Aged Mental Health Research Unit, School of Psychology and Psychiatry, Monash University, Melbourne, Australia.
Int Psychogeriatr. 2010 Nov;22(7):1149-53. doi: 10.1017/S1041610210000165. Epub 2010 Mar 4.
Nursing home residents are often prescribed large numbers of psychotropic medications. Previous studies suggest that antipsychotic medications are often unnecessary and can be withdrawn without ill effects. Depression, in contrast, is believed to be under-recognized and under-treated.
A six-month audit was carried out of the antipsychotic, antidepressant, anxiolytic and hypnotic medications prescribed to 166 newly admitted residents of a convenience sample of seven nursing homes in Melbourne, Australia.
Over the six-month period, antidepressants were started in 6% of all cases and stopped in 2% of treated cases. Antipsychotics were added in 5% of all cases and stopped in 15% of treated cases. Residents were switched from one antidepressant to another in 5% of treated cases and from one antipsychotic to another in 4%. Benzodiazepine use was relatively modest.
Judging from epidemiological data, treatment revisions were almost certainly insufficient to address residents' mental health needs. We discuss ways of harnessing existing nursing and pharmacy resources to ensure better care for aged residents.
养老院居民经常开处大量精神科药物。既往研究提示，抗精神病药物通常是不必要的，撤药不会产生不良后果。相反，人们认为抑郁常常被低估和治疗不足。
我们对澳大利亚墨尔本的 7 家养老院的 166 名新入院居民的抗精神病药、抗抑郁药、抗焦虑药和催眠药处方进行了为期 6 个月的审核。
在 6 个月期间，所有患者中有 6%开始用抗抑郁药，其中 2%的治疗患者停药；所有患者中有 5%加用抗精神病药，其中 15%的治疗患者停药；治疗患者中有 5%从一种抗抑郁药转换为另一种，4%从一种抗精神病药转换为另一种。苯二氮䓬类药物的使用相对较少。
根据流行病学数据，治疗调整几乎肯定不足以满足居民的心理健康需求。我们讨论了利用现有的护理和药剂资源来确保老年居民得到更好护理的方法。
