a Heymans Institute of Pharmacology, Division of Clinical Pharmacology, Ghent University , Gent , Belgium.
Aging Ment Health. 2014;18(3):346-53. doi: 10.1080/13607863.2013.832732. Epub 2013 Sep 9.
Despite safety warnings on serious adverse effects and guidance advising discontinuation, antipsychotic use in nursing homes remains high. Studies documenting the barriers experienced to antipsychotic discontinuation are rare. This exploratory study investigates the willingness of nurses and general practitioners (GPs) as well as the barriers to undertake antipsychotic discontinuation.
A mixed-method study involving an expert meeting, followed by a survey using structured questionnaires distributed to responsible nurses (primary caregivers) and treating GPs on selected nursing home residents in Belgian nursing homes to generate case-specific information.
Antipsychotic users (n = 113) had a mean age of 81 years (range 57-97); 62% were female and 81% had moderate to severe cognitive impairment. Nurses and GPs indicated a willingness for antipsychotic discontinuation in a small proportion of residents, 13.8% and 12.2%, respectively, with a shared willingness in only 4.2%. Residents for whom there was a higher willingness to try antipsychotic discontinuation were generally older (mean age 84.6 vs. 80.3, p = 0.07), had high physical dependency (ADL > 14, 93.3% vs. 60.9%, p = 0.01) and resided on a ward with controlled access (80.0% vs. 45.7%, p = 0.02). In contrast, residents for whom there was a significant lower willingness for discontinuation already had a previously failed discontinuation effort, and may present risk of harm to themselves or to others. Nurses working longer on the ward, with lower education, presented higher barriers to discontinuation of antipsychotics.
Nurses and GPs share a very low willingness and high barriers to antipsychotic discontinuation. To implement discontinuation programs, complex multidisciplinary interventions should be offered taking existing barriers into account.
尽管有关于严重不良反应的安全警告和建议停药的指导意见，但养老院的抗精神病药物使用仍然很高。很少有研究记录抗精神病药物停药所面临的障碍。这项探索性研究调查了护士和全科医生（GP）愿意以及进行抗精神病药物停药的障碍。
一项混合方法研究，包括一次专家会议，随后对比利时养老院选定的养老院居民的负责护士（主要照顾者）和治疗 GP 使用结构化问卷进行调查，以生成特定于病例的信息。
抗精神病药物使用者（n = 113）的平均年龄为 81 岁（范围 57-97 岁）；62%为女性，81%有中度至重度认知障碍。护士和 GP 分别表示愿意在一小部分居民中停止使用抗精神病药物，分别为 13.8%和 12.2%，仅有 4.2%的居民表示愿意共同尝试。愿意尝试停止使用抗精神病药物的居民年龄一般较大（平均年龄 84.6 岁比 80.3 岁，p = 0.07），身体依赖性较高（ADL > 14，93.3%比 60.9%，p = 0.01），居住在有控制准入的病房（80.0%比 45.7%，p = 0.02）。相比之下，那些明显不愿意停药的居民之前已经停止过停药，可能对自己或他人有伤害的风险。在病房工作时间较长、教育程度较低的护士在停止使用抗精神病药物方面面临更高的障碍。
护士和 GP 对停止使用抗精神病药物的意愿非常低，障碍很高。为了实施停药计划，应提供复杂的多学科干预措施，同时考虑到现有障碍。
