Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postbox 8905, N-7491, Trondheim, Norway.
Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
BMC Geriatr. 2019 Apr 25;19(1):119. doi: 10.1186/s12877-019-1126-y.
Little is known about the use of psychotropic drugs in older adults receiving domiciliary care. The first aim was to describe the prevalence and persistency of use of psychotropic drugs in older adults (≥ 70 years) with and without dementia receiving domiciliary care. Furthermore, the second aim was to explore factors associated with persistent drug use at two consecutive time-points. Lastly, we aimed to examine if use of psychotropic drugs changed after admission to a nursing home.
In total, 1001 community-dwelling older adults receiving domiciliary care at inclusion participated in the study. Information about psychotropic drug use was collected at baseline, after 18 months and after 36 months. The participants' cognitive function, neuropsychiatric symptoms (NPS) and physical health were assessed at the same assessments. Participants were evaluated for dementia based on all gathered information. Formal level of care (domiciliary care or in a nursing home) was registered at the follow-up assessments.
Prevalence and persistent use of psychotropic drugs in older adults receiving domiciliary care was high. Participants with dementia more often used antipsychotics and antidepressants than participants without dementia. The majority of the participants using antipsychotic drugs used traditional antipsychotics. Younger age was associated with higher odds for persistent use of antipsychotics and antidepressants, and lower odds for persistent use of sedatives. Severity of NPS was associated with persistent use of antidepressants. The odds for use of antipsychotics and antidepressants were higher in those admitted to a nursing home as compared to the community-dwelling participants at the last follow-up.
There was a high prevalence and persistency of use of psychotropic drugs. The prevalence of use of traditional antipsychotics was surprisingly high, which is alarming. Monitoring the effect and adverse effects of psychotropic drugs is an important part of the treatment, and discontinuation should be considered when possible due to the odds for severe adverse effects of such drugs in people with dementia.
对于接受家庭护理的老年人使用精神药物的情况知之甚少。第一个目的是描述在接受家庭护理的患有和不患有痴呆症的老年人（≥70 岁）中使用精神药物的流行率和持续性。此外，第二个目的是探索与连续两个时间点药物持续使用相关的因素。最后，我们旨在检查在入住养老院后是否改变了精神药物的使用。
共有 1001 名在入住时接受家庭护理的社区居住的老年人参加了这项研究。在基线、18 个月和 36 个月时收集精神药物使用信息。在相同的评估中评估参与者的认知功能、神经精神症状（NPS）和身体健康。根据所有收集的信息评估参与者是否患有痴呆症。正式的护理水平（家庭护理或养老院）在随访评估时记录。
接受家庭护理的老年人使用精神药物的流行率和持续性较高。患有痴呆症的参与者比没有痴呆症的参与者更常使用抗精神病药和抗抑郁药。使用抗精神病药物的大多数参与者使用传统抗精神病药物。年龄较小与抗精神病药和抗抑郁药持续使用的可能性较高相关，与镇静剂持续使用的可能性较低相关。NPS 的严重程度与抗抑郁药的持续使用相关。与社区居住的参与者相比，在最后一次随访时入住养老院的参与者使用抗精神病药和抗抑郁药的可能性更高。
精神药物的使用存在较高的流行率和持续性。传统抗精神病药物的使用率高得惊人，令人担忧。监测精神药物的效果和不良反应是治疗的重要组成部分，并且由于此类药物在痴呆症患者中出现严重不良反应的可能性较高，应考虑停药。
