Østfold Hospital Trust, Grålum, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway; Research Centre for age related functional decline and diseases, Innlandet Hospital Trust, Ottestad, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
J Am Med Dir Assoc. 2021 Jan;22(1):101-108.e1. doi: 10.1016/j.jamda.2020.08.034. Epub 2020 Oct 17.
To explore the course of psychotropic drug (PTD) prescription from admission (BL) to 6-month follow-up (6m) in Norwegian nursing homes (NHs). To examine how clinical variables, such as neuropsychiatric symptoms (NPS), cognition, physical health, and NH characteristics at BL are associated with prescription rates at 6 months.
An observational longitudinal cohort study (data from the Resource Use and Disease Course in Dementia-Nursing Home study) designed to examine the course of dementia, psychiatric and somatic diseases, and drug prescriptions in NH patients during the first 6 months after admission.
We included 696 patients at admission to 47 representative Norwegian NHs.
Demographic and clinical characteristics at BL and 6m are presented. Dementia severity was assessed by the Clinical Dementia Rating scale and the Functional Assessment Staging of Alzheimer's Disease scale. Final diagnosis was made by 2 of the authors (G.S. and S.B.) according to ICD-10 criteria. Prevalence, incidence, and persistence rates of PTD prescriptions for people with dementia are presented. Generalized mixed models were used to identify possible predictors for the course of PTD prescription from BL to 6m.
Prescription rates of antidepressants, antipsychotics, anxiolytics, sedatives, and hypnotics increased in people with dementia from BL (67.5% received at least 1 PTD) to 6m (74.0% received at least 1 PTD). Younger age and higher Neuropsychiatric Inventory-affective subsyndrome score at BL were associated with higher odds of antidepressant prescription, whereas patients with higher comorbidity at BL had lower odds of receiving antidepressants, both at BL and 6m. Higher Neuropsychiatric Inventory-affective subsyndrome scores at BL were associated with higher odds of sedative and hypnotic prescription at both assessment points.
PTD prescription rates increase from BL to 6m. Medication appropriateness should be frequently evaluated after admission to optimize PTD prescriptions.
探索挪威养老院（NH）从入院（BL）到 6 个月随访（6m）期间精神药物（PTD）处方的变化过程。考察 BL 时的临床变量（如神经精神症状[NPS]、认知、身体健康和 NH 特征）与 6 个月时的处方率之间的关系。
这是一项观察性纵向队列研究（数据来自资源利用和痴呆-养老院研究的疾病过程），旨在研究 NH 患者入院后前 6 个月内痴呆、精神和躯体疾病以及药物处方的变化过程。
我们纳入了 47 家具有代表性的挪威 NH 中 696 名入院患者。
介绍 BL 和 6m 时的人口统计学和临床特征。采用临床痴呆评定量表和阿尔茨海默病功能评估分期量表评估痴呆严重程度。两位作者（G.S. 和 S.B.）根据 ICD-10 标准做出最终诊断。报告痴呆患者 PTD 处方的患病率、发病率和持续率。使用广义混合模型确定从 BL 到 6m 期间 PTD 处方变化的可能预测因素。
BL 时（67.5%的患者至少服用 1 种 PTD），抗抑郁药、抗精神病药、抗焦虑药、镇静剂和催眠药处方率在痴呆患者中从 BL 增加到 6m（74.0%的患者至少服用 1 种 PTD）。BL 时年龄较小和神经精神症状量表-情感亚综合征评分较高与抗抑郁药处方的可能性较高相关，而 BL 时合并症较多的患者在 BL 和 6m 时接受抗抑郁药的可能性较低。BL 时神经精神症状量表-情感亚综合征评分较高与 BL 和 6m 时镇静剂和催眠药处方的可能性较高相关。
PTD 处方率从 BL 增加到 6m。入院后应经常评估药物的适当性，以优化 PTD 处方。
