School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK.
BMC Geriatr. 2011 Sep 30;11:56. doi: 10.1186/1471-2318-11-56.
The objective of this study was to determine the sedative load and use of sedative and psychotropic medications among older people with dementia living in (residential) care homes.
Medication data were collected at baseline and at two further time-points for eligible residents of six care homes participating in the EVIDEM-End Of Life (EOL) study for whom medication administration records were available. Regular medications were classified using the Anatomical Therapeutic Chemical classification system and individual sedative loads were calculated using a previously published model.
At baseline, medication administration records were reviewed for 115 residents; medication records were reviewed for 112 and 105 residents at time-points 2 and 3 respectively. Approximately one-third of residents were not taking any medications with sedative properties at each time-point, while a significant proportion of residents had a low sedative load score of 1 or 2 (54.8%, 59.0% and 57.1% at baseline and time-points 2 and 3 respectively). More than 10% of residents had a high sedative load score (≥ 3) at baseline (12.2%), and this increased to 14.3% at time-points 2 and 3. Approximately two-thirds of residents (66.9%) regularly used one or more psychotropic medication(s). Antidepressants, predominantly selective serotonin re-uptake inhibitors (SSRIs), were most frequently used, while antipsychotics, hypnotics and anxiolytics were less routinely administered. The prevalence of antipsychotic use among residents was 19.0%, lower than has been previously reported for nursing home residents. Throughout the duration of the study, administration of medications recognised as having prominent sedative adverse effects and/or containing sedative components outweighed the regular use of primary sedatives.
Sedative load scores were similar throughout the study period for residents with dementia in each of the care homes. Scores were lower than previously reported in studies conducted in long-term care wards which have on-site clinical support. Nevertheless, strategies to optimise drug therapy for care home residents with dementia which rely on clinicians external to the care home for support and medication review are required.
本研究旨在确定居住在（养老院）护理院中的老年痴呆症患者的镇静负荷和镇静及精神药物的使用情况。
在 EVIDEM-临终（EOL）研究中，对参与研究的六家养老院中符合条件的居民进行了基线和另外两个时间点的药物数据收集，这些居民的药物管理记录可用。使用解剖治疗化学分类系统对常规药物进行分类，并使用先前发表的模型计算个体镇静负荷。
在基线时，对 115 名居民的药物管理记录进行了审查；在第 2 和第 3 个时间点，分别对 112 名和 105 名居民的药物记录进行了审查。大约三分之一的居民在每个时间点都没有服用任何具有镇静作用的药物，而很大一部分居民的镇静负荷评分较低（基线时为 1 或 2，分别为 54.8%、59.0%和 57.1%）。超过 10%的居民在基线时（12.2%）有较高的镇静负荷评分（≥3），而在第 2 和第 3 个时间点时，这一比例增加到 14.3%。大约三分之二的居民（66.9%）经常使用一种或多种精神药物。抗抑郁药，主要是选择性 5-羟色胺再摄取抑制剂（SSRIs），使用最频繁，而抗精神病药、催眠药和抗焦虑药的使用则不那么常规。居民中抗精神病药的使用比例为 19.0%，低于以前报道的养老院居民的比例。在整个研究期间，使用具有明显镇静不良反应和/或含有镇静成分的药物的情况超过了常规使用主要镇静剂的情况。
在每个养老院中，痴呆症患者的镇静负荷评分在整个研究期间相似。这些评分低于以前在有现场临床支持的长期护理病房进行的研究中报道的评分。然而，需要为居住在养老院中的痴呆症患者制定优化药物治疗的策略，这些策略依赖于养老院以外的临床医生提供支持和药物审查。
