Senior Lecturer, University of Auckland.
Clinical Nurse Specialist, Waikato District Health Board.
N Z Med J. 2021 Jun 25;134(1537):56-65.
This study aimed to quantify use of antipsychotic and sedative medications in residents with dementia in long-term care facilities in the Waikato District Health Board (DHB) catchment and to identify factors associated with the prescription of these medications.
Resident records and the medication charts of 271 residents with a diagnosis of dementia from 13 dementia units in the Waikato DHB catchment, as well as the psychogeriatric (PG) unit, were reviewed for current prescriptions for any antipsychotic or sedative medication and the date those medications were most recently prescribed.
Antipsychotics were prescribed for 133 (49.1%) residents, with a mean (95% CI) of 401 (354-448) days since the most recent prescription was made. Only 16.8% of antipsychotic prescriptions were prescribed in the preceding 12 weeks, with 31.3% of prescriptions prescribed more than a year prior. Residents were more likely to be prescribed an antipsychotic if they were male (56.9% vs 42.6%, p=.019) or had an incident form completed (30.8% vs 19.6% p=.03). Regression analysis showed only gender (OR 1.79, 95%CI 1.07-2.98, p=.026) was associated with antipsychotic medication prescription. Sedatives were prescribed for 60 (22.1%) residents, with a mean (95%CI) of 487 (431-544) days since the most recent prescription was made, and 44.8% of prescriptions were dated more than a year prior. Residents were more likely to be prescribed a sedative if they entered the facility at a younger age (76.9 vs 79.5, p=.042) or had been in the current facility longer (980 vs 734 days, p=.048). Following regression analysis, no individual factors were significantly associated with sedative prescription.
With clear evidence of the risks of antipsychotics to patients with dementia, the proportion of residents prescribed an antipsychotic or sedative in this study, in conjunction with the prolonged duration of prescription, is cause for concern and needs addressing.
本研究旨在量化怀卡托地区卫生委员会（DHB）范围内长期护理机构中痴呆患者使用抗精神病药和镇静剂的情况，并确定与这些药物处方相关的因素。
对怀卡托 DHB 范围内 13 个痴呆单位（包括精神科老年病房）的 271 名痴呆诊断患者的病历和用药记录进行了回顾性分析，以确定当前是否开具任何抗精神病药或镇静剂，以及最近一次开具这些药物的日期。
共为 133 名（49.1%）患者开具了抗精神病药，最近一次处方后平均（95%CI）为 401（354-448）天。仅 16.8%的抗精神病药处方是在过去 12 周内开具的，31.3%的处方是在一年前开具的。如果患者为男性（56.9%比 42.6%，p=.019）或有新入院记录（30.8%比 19.6%，p=.03），则更有可能被开具抗精神病药。回归分析显示，只有性别（OR 1.79，95%CI 1.07-2.98，p=.026）与抗精神病药处方相关。共为 60 名（22.1%）患者开具了镇静剂，最近一次处方后平均（95%CI）为 487（431-544）天，44.8%的处方是在一年前开具的。如果患者进入护理机构的年龄较小（76.9 岁比 79.5 岁，p=.042）或在当前机构的时间较长（980 天比 734 天，p=.048），则更有可能被开具镇静剂。经过回归分析，没有一个单独的因素与镇静剂处方显著相关。
鉴于抗精神病药对痴呆患者的风险有明确证据，本研究中被开具抗精神病药或镇静剂的患者比例，以及处方的持续时间，都令人担忧，需要加以解决。
