养老院中使用抗精神病药物的老年人自我报告与代理报告的健康生活质量之间的关联。一项横断面研究。
Association between self-reported and proxy informant Health Quality of life of older adults with the use of antipsychotic drugs in nursing homes. A cross-sectional study.
作者信息
Boucaud-Maitre Denis, Jaballah Fares, Letenneur Luc, Rinaldo Leila, Dartigues Jean-François, Dramé Moustapha, Amieva Hélène, Tabué-Teguo Maturin
机构信息
DRCI, Centre Hospitalier le Vinatier, Bron, France.
Equipe EPICLIV, Université des Antilles, Fort-de-France, Martinique.
出版信息
PLoS One. 2025 Jan 7;20(1):e0311823. doi: 10.1371/journal.pone.0311823. eCollection 2025.
INTRODUCTION
Antipsychotic prescriptions are frequent in nursing homes due to the challenging management of symptoms associated with Alzheimer's disease and related neurodegenerative disorders. This study aimed to assess the association between Health-related Quality Of Life (HrQOL) and antipsychotic use in nursing homes.
METHODS
This is a cross-sectional study of the KASEHPAD (Karukera Study of Ageing in Nursing Homes) study conducted in six nursing homes in Guadeloupe and Martinique (French West Indies). The EuroQol 5-dimensional questionnaire (EQ-5D) was used to measure HRQoL. Clinical characteristics and use of antipsychotic drugs of 194 older adults with both self-reported and proxy informant HrQOL index were extracted. Other outcomes measures included the frequency and severity of delusions, hallucinations and agitation using the reduced Neuropsychiatric Inventory Nursing Home (NPI-R) score, Activities of Daily Living (ADL) score and Mini-Mental State Examination (MMSE) score.
RESULTS
The mean age of participants was 81.3 years and 63.6% had major cognitive impairment (MMSE score ≤18). The prevalence of delusions (39.7%), hallucinations (27.8%) and agitation (40.7%) was high. Antipsychotic medication was prescribed to 37.1% of the participants. The self-reported HrQOL Index of older adults was higher than the proxy HrQOL Index (0.54 ± 0.43 versus 0.40 ± 0.43) with a correlation coefficient of 0.63 (p<0.001). The use of antipsychotic medication was associated with a higher self-reported HrQOL index, after controlling for the frequency (β = 0.144, p = 0.024) or severity (β = 0.159, p = 0.009) of delusions, hallucinations and agitation symptoms. Conversely, antipsychotic use was not associated with proxy HrQOL Index.
CONCLUSION
Despite the adverse effects of long-term use of antipsychotic drugs in older adults, it is associated with better-perceived HrQOL among nursing home residents. However, this association was not observed when HrQOL was assessed by proxy informants. This finding may explain the challenges in reducing the use of this therapeutic class in nursing homes.
引言
由于阿尔茨海默病及相关神经退行性疾病症状管理具有挑战性，养老院中抗精神病药物的处方很常见。本研究旨在评估养老院中健康相关生活质量（HrQOL）与抗精神病药物使用之间的关联。
方法
这是一项对瓜德罗普岛和马提尼克岛（法属西印度群岛）六家养老院进行的KASEHPAD（养老院老年研究）研究的横断面研究。使用欧洲五维健康量表问卷（EQ-5D）来测量健康相关生活质量。提取了194名既有自我报告又有代理人报告的健康相关生活质量指数的老年人的临床特征和抗精神病药物使用情况。其他结局指标包括使用简化版养老院神经精神科问卷（NPI-R）评分、日常生活活动能力（ADL）评分和简易精神状态检查表（MMSE）评分来评估妄想、幻觉和激越的频率及严重程度。
结果
参与者的平均年龄为81.3岁，63.6%的人有重度认知障碍（MMSE评分≤18）。妄想（39.7%）、幻觉（27.8%）和激越（40.7%）的患病率很高。37.1%的参与者开具了抗精神病药物处方。老年人自我报告的健康相关生活质量指数高于代理人报告的健康相关生活质量指数（0.54±0.43对0.40±0.43），相关系数为0.63（p<0.001）。在控制妄想、幻觉和激越症状的频率（β = 0.144，p = 0.024）或严重程度（β = 0.159，p = 0.009）后，抗精神病药物的使用与自我报告的较高健康相关生活质量指数相关。相反，抗精神病药物的使用与代理人报告的健康相关生活质量指数无关。
结论
尽管长期使用抗精神病药物对老年人有不良影响，但它与养老院居民自我感知的较好健康相关生活质量相关。然而，当由代理人信息提供者评估健康相关生活质量时，未观察到这种关联。这一发现可能解释了在养老院减少这类治疗药物使用方面的挑战。
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