Perceived anxiety, depression, and sleeping problems in relation to psychotropic drug use among elderly in assisted-living facilities

Sociodemographic determinants of life satisfaction among grandparent caregivers

Introduction

It has become a common contemporary phenomenon for grandparents to provide care for young children in their family in both urban and rural areas. This study attempted to investigate psychological wellbeing and quality of life among grandparents involved in childcare in China, and to explore the relationships between sociodemographic characteristics, quality of life, and life satisfaction in this group.

Methods

Using stratified random cluster sampling, we conducted a survey of grandparent caregivers in Wuhan in November and December of 2020 (N = 1,640). Descriptive statistics to univariate analysis, multiple linear regression, and structural equation modeling were carried out.

Results

Across all respondents, mean scores on life satisfaction, sleep quality, and quality of life were 14.05 ± 3.50, 5.02 ± 3.37, and 74.51 ± 16.88, respectively. Marital status, income, chronic diseases, family relationships, and physical exercise were found to be associated with life satisfaction. The results of structural equation modeling indicated that quality of life, sleep quality, and sociodemographic characteristics may exert direct and indirect effects on life satisfaction. Mediating effects accounted for 30.0% of the total effects.

Conclusion

Overall, grandparent caregivers have poor life satisfaction, quality of life, and sleep quality. A higher household income, better relationships with family members, healthy lifestyle habits, and high-quality sleep may effectively help to improve life satisfaction among grandparent caregivers.

Evaluating the Prevalence and Predictors of Moderate to Severe Depression in Fort McMurray, Canada during the COVID-19 Pandemic

Background: The Coronavirus disease (COVID-19) pandemic has produced adverse health consequences, including mental health consequences. Studies indicate that residents of Fort McMurray, a community which has experienced trauma from flooding and wildfires in the past, may be more vulnerable to the mental health effects of the pandemic. Objective: This study aimed to examine the prevalence and predictors of likely Major Depressive Disorder (MDD) among residents of Fort McMurray during the COVID-19 pandemic. Methods: A cross-sectional approach was adopted utilizing an online survey questionnaire to gather sociodemographic data, COVID-19 related data, and clinical information, including likely MDD using the Patient Health Questionnaire (PHQ-9) scale, from the residents of Fort McMurray between the period of 24 April to 2 June 2021. Results: Overall, 186 individuals completed the survey out of 249 residents who accessed the online survey, yielding a completion rate of 74.7%. The prevalence of likely MDD among respondents was 45%. Respondents willing to receive mental health counselling were five times more likely to experience MDD during the COVID-19 pandemic (OR = 5.48; 95% CI: 1.95–15.40). Respondents with a history of depression were nearly five folds more likely to report MDD during the era of the pandemic than residents without a history of depression (OR = 4.64; 95% CI: 1.49–14.44). Similarly, respondents with a history of taking hypnotics (sleeping tablets) were nearly six-fold more likely to express MDD than respondents with no history of receiving sleeping tablets (OR = 5.72; 95% CI: 1.08–30.30). Finally, respondents who reported receiving only partial support from the employer had three times higher odds of having likely MDD than those who received absolute support from the employer (OR = 3.50; 95% CI: 1.24–9.82). Conclusion: In addition to the effect of the pandemic and other measures taken to curb the psychopathological impact of the pandemic, policymakers need to implement policies to manage individuals with preexisting mental health conditions and provide strong employer support.

Personalized Management and Treatment of Alzheimer's Disease

Alzheimer’s disease (AD) is a priority health problem with a high cost to society and a large consumption of medical and social resources. The management of AD patients is complex and multidisciplinary. Over 90% of patients suffer from concomitant diseases and require personalized therapeutic regimens to reduce adverse drug reactions (ADRs), drug−drug interactions (DDIs), and unnecessary costs. Men and women show substantial differences in their AD-related phenotypes. Genomic, epigenetic, neuroimaging, and biochemical biomarkers are useful for predictive and differential diagnosis. The most frequent concomitant diseases include hypertension (>25%), obesity (>70%), diabetes mellitus type 2 (>25%), hypercholesterolemia (40%), hypertriglyceridemia (20%), metabolic syndrome (20%), hepatobiliary disorder (15%), endocrine/metabolic disorders (>20%), cardiovascular disorder (40%), cerebrovascular disorder (60−90%), neuropsychiatric disorders (60−90%), and cancer (10%). Over 90% of AD patients require multifactorial treatments with risk of ADRs and DDIs. The implementation of pharmacogenetics in clinical practice can help optimize the limited therapeutic resources available to treat AD and personalize the use of anti-dementia drugs, in combination with other medications, for the treatment of concomitant disorders.

