老年痴呆症疗养院居民停用抗抑郁药的效果——一项整群随机对照试验
Effects of deprescribing antidepressants in nursing home residents with dementia-a cluster randomized controlled trial.
作者信息
Hølmkjær Pernille, Rozing Maarten Pieter, Overbeck Gritt, Siersma Volkert, Holm Anne
机构信息
Department of Public Health, Center for General Practice, University of Copenhagen, Øster Farimagsgade 5, Building 24, Section Q, 1. Floor, Copenhagen, 1353, Denmark.
出版信息
BMC Prim Care. 2025 Jun 3;26(1):190. doi: 10.1186/s12875-025-02894-y.
BACKGROUND
Older nursing home residents with dementia are commonly prescribed antidepressants despite limited evidence of clinical effect and a high risk of side effects. Deprescribing can be challenging and is often not attempted. The aim of the study is to investigate the effect of a multifaceted intervention targeting nursing home general practitioners and their collaboration with the nursing home staff on the reduction of antidepressant medication in older nursing home residents with dementia.
METHOD
The study is a cluster-randomized, non-blinded, controlled trial. General practitioners working as nursing home physicians in the Capital Region of Denmark were recruited between June 1 and October 1, 2021. Eligible participants were individuals with dementia (diagnosed or suspected), ≥ 72 years old, receiving one or more antidepressants, and living in a nursing home with the associated nursing home physician. The complex intervention consisted of three main parts: 1) a training session occurring in the nursing home, 2) a pre-visit reflection tool, and 3) a dialog tool used during a structured home visit at the nursing home. The control group received enhanced care as usual. Primary outcome was the reduction of the total defined daily dose of antidepressants from pre- to post-intervention in the intervention group, compared to the control group. Secondary outcomes included mortality, changes in other psychotropic medication, hospitalization, and symptoms changes.
RESULTS
We recruited 21 clusters with 128 eligible participants (62/66 in intervention and control). Four clusters withdrew. Most participants were women, and the median age was 85. They received an average of nine different drugs, and the most commonly prescribed antidepressants were sertraline and mirtazapine. The OR for the reduction of antidepressants in the intervention group versus control was 2.3 (95% CI = 0.84-6.2). Mortality rates were similar between groups.
CONCLUSIONS
The intervention did not significantly reduce antidepressant use among older nursing home residents with dementia. Further optimization and testing in a larger study are needed.
TRIAL REGISTRATION
ClinicalTrials.gov ID NCT04985305, registration date: 2021-08-02.
背景
患有痴呆症的老年疗养院居民通常会被开具抗抑郁药，尽管临床疗效证据有限且副作用风险很高。逐渐停用抗抑郁药可能具有挑战性，而且往往不会尝试。本研究的目的是调查针对疗养院全科医生及其与疗养院工作人员的合作的多方面干预措施对减少患有痴呆症的老年疗养院居民抗抑郁药使用的效果。
方法
该研究是一项整群随机、非盲、对照试验。2021年6月1日至10月1日期间招募了在丹麦首都地区担任疗养院医生的全科医生。符合条件的参与者为患有痴呆症（已确诊或疑似）、年龄≥72岁、正在服用一种或多种抗抑郁药且居住在配有相关疗养院医生的疗养院中的个体。复杂干预措施包括三个主要部分：1）在疗养院举办的培训课程，2）访视前反思工具，3）在疗养院进行结构化家访期间使用的对话工具。对照组接受常规强化护理。主要结局是干预组与对照组相比，干预前后抗抑郁药的总限定日剂量的减少情况。次要结局包括死亡率、其他精神药物的变化、住院情况和症状变化。
结果
我们招募了21个整群，128名符合条件的参与者（干预组和对照组各62/66名）。4个整群退出。大多数参与者为女性，中位年龄为85岁。他们平均服用9种不同药物，最常开具的抗抑郁药是舍曲林和米氮平。干预组与对照组相比，抗抑郁药减少的比值比为2.3（95%置信区间=0.84-6.2）。两组死亡率相似。
结论
该干预措施并未显著减少患有痴呆症的老年疗养院居民的抗抑郁药使用。需要在更大规模的研究中进行进一步优化和测试。
试验注册
ClinicalTrials.gov标识符NCT04985305，注册日期：2021年8月2日。
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