de Mauleon Adelaide, Sourdet Sandrine, Renom-Guiteras Anna, Gillette-Guyonnet Sophie, Leino-Kilpi Helena, Karlsson Staffan, Bleijlevens Michel, Zabategui Adela, Saks Kai, Vellas Bruno, Jolley David, Soto Maria
Department of Geriatric Medicine, Gerontopole, Toulouse University Hospital, INSERM 1027, Toulouse, France.
Institut fuer Allgemeinmedizin und Familienmedizin, Universitaet Witten/Herdecke, Witten, Germany.
J Am Med Dir Assoc. 2014;15(11):812-8. doi: 10.1016/j.jamda.2014.06.015. Epub 2014 Aug 14.
To determine factors associated with the antipsychotic (AP) prescription for people with dementia (PwD) recently admitted to institutional long-term care facilities (LTCFs) and to ascertain differences in the use of this medication in 8 European countries.
An exploratory cross-sectional study.
LTCFs from 8 European countries (Estonia, Finland, France, Germany, The Netherlands, Spain, Sweden, and England).
A total of 791 PwD recently admitted to an LTCF and their caregivers.
Baseline data from RightTimePlaceCare survey was used. Patients' medical conditions, neuropsychiatric symptoms, physical and cognitive status, and medications were recorded. Multiple logistic regression models were used to assess associations with the AP use.
A group of 296 patients (37.4%) of 791 patients recently admitted received AP medication. The prevalence of the use of 1 or more APs varied between study countries, ranging from 12% in Sweden to 54% in Spain. Factors independently associated with the AP use were living in Sweden [odds ratio (OR) 0.12, 95% confidence interval (CI) 0.05-0.30], Finland (OR 0.26, 95% CI 0.14-0.48), Germany (OR 2.75, 95% CI 1.55-4.86) and Estonia (OR 6.79, 95% CI 3.84-12.0). The odds of AP use decreased with the presence of a dementia specific unit in the LTCF (OR 0.60, 95% CI 0.39-0.92), but was higher among residents with a hyperactivity behavior (OR 2.12, 95% CI 1.41-3.18).
The current study shows that more than one-third of the residents recently admitted received APs and that prescription frequency across countries varied significantly. This study raises the possibility that the presence of a dementia-specific unit might play a role in the AP use. Further studies should investigate this association and seek better understanding of what will achieve optimal quality of AP use among newly admitted residents in LTCF.
确定与近期入住机构长期护理机构（LTCF）的痴呆症患者（PwD）使用抗精神病药物（AP）相关的因素，并查明8个欧洲国家在使用这种药物方面的差异。
一项探索性横断面研究。
来自8个欧洲国家（爱沙尼亚、芬兰、法国、德国、荷兰、西班牙、瑞典和英国）的长期护理机构。
共有791名近期入住长期护理机构的痴呆症患者及其护理人员。
使用了RightTimePlaceCare调查的基线数据。记录了患者的医疗状况、神经精神症状、身体和认知状态以及用药情况。使用多元逻辑回归模型评估与使用抗精神病药物的关联。
在791名近期入院的患者中，有296名患者（37.4%）接受了抗精神病药物治疗。使用一种或多种抗精神病药物的患病率在不同研究国家之间有所不同，从瑞典的12%到西班牙的54%不等。与使用抗精神病药物独立相关的因素包括居住在瑞典[比值比（OR）0.12，95%置信区间（CI）0.05 - 0.30]、芬兰（OR 0.26，95% CI 0.14 - 0.48）、德国（OR 2.75，95% CI 1.55 - 4.86）和爱沙尼亚（OR 6.79，95% CI 3.84 - 12.0）。长期护理机构中设有痴呆症专科病房会降低使用抗精神病药物的几率（OR 0.60，95% CI 0.39 - 0.92），但多动行为的居民使用抗精神病药物的几率更高（OR 2.12，95% CI 1.41 - 3.18）。
当前研究表明，超过三分之一的近期入院居民接受了抗精神病药物治疗，且各国的处方频率差异显著。本研究提出了痴呆症专科病房的存在可能在抗精神病药物使用中起作用的可能性。进一步的研究应调查这种关联，并更好地了解如何在长期护理机构新入院居民中实现抗精神病药物的最佳使用质量。