Pharmacogenomics of Alzheimer's Disease: Novel Strategies for Drug Utilization and Development

Alzheimer's disease (AD) is a priority health problem in developed countries with a high cost to society. Approximately 20% of direct costs are associated with pharmacological treatment. Over 90% of patients require multifactorial treatments, with risk of adverse drug reactions (ADRs) and drug-drug interactions (DDIs) for the treatment of concomitant diseases such as hypertension (>25%), obesity (>70%), diabetes mellitus type 2 (>25%), hypercholesterolemia (40%), hypertriglyceridemia (20%), metabolic syndrome (20%), hepatobiliary disorder (15%), endocrine/metabolic disorders (>20%), cardiovascular disorder (40%), cerebrovascular disorder (60-90%), neuropsychiatric disorders (60-90%), and cancer (10%).For the past decades, pharmacological studies in search of potential treatments for AD focused on the following categories: neurotransmitter enhancers (11.38%), multitarget drugs (2.45%), anti-amyloid agents (13.30%), anti-tau agents (2.03%), natural products and derivatives (25.58%), novel synthetic drugs (8.13%), novel targets (5.66%), repository drugs (11.77%), anti-inflammatory drugs (1.20%), neuroprotective peptides (1.25%), stem cell therapy (1.85%), nanocarriers/nanotherapeutics (1.52%), and other compounds (<1%).Pharmacogenetic studies have shown that the therapeutic response to drugs in AD is genotype-specific in close association with the gene clusters that constitute the pharmacogenetic machinery (pathogenic, mechanistic, metabolic, transporter, pleiotropic genes) under the regulatory control of epigenetic mechanisms (DNA methylation, histone/chromatin remodeling, microRNA regulation). Most AD patients (>60%) are carriers of over ten pathogenic genes. The genes that most frequently (>50%) accumulate pathogenic variants in the same AD case are A2M (54.38%), ACE (78.94%), BIN1 (57.89%), CLU (63.15%), CPZ (63.15%), LHFPL6 (52.63%), MS4A4E (50.87%), MS4A6A (63.15%), PICALM (54.38%), PRNP (80.7059), and PSEN1 (77.19%). There is also an accumulation of 15 to 26 defective pharmagenes in approximately 85% of AD patients. About 50% of AD patients are carriers of at least 20 mutant pharmagenes, and over 80% are deficient metabolizers for the most common drugs, which are metabolized via the CYP2D6, CYP2C9, CYP2C19, and CYP3A4/5 enzymes.The implementation of pharmacogenetics can help optimize drug development and the limited therapeutic resources available to treat AD, and personalize the use of anti-dementia drugs in combination with other medications for the treatment of concomitant disorders.

Sleep Quality and Daytime Functioning in Older European Adults

Abstract. The aim of this article was to review research studies related to the issues of sleep in older adults, examining the relationship between sleep quality and a set of psychological variables of daytime functioning in healthy older adults: quality of life, subjective health, functional ability, cognitive function, and emotional state, in Europe. Combined scoping review search strategies resulted in a total of 84 articles selected for review. We conclude there is a considerable amount of European research on sleep quality and its correlates in older adults’ population. Studying these relationships may be the basis for the targeted planning of psychological interventions aiming at raising the quality of life in older adults. The selected domains of older adults’ everyday functioning were all well represented in the retrieved research studies.

