs such as haloperidol. Regression analysis suggests that the presence of depressive symptoms (odds ratio [OR]= 3.5, p < .01) and low levels of RN staffing (OR = 1.0, p < .01) were associated with the use of PD.
Psychotropic drugs are prescribed frequently for nursing home residents, although such usage is variable. Behavioral symptoms were not an independent predictive factor for PD use. Rather, combined resident and facility characteristics best predicted the use of PDs in nursing home residents. The evaluation of nursing home systems for these characteristics as predictive factors for PD usage in nursing home patients with dementia is suggested by the results. Likewise, attention to new drugs such as selective serotonin reuptake inhibitors and their appropriate use is recommended.
尽管联邦法规要求疗养院对精神药物（PD）的使用进行监测，但精神药物的使用率很高，且各疗养院之间的使用情况存在显著差异。
本研究的目的是（a）描述疗养院目前精神药物的使用情况，以及（b）检查与痴呆症疗养院居民精神药物使用相关的居民和疗养院因素。
对密歇根州东南部九家随机选择的疗养院中107名痴呆症患者的数据进行了多变量、多地点横断面描述性研究。所关注的精神药物使用包括抗精神病药、抗抑郁药、抗焦虑药或镇静剂以及心境稳定剂。回归分析测试了居民因素，包括认知能力、功能能力、抑郁症状的存在情况和人口统计学特征，以及三个机构因素（疗养院规模、所有权类型和注册护士[RN]人员配备水平）与精神药物使用情况的相关性。
在本研究中，67.3%的参与者至少接受了一种精神药物治疗。最常开具的精神药物是抗抑郁药（41.1%）和抗精神病药（37.4%）。与氟哌啶醇等传统药物相比，利培酮等新开发的抗精神病药在居民中使用得更频繁。回归分析表明，抑郁症状的存在（优势比[OR]=3.5，p<.01）和注册护士人员配备水平低（OR = 1.0，p<.01）与精神药物的使用有关。
精神药物在疗养院居民中经常被开具，尽管这种使用情况存在差异。行为症状不是精神药物使用的独立预测因素。相反，居民和机构特征的综合因素最能预测疗养院居民精神药物的使用情况。研究结果表明，应对疗养院系统的这些特征进行评估，作为痴呆症疗养院患者精神药物使用的预测因素。同样，建议关注选择性5-羟色胺再摄取抑制剂等新药及其合理使用。
