Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
Aging Ment Health. 2022 Jun;26(6):1087-1094. doi: 10.1080/13607863.2021.1922601. Epub 2021 May 13.
Psychotropic medications are commonly inappropriately prescribed for people with dementia (PwD) residing in nursing homes. This population is often multi-morbid, receiving multiple medications and therefore at an increased risk of mortality. This overview aimed to collate all synthesised quantitative, qualitative, and mixed-method evidence pertaining to the effectiveness of interventions aimed at reducing inappropriate psychotropic prescribing for nursing home residents with dementia; the perceived barriers and facilitators to the implementation of these interventions; and the attitudes and experiences of stakeholders toward prescribing. An overview of reviews was conducted (PROSPERO protocol registration CRD42020187288). Five databases were systematically searched from January 2010 through June 2020, supplemented by grey literature searching. Reviews presenting evidence pertaining to either randomised controlled trials (RCT) aiming to reduce inappropriate prescribing or qualitative/mixed method studies of stakeholder views, were included.
Of 273 records identified, 11 systematic reviews were included. The quality of reviews ranged from critically low to moderate. There was mixed evidence for the use of education-only interventions. Multicomponent interventions (typically staff education combined with organisational and structural components), medication review, and interventions aimed at cultural change were evidenced as effective compared to care as usual. Stakeholders cited the importance of multidisciplinary collaboration and targeting organisational climate in changing psychotropic prescribing behaviours.
The inappropriate use of psychotropic medications in nursing homes for PwD is a complex issue with many contextual factors. The evidence suggests a comprehensive approach, targeting organisational climate and multidisciplinary collaboration, along with staff education and training, may be an effective strategy.
精神药物在居住在养老院的痴呆症患者（PwD）中经常被不适当地开处方。这一人群通常患有多种疾病，接受多种药物治疗，因此死亡风险增加。本综述旨在综合所有关于旨在减少痴呆症养老院居民不适当精神药物处方的干预措施的有效性、实施这些干预措施的障碍和促进因素以及利益相关者对处方的态度和经验的综合定量、定性和混合方法证据。（PROSPERO 协议注册 CRD42020187288）。从 2010 年 1 月到 2020 年 6 月，系统地搜索了五个数据库，并补充了灰色文献搜索。纳入了呈现关于旨在减少不适当处方的随机对照试验（RCT）证据或利益相关者观点的定性/混合方法研究的综述。
在确定的 273 条记录中，有 11 项系统评价被纳入。评价的质量从批判性低到中等不等。单纯教育干预的证据存在差异。多组分干预措施（通常是员工教育与组织和结构成分相结合）、药物审查和旨在改变文化的干预措施与常规护理相比被证明是有效的。利益相关者指出了多学科合作和改变精神药物处方行为的目标组织氛围的重要性。
在为 PwD 居住的养老院中不恰当地使用精神药物是一个复杂的问题，涉及许多背景因素。有证据表明，一种全面的方法，针对组织氛围和多学科合作，以及员工教育和培训，可能是一种有效的策略。
