Psychiatric Clinic, Stavanger University Hospital, Stavanger, Norway.
Int J Geriatr Psychiatry. 2010 Jul;25(7):725-31. doi: 10.1002/gps.2414.
Understanding the underlying mechanisms and risk factors leading to agitation is crucial to reduce the severity of agitation and increase quality of life. International comparative studies offer special advantages in elucidating environmental risk factors by providing a wider diversity of environmental exposures such as nursing home structures, health care systems and genetic diversity.
Baseline data for three different intervention studies in Austria (n = 38), England (n = 302) and Norway (n = 163) were combined posthoc. Patients were grouped according to their dementia severity using the global deterioration scale (GDS), functional assessment staging (FAST) and clinical dementia rating (CDR) scales. For the measurement of agitation, the Cohen-Mansfield Agitation Inventory (CMAI) was used. Data analysis was performed using one-way ANOVA, multivariate and linear regression analysis.
CMAI scores were available for 503 subjects with dementia. There were significant differences between the nursing home residents in the three countries regarding age, gender and dementia severity (all p values < 0.001). In the multivariate analyses, the level of agitation differed with higher mean scores in the Austrian (mean (SD) score 51.9(21.8)) compared to UK (43.3(16.1)) and Norwegian (41.6(13.2)) nursing homes (p = 0.002). Similarly, the use of psychotropic drugs differed significantly, with a higher proportion of neuroleptics in UK (48%, p < 0.001) and Austrian (52.6%; p = 0.001) compared to Norwegian (19%) nursing homes.
We found differences in agitation and antipsychotic drug use which are likely related to structural and cultural differences in nursing homes in three European countries. These findings suggest that structural changes can improve quality of care and quality of life for nursing home residents.
了解导致躁动的潜在机制和风险因素对于减轻躁动的严重程度和提高生活质量至关重要。国际比较研究通过提供更广泛的环境暴露多样性，如养老院结构、医疗保健系统和遗传多样性，具有阐明环境风险因素的特殊优势。
对奥地利（n=38）、英国（n=302）和挪威（n=163）的三项不同干预研究的基线数据进行了事后组合。根据全球恶化量表（GDS）、功能评估分期（FAST）和临床痴呆评定量表（CDR）将患者分为不同的痴呆严重程度组。为了测量躁动，使用了科恩-曼斯菲尔德躁动量表（CMAI）。使用单因素方差分析、多变量和线性回归分析进行数据分析。
CMAI 评分可用于 503 名痴呆症患者。这三个国家的养老院居民在年龄、性别和痴呆严重程度方面存在显著差异（所有 p 值均<0.001）。在多变量分析中，奥地利养老院（平均（SD）评分 51.9（21.8））的躁动水平与英国（43.3（16.1））和挪威（41.6（13.2））养老院相比存在显著差异（p=0.002）。同样，抗精神病药物的使用也存在显著差异，英国（48%，p<0.001）和奥地利（52.6%；p=0.001）养老院使用神经阻滞剂的比例明显高于挪威（19%）养老院。
我们发现了躁动和抗精神病药物使用方面的差异，这些差异可能与三个欧洲国家养老院的结构和文化差异有关。这些发现表明，结构性变化可以改善养老院居民的护理质量和生活质量。
