抗精神病药与加拿大的痴呆症：四个卫生部门的回顾性横断面研究。
Antipsychotics and dementia in Canada: a retrospective cross-sectional study of four health sectors.
机构信息
School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
Schlegel Research Institute for Aging, Waterloo, ON, Canada.
出版信息
BMC Geriatr. 2017 Oct 23;17(1):244. doi: 10.1186/s12877-017-0636-8.
BACKGROUND
Antipsychotic medications are not recommended for the management of symptoms of dementia, particularly among persons with no behavioral or psychological symptoms. We examine patterns of antipsychotic medication use among persons with dementia across health sectors in Canada, with a focus on factors related to use among those without behavioral or psychotic symptoms.
METHODS
Using a retrospective cross-sectional design, this study examines antipsychotic use among adults aged 65 or older with dementia in home care (HC), complex continuing care (CCC), long-term care (LTC), and among alternate level care patients in acute hospitals (ALC). Using clinical data from January 1, 2009 to December 31, 2014, the prevalence of antipsychotic medication use was estimated by the presence of behavioral and psychotic symptoms. Logistic regression was used to identify sector specific factors associated with antipsychotic use in the absence of behavioral and psychotic symptoms.
RESULTS
The total prevalence of antipsychotic use among older adults with dementia was 19% in HC, 42% in ALC, 35% in CCC, and 37% in LTC. This prevalence ranged from 39% (HC) to 70% (ALC) for those with both behavioral and psychotic symptoms and from 12% (HC) to 32% (ALC) among those with no symptoms. The regression models identified a number of variables were related to antipsychotic use in the absence of behavior or psychotic symptoms, such as bipolar disorder (OR = 5.63 in CCC; OR = 5.52 in LTC), anxious complaints (OR = 1.54 in LTC to 2.01 in CCC), and wandering (OR = 1.83 in ALC).
CONCLUSIONS
Potentially inappropriate use of antipsychotic medications is prevalent among older adults with dementia across health sectors. The variations in prevalence observed from community to facility based care suggests that system issues may exist in appropriately managing persons with dementia.
背景
抗精神病药物不推荐用于痴呆症症状的管理，特别是对于没有行为或心理症状的患者。我们研究了加拿大各卫生部门中痴呆症患者使用抗精神病药物的模式，重点关注与无行为或精神病症状患者使用相关的因素。
方法
本研究采用回顾性横断面设计，研究了在家庭护理 (HC)、复杂持续护理 (CCC)、长期护理 (LTC) 以及急性医院的替代水平护理 (ALC) 中，年龄在 65 岁或以上的患有痴呆症的成年人使用抗精神病药物的情况。使用 2009 年 1 月 1 日至 2014 年 12 月 31 日的临床数据，根据有无行为和精神病症状来估计抗精神病药物使用的患病率。使用逻辑回归确定与无行为和精神病症状相关的与部门特异性相关的抗精神病药物使用因素。
结果
患有痴呆症的老年人中，HC 中抗精神病药物使用的总患病率为 19%，ALC 中为 42%，CCC 中为 35%，LTC 中为 37%。对于既有行为又有精神病症状的患者，这一患病率范围为 39%（HC）至 70%（ALC），而对于无任何症状的患者，这一患病率范围为 12%（HC）至 32%（ALC）。回归模型确定了一些变量与无行为或精神病症状相关的抗精神病药物使用有关，例如双相情感障碍（CCC 中的 OR=5.63；LTC 中的 OR=5.52）、焦虑症状（LTC 中的 OR=1.54 至 2.01；CCC 中的 OR=1.54）和徘徊（ALC 中的 OR=1.83）。
结论
在各卫生部门中，患有痴呆症的老年人普遍存在潜在不合理使用抗精神病药物的情况。从社区到机构护理的患病率差异表明，在适当管理痴呆症患者方面可能存在系统问题。
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