Sleep problems and social support: Frailty in a Brazilian Elderly Multicenter Study

This study identifies relationships among the quality of perceived social support and sleep problems and napping habits in community-dwelling elderly. This study is part of a larger multicenter project entitled "Frailty in Brazilian Elderly Individuals", conducted in 17 Brazilian cities. A total of 498 elderly individuals capable of participating in interviews and free of cognitive deficits or functional impairment were found. The following instruments were used in data collection: Questionnaire addressing socio-demographic data; Interpersonal Support Evaluation Scale; questions concerning sleep patterns (Nottingham Health Profile); questions related to napping habits (Minnesota Leisure Activity Questionnaire). Descriptive statistics and the Mann-Whitney test were used for data analysis. The elderly individuals who reported having sleep problems in general, taking longer to fall asleep and sleeping poorly at night had lower scores on the Interpersonal Support Evaluation Scale than the elderly who denied such problems. Strategies to improve the quality of social support could also help reduce sleep problems.

Psychotropic medication use among elderly nursing home residents in Slovenia: cross-sectional study

AIM

To determine the prevalence of psychotropic medication prescribing in elderly nursing home residents in Slovenia and to explore the residents', physicians', and nursing home characteristics associated with prescribing.

METHODS

In a cross-sectional study, we collected the data for 2040 nursing home residents aged 65 years and older in 12 nursing homes in Slovenia between September 25 and November 30, 2006. Prescribed medications lists were retrieved from patients' medical records. Psychotropic medications were coded according to Anatomical Therapeutic Chemical Classification 2005, which we adjusted for the purposes of the study. Multivariate logistic regression analysis was performed to determine the residents', physicians', and nursing home characteristics associated with prescribing.

RESULTS

Residents were from 65 to 104 years old (median, 83 years) and 1606 (79%) of them were female. A total of 970 (48%) residents had dementia and 466 had depression (23%). In 1492 (73%) residents, at least one psychotropic medication was prescribed. Nine hundred sixty residents were prescribed hypnotics and sedatives (47%), 572 (28%) antipsychotics, 460 (23%) antidepressants, and 432 (21%) anxiolytics. Residents' characteristics associated with psychotropic medication use were female sex (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.03-1.80), age (OR, 0.97; 95% CI, 0.95-0.98), permanent restlessness (OR, 2.54; 95% CI, 1.71-3.78), dementia (OR, 1.76; 95% CI, 1.33-2.34), depression (OR, 5.51; 95% CI, 3.50-7.58), and the number of prescribed medications (OR, 1.29; 95% CI, 1.23-1.35). Of physicians' characteristics (sex, age, specialization in general practice, years of working experiences as a general practitioner, and years of experiences working in a nursing home), male sex was associated with psychotropic medication prescribing (OR, 1.80; 95% CI, 1.17-2.76).

CONCLUSION

Frequency of psychotropic medication prescribing in elderly nursing home residents in Slovenia is high and is comparable to Western European countries. Our next step should be optimizing the prescribing in patients with the highest prescription rate.

Perceptions of nurses in nursing homes on the usage of benzodiazepines

AIM

This paper reports the findings of a qualitative study on how nurses perceive their own role in the use of benzodiazepines in nursing homes and to identify the factors that have an impact on the nurses' role in the use of benzodiazepines.

BACKGROUND

The use of benzodiazepines in nursing homes is of particular concern, as nursing-home residents receive considerably more benzodiazepines than non-institutionalised older persons. Evidence of their long-term effectiveness is lacking. Nurses are important partners in the decision-making process of starting and discontinuation of benzodiazepines.

DESIGN

Qualitative descriptive.

METHOD

Three focus group interviews and 10 additional semi-structured interviews were used with 33 registered nurses. The interviews were thematically analysed.

FINDINGS

Nurses' main concern is to work towards the comfort of the patient. Benzodiazepines are an easy option with not too many side effects and administration of benzodiazepines is experienced as a routine action. When prescribed they will almost automatically lead to chronic usage as there is no evaluation of their effect. There are three aspects that have an impact on nurse's perceptions of their role in benzodiazepine usage: their own individual attitude and perceptions, their knowledge and organisational factors.

CONCLUSION

Nurses do not see benzodiazepines as a problem drug and once a prescription is initiated it will almost automatically lead to chronic usage. Nurses should work towards a pro-active promotion of addressing sleeping problems and they can play a key role in non-pharmacological interventions.

RELEVANCE TO CLINICAL PRACTICE

Nurses can play a key role in suggesting non-pharmacological alternatives. Education to provide more insight into the problems of insomnia and anxiety may positively influence their attitudes and behaviour. All caregivers in nursing homes should be informed about the relevance of this issue.