Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
JARA UNIT, Concord Centre for Mental Health, Concord Hospital, 1 Hospital Road, Concord, NSW, 2137, Australia.
Drugs Aging. 2023 Dec;40(12):1053-1084. doi: 10.1007/s40266-023-01070-0. Epub 2023 Nov 9.
There has been considerable focus on the use of psychotropic agents in people living with dementia in long-term care. However, psychotropic use often commences well before transitioning to long-term care.
To synthesize the available literature to identify factors associated with psychotropic medication use in people living with dementia in the community.
This PROSPERO-registered review reports findings from a comprehensive search of Embase, PsycINFO, and PubMed (including MEDLINE) databases according to predefined inclusion and exclusion criteria (2010-2022). Inclusion criteria were original prospective or retrospective design research papers enrolling people diagnosed with dementia utilizing a psychotropic medication and living at home. Quality and risk of bias was assessed Newcastle-Ottawa Quality Assessment Scale. The last search was conducted in November 2022. Thematic analysis was used to synthesize the emergent factors identified, and a meta-analysis was undertaken on suitable data.
The search identified 619 articles. After review and exclusions, 39 articles were included for synthesis, including 1,338,737 people. The majority of papers (67%) were rated as low risk of bias and corresponding good quality. Thematic analysis suggested associations between psychotropic prescribing and patient and environmental factors, with little data concerning carer and prescriber factors. Such factors included age (< 75 years, > 90 years), sex, more advanced functional decline, and living alone. Meta-analysis identified significant associations between psychotropic use and respite (temporary full-time care or hospitalization) and comorbid psychiatric illness.
While it is clear from this review that there remains a significant lack of clarity as to the reasons why these medications are being utilized in this population, this review provides greater insight and understanding into the context of psychotropic use. The study has highlighted an opportunity for further targeted research to be conducted and provides a much-needed context for this to occur.
CRD42021286322.
在长期护理中，人们非常关注痴呆患者使用精神药物。然而，精神药物的使用通常在转入长期护理之前就开始了。
综合现有文献，确定与社区中痴呆患者使用精神药物相关的因素。
本 PROSPERO 注册综述根据预先设定的纳入和排除标准，报告了对 Embase、PsycINFO 和 PubMed（包括 MEDLINE）数据库进行全面检索的结果（2010-2022 年）。纳入标准为原始前瞻性或回顾性设计研究论文，纳入诊断为痴呆症、在家中使用精神药物治疗的患者。使用纽卡斯尔-渥太华质量评估量表评估质量和偏倚风险。最后一次搜索于 2022 年 11 月进行。采用主题分析综合确定出现的因素，并对合适的数据进行荟萃分析。
搜索共确定了 619 篇文章。经过审查和排除，有 39 篇文章被纳入综述，共涉及 1338737 人。大多数论文（67%）被评为低偏倚风险和相应的高质量。主题分析表明，精神药物处方与患者和环境因素之间存在关联，但关于照顾者和处方者因素的数据较少。这些因素包括年龄（<75 岁，>90 岁）、性别、更严重的功能下降和独居。荟萃分析确定了精神药物使用与临时全职护理或住院治疗和合并精神疾病之间的显著关联。
尽管从本次综述中可以清楚地看出，对于这些药物在这一人群中使用的原因仍然存在很大的不确定性，但本次综述提供了对精神药物使用背景的更深入了解。该研究强调了进一步进行有针对性研究的机会，并为这一研究提供了急需的背景。
PROSPERO 注册号：CRD42021286322。
