Moyle Wendy, El Saifi Najwan, Draper Brian, Jones Cindy, Beattie Elizabeth, Shum David, Thalib Lukman, Mervin Cindy, O Dwyer Siobhan
Griffith University - Menzies Health Institute QLD; School of Nursing and Midwifery Nathan, Brisbane, QLD,Australia.
Curr Drug Saf. 2017 Feb 9;12(2):95-102. doi: 10.2174/1574886312666170209113203.
Neuropsychiatric symptoms of dementia are often treated through the prescription of one or more psychotropic medications. However, limited efficacy and potential harmful side-effects has resulted in efforts to reduce the use of psychotropic medication in this population, particularly for those living in long-term care.
This study sought to describe the pattern of central nervous system medication usage in older adults with dementia living in long-term care; assess the appropriateness of prescribing against Beers criteria; and detect potential drug interactions from co-administered medications.
A retrospective descriptive audit of the medical records of n=415 residents, aged >60 years with a diagnosis of dementia, from 28 long-term care facilities in Queensland, Australia. Information extracted included the types and usage of regular and Pro Re Nata central nervous system medications.
Of those taking medication (n=317), 68% were prescribed at least one potentially inappropriate medication, and there was a significant positive correlation between the number of medications prescribed and the number of potentially inappropriate medications. Two-hundred potential interactions with variable severity were identified from 130 residents on ≥1 medication - 38% were potentially severe interactions, 46% were moderate.
This medication audit raises concerns that prescription of medications may still be the first resort to treat behavioural and psychological symptoms of dementia. There is a need for effective and sustainable person-centred interventions that address barriers for appropriate prescribing practice, and involve the collaboration of all healthcare professionals to optimise prescribing and improve the quality use of medicines in older people with dementia.
痴呆症的神经精神症状通常通过开具一种或多种精神药物来治疗。然而，疗效有限以及潜在的有害副作用导致人们努力减少该人群中精神药物的使用，尤其是那些长期护理机构中的患者。
本研究旨在描述长期护理机构中患有痴呆症的老年人中枢神经系统药物的使用模式；根据Beers标准评估处方的合理性；并检测联合用药之间潜在的药物相互作用。
对澳大利亚昆士兰州28家长期护理机构中n = 415名年龄大于60岁且诊断为痴呆症的居民的病历进行回顾性描述性审计。提取的信息包括常规和按需使用的中枢神经系统药物的类型和使用情况。
在服用药物的患者（n = 317）中，68%的患者至少开具了一种潜在不适当的药物，并且所开药物数量与潜在不适当药物数量之间存在显著正相关。从130名服用≥1种药物的居民中识别出200种不同严重程度的潜在相互作用——38%为潜在严重相互作用，46%为中度相互作用。
本次药物审计引发了人们对药物处方可能仍是治疗痴呆症行为和心理症状的首选方法的担忧。需要采取有效且可持续的以人为本的干预措施，以解决适当处方实践中的障碍，并让所有医疗保健专业人员共同协作，优化处方并提高痴呆症老年人的药物合理使用水平。
