School of Aging Studies, University of South Florida, Tampa, FL, USA.
College of Public Health, University of South Florida, Tampa, FL, USA.
Int Psychogeriatr. 2021 Oct;33(10):1083-1098. doi: 10.1017/S1041610220004032. Epub 2021 Jan 7.
Nursing home (NH) residents with dementia is exposed to high rates of psychotropic prescriptions. Our objectives were to: (1) pool the prevalence estimates of psychotropic polypharmacy from the existing literature and (2) examine potentially influential factors that are related to a higher or lower prevalence.
Meta-analysis of data collected from randomized trials, quasi-experimental, prospective or retrospective cohort, and cross-sectional studies. English-language searches of PubMed and PsycINFO were completed by November 2020. Included studies reported prevalence estimates of psychotropic polypharmacy (i.e. defined as either two-or-more or three-or-more medications concurrently) in NH residents with dementia.
NH residents with dementia.
Random-effects models were used to pool the prevalence of psychotropic polypharmacy in NH residents with dementia across studies. Estimates were provided for both two-or-more and three-or-more concurrent medications. Heterogeneity and publication bias were measured. Meta-regression examined the influence of the percentage of the sample who were male, mean age of the sample, geographic region (continent), sample size, and study year on the prevalence of psychotropic polypharmacy.
Twenty-five unique articles were included comprising medications data from 92,370 NH residents with dementia in 12 countries. One-in-three (33%, [95% CI: 28%, 39%]) NH residents with dementia received two-or-more psychotropic medications concurrently. One-in-eight (13%, [95% CI: 10%, 17%]) received three-or-more psychotropic medications concurrently. Estimates were highly variable across both definitions of psychotropic polypharmacy (p < 0.001). Among study-level demographics, geographic region, sample size, or study year, only male sex was associated with greater use of two-or-more psychotropic medications (Unadjusted OR = 1.02, p = 0.006; Adjusted OR = 1.04, p = 0.07).
Psychotropic polypharmacy is common among NH residents with dementia. Identifying the causes of utilization and the effects on resident health and well-being should be prioritized by federal entities seeking to improve NH quality.
养老院（NH）中患有痴呆症的居民服用精神药物的比例很高。我们的目的是：（1）汇总现有文献中精神药物的多药治疗的流行率估计值，（2）检查与更高或更低流行率相关的潜在影响因素。
对来自随机试验、准实验、前瞻性或回顾性队列以及横断面研究的数据进行荟萃分析。截至 2020 年 11 月，通过 PubMed 和 PsycINFO 进行了英语检索。纳入的研究报告了 NH 中患有痴呆症的居民的精神药物多药治疗的流行率估计值（即定义为同时使用两种或更多种或三种或更多种药物）。
NH 中患有痴呆症的居民。
使用随机效应模型汇总 NH 中患有痴呆症的居民中精神药物多药治疗的流行率。提供了两种或更多种药物和三种或更多种药物同时使用的估计值。测量了异质性和发表偏倚。元回归检查了样本中男性比例、样本平均年龄、地理区域（大陆）、样本量和研究年份对精神药物多药治疗流行率的影响。
共纳入 25 篇不同的文章，包含来自 12 个国家的 92370 名 NH 中患有痴呆症的居民的药物数据。三分之一（33%，[95%置信区间：28%，39%]）的 NH 中患有痴呆症的居民同时服用两种或更多种精神药物。八分之一（13%，[95%置信区间：10%，17%]）的人同时服用三种或更多种精神药物。两种定义的精神药物多药治疗的估计值差异很大（p < 0.001）。在研究水平的人口统计学数据中，只有男性与使用两种或更多种精神药物的比例较高有关（未调整的 OR = 1.02，p = 0.006；调整后的 OR = 1.04，p = 0.07）。
NH 中患有痴呆症的居民中精神药物多药治疗很常见。联邦实体应优先确定利用率的原因以及对居民健康和福祉的影响，以改善 NH 的质量。
