Snowdon J
Academic Department of Psychogeriatrics, Prince Henry Hospital, Sydney, New South Wales, Australia.
Drugs Aging. 1993 Mar-Apr;3(2):122-30. doi: 10.2165/00002512-199303020-00003.
Most elderly persons in nursing homes and residential care have mental disorders; up to 75% have dementia. Depression and behavioural problems are common. There are big differences between institutions in the proportion of residents prescribed psychotropic medication. A review of the literature suggests that antipsychotics and benzodiazepines are modestly effective in diminishing agitation in some dementing patients. Antidepressants may be underutilized, but clear guidelines about which depressed individuals should receive them are lacking. Attention should be given to ways of improving the environment within these homes, in order to relieve depression and anxiety, and to increase life satisfaction and self-esteem, before commencing psychotropic medication to deal with mental disturbances. Shortage of trained staff and inappropriate design of nursing homes are factors associated with behavioural disturbance in some cases. Special dementia care units are a desirable option for a minority of residents. Involvement of pharmacists and medical directors in monitoring effects, adverse side effects, possible interactions and appropriateness of medications in nursing homes is recommended.
大多数住在养老院和寄宿护理机构的老年人都患有精神障碍；高达75%的人患有痴呆症。抑郁症和行为问题很常见。各机构在接受精神药物治疗的居民比例上存在很大差异。一项文献综述表明，抗精神病药物和苯二氮䓬类药物在减轻一些痴呆患者的躁动方面有一定效果。抗抑郁药的使用可能不足，但缺乏关于哪些抑郁症患者应该使用它们的明确指导方针。在开始使用精神药物来处理精神障碍之前，应该关注改善这些机构环境的方法，以缓解抑郁和焦虑，提高生活满意度和自尊。在某些情况下，训练有素的工作人员短缺和养老院设计不当是与行为紊乱相关的因素。对于少数居民来说，特殊的痴呆症护理单元是一个理想的选择。建议药剂师和医疗主任参与监测养老院药物的疗效、副作用、可能的相互作用以及用药的适宜性。
