Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, Sydney, NSW, Australia.
BMC Geriatr. 2024 Nov 16;24(1):953. doi: 10.1186/s12877-024-05542-9.
Psychotropic medications are frequently utilised in residential aged care facilities (RACFs). Longitudinal medication administration data can offer crucial insights into the potential inappropriate use of psychotropic medicines (PIPMs), guiding future quality improvement initiatives. This study aimed to determine the prevalence and predictors of PIPMs use and assess variation in PIPMs use by facility for residents of RACFs.
We conducted a retrospective longitudinal cohort study using routinely collected electronic health data (2020-2021) relating to 3064 residents from 23 RACFs in New South Wales, Australia. The study included permanent residents aged ≥ 65 years and median length of stay was 483 days. The prevalence of PIPMs use was estimated using updated Beers criteria 2023. The extent of exposure to PIPMs was measured using two metrics i.e., number of days residents were exposed to PIPMs and the proportion of days covered by PIPMs. We used logistic regression model to determine factors associated with PIPM use. Funnel plots to visualised variation in PIPMs use across facilities.
In total 40% (n = 1224) residents used at least one PIPM and 10% (n = 302) used ≥ 2. The most frequently used PIPMs categories were benzodiazepines and Z-drugs (27.4%), followed by first and second generation antipsychotics (17.2%). Certain diagnoses (dementia, pain, depression, anxiety, and endocrine disorders) were associated with the increased use of PIPMs. For example, residents with dementia were 1.94 times more likely to use ≥ 2 PIPMs (OR 1.94; 95% CI 1.50-2.51). The prevalence of at least one PIPM by residents in each facility ranged from 23.3 to 57.0% across facilities. The overall median number of days residents were exposed to PIPMs were 91 days (IQR 6-320) while the median proportion of days covered by at least one PIPM was 39.3% (IQR 2.6-86.6%).
Residents in aged care facilities showed a high rate of PIPMs use with substantial variation across facilities. Quality improvement initiatives which target inappropriate psychotropic medication use are necessary, particularly considering the link between psychotropic drug use and adverse events such as falls.
精神药物经常在养老院中使用。纵向药物管理数据可以为潜在的不适当使用精神药物（PIPM）提供重要见解，指导未来的质量改进计划。本研究旨在确定 PIPM 使用的患病率和预测因素，并评估养老院居民的设施中 PIPM 使用的变化。
我们使用澳大利亚新南威尔士州 23 家养老院（2020-2021 年）的常规收集电子健康数据进行了回顾性纵向队列研究。该研究包括年龄≥65 岁的常住居民，中位入住时间为 483 天。使用 2023 年更新的 Beers 标准估计 PIPM 使用的患病率。使用两个指标衡量 PIPM 的暴露程度，即居民暴露于 PIPM 的天数和 PIPM 覆盖的天数比例。我们使用逻辑回归模型确定与 PIPM 使用相关的因素。使用漏斗图可视化设施之间 PIPM 使用的变化。
共有 40%（n=1224）的居民至少使用了一种 PIPM，10%（n=302）使用了≥2 种。最常使用的 PIPM 类别是苯二氮䓬类和 Z 类药物（27.4%），其次是第一代和第二代抗精神病药（17.2%）。某些诊断（痴呆、疼痛、抑郁、焦虑和内分泌疾病）与 PIPM 使用增加有关。例如，患有痴呆症的居民使用≥2 种 PIPM 的可能性增加 1.94 倍（OR 1.94；95%CI 1.50-2.51）。每个设施的居民至少使用一种 PIPM 的患病率在设施之间的范围为 23.3%至 57.0%。居民暴露于 PIPM 的总中位数天数为 91 天（IQR 6-320），而至少一种 PIPM 覆盖的中位数天数比例为 39.3%（IQR 2.6-86.6%）。
养老院居民的 PIPM 使用率很高，设施之间存在很大差异。需要针对不适当的精神药物使用进行质量改进计划，特别是考虑到精神药物使用与跌倒等不良事件之间的联系。
