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Arsenault-Lapierre G, Bui TX, Le Berre M, Bergman H, Vedel I. Rural and urban differences in quality of dementia care of persons with dementia and caregivers across all domains: a systematic review. BMC Health Serv Res 2023; 23:102. [PMID: 36721162 PMCID: PMC9887943 DOI: 10.1186/s12913-023-09100-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are challenges in healthcare service delivery in rural areas, and this may be especially true for persons with dementia, who have higher needs to access to the healthcare system, and may have difficulties to commute easily and safely to these services. There is a growing body of literature regarding geographical disparities, but there is no comprehensive systematic review of geographical differences in persons with dementia across all domains of care quality. Therefore, the objective of this study is to conduct a systematic review of the literature on rural and urban differences in quality of dementia care outcomes of persons with dementia across all quality-of-care domains. METHODS We performed a digital search in Ovid MEDLINE on July 16, 2019, updated on May 3, 2021, for French or English records. We selected studies that reported outcome from at least one domain of quality of dementia care (Access, Integration, Effective Care, Efficient Care, Population Health, Safety, and Patient-Centered) in both rural and urban persons with dementia or caregivers. We used rigorous, systematic methods for screening, selection, data extraction and we analyzed outcomes reported by at least two studies using vote counting and appraised the certainty of evidence. Finally, we explored sources of heterogeneity. RESULTS From the 38 included studies, we found differences in many dementia care domains. Rural persons with dementia had higher mortality rates (Population Health), lower visits to any physicians (Access), more hospitalizations but shorter stays (Integration), higher antipsychotic medications (Safety), lower use of home care services and higher use of nursing home (Patient-Centered Care) compared to urban persons with dementia. CONCLUSIONS This comprehensive portrait of rural-urban differences in dementia care highlights possible geographically based inequities and can be used by researchers and decision makers to guide development of more equitable dementia care policies.
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Affiliation(s)
- Geneviève Arsenault-Lapierre
- Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC, H3S 1Z1, Canada.
| | - Tammy X. Bui
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC H3S 1Z1 Canada
| | - Mélanie Le Berre
- grid.14848.310000 0001 2292 3357Université de Montréal, Institut Universitaire de Gériatrie de Montréal, 4565 Chemin Queen Mary, Montreal, H3W 1W5 Canada
| | - Howard Bergman
- grid.14709.3b0000 0004 1936 8649Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
| | - Isabelle Vedel
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC H3S 1Z1 Canada ,grid.14709.3b0000 0004 1936 8649Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
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Riedel O, Braitmaier M, Langner I. Dementia in health claims data: The influence of different case definitions on incidence and prevalence estimates. Int J Methods Psychiatr Res 2022:e1947. [PMID: 36168670 DOI: 10.1002/mpr.1947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The epidemiology of dementia subtypes including Alzheimer's disease (AD) and vascular dementia (VD) and their reliance on different case definitions ("algorithms") in health claims data are still understudied. METHODS Based on health claims data, prevalence estimates (per 100 persons), incidence rates (IRs, per 100 person-years), and proportions of AD, VD, and other dementias (oD) were calculated. Five algorithms of increasing strictness considered inpatient/outpatient diagnoses (#1, #2), antidementia drugs (#3) or supportive diagnostics (#4, #5). RESULTS Algorithm 1 detected 213,409 cases (#2: 197,400; #3: 48,688; #4: 3033; #5: 3105), a prevalence for any dementia of 3.44 and an IR of 1.39 (AD: 0.80/0.21, VD: 0.79/0.31). The prevalence decreased by algorithms for any dementia (#2: 3.19; #3: 0.75; #4: 0.04; #5: 0.05) as did IRs (#2: 1.13; #3: 0.18; #4: 0.05, #5: 0.05). Algorithms 1-2, and 4-5 revealed similar proportions of AD (23.3%-26.6%), VD (19.9%-23.2%), and oD (53.1%-53.8%), algorithm 3 estimated 45% (AD), 12.1% (VD), and 43.0% (oD). CONCLUSIONS Health claims data show lower estimates of AD than previously reported, due to markedly lower prevalent/incident proportions of patients with corresponding codes. Using medication in defining dementia potentially improves estimating the proportion of AD while supportive diagnostics were of limited use.
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Affiliation(s)
- Oliver Riedel
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Malte Braitmaier
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Ingo Langner
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Dörks M, Hoffmann F, Jobski K. Antidepressant drug use and regional prescribing patterns in Germany: results from a large population-based study. Int Clin Psychopharmacol 2022; 37:185-192. [PMID: 35143440 DOI: 10.1097/yic.0000000000000393] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To consider antidepressant prescribing on a population level with a focus on regional prescribing patterns in Germany. BASIC METHODS Based on data from about 70 million individuals covered by all statutory health insurance funds in Germany in 2010, the prevalence of antidepressant use (overall, for drug classes and individual drugs) was calculated stratified by age and sex. Regional analyses were performed on a state and also on a district level. MAIN RESULTS The study population comprised 68 427 464 (female: 53.0%) persons, of which 5 052 293 (7.4%) were prescribed at least one antidepressant. The most frequently prescribed drug class was tricyclic antidepressants whereas on a substance level citalopram was most commonly used. Antidepressant prescribing was lowest in children and adolescents (0.2%) and most common in persons aged 70 years and older (13.4%). Women more often received antidepressants than men (9.7% vs. 4.8%). Prevalence of antidepressant use varied between 8.7% (Saarland) and 6.3% (Saxony-Anhalt) and was generally highest in the southwestern and lowest in the eastern states. Accordingly, districts with the highest prevalence were located in the southwestern states. PRINCIPAL CONCLUSIONS Antidepressant use in Germany varied considerably by age and sex and also on a state and district level.
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Affiliation(s)
- Michael Dörks
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Lech S, O'Sullivan JL, Drewelies J, Herrmann W, Spang RP, Voigt-Antons JN, Nordheim J, Gellert P. Dementia care and the role of guideline adherence in primary care: cross-sectional findings from the DemTab study. BMC Geriatr 2021; 21:717. [PMID: 34922486 PMCID: PMC8683809 DOI: 10.1186/s12877-021-02650-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022] Open
Abstract
Background General practitioners (GPs) play a key role in the care of people with dementia (PwD). However, the role of the German Dementia Guideline in primary care remains unclear. The main objective of the present study was to examine the role of guideline-based dementia care in general practices. Methods A cross-sectional analysis of data obtained from the DemTab study was conducted. Descriptive analyses of sociodemographic and clinical characteristics for GPs (N = 28) and PwD (N = 91) were conducted. Adherence to the German Dementia Guideline of GPs was measured at the level of PwD. Linear Mixed Models were used to analyze the associations between adherence to the German Dementia Guideline and GP factors at individual (age, years of experience as a GP, frequency of utilization of guideline, perceived usefulness of guideline) and structural (type of practice, total number of patients seen by a participating GP, and total number of PwD seen by a participating GP) levels as well as between adherence to the German Dementia Guideline and PwD’s quality of life. Results Self-reported overall adherence of GPs was on average 71% (SD = 19.4, range: 25–100). Adherence to specific recommendations varied widely (from 19.2 to 95.3%) and the majority of GPs (79.1%) reported the guideline as only partially or somewhat helpful. Further, we found lower adherence to be significantly associated with higher numbers of patients (γ10 = − 5.58, CI = − 10.97, − 0.19, p = .04). No association between adherence to the guideline and PwD’s quality of life was found (γ10 = −.86, CI = − 4.18, 2.47, p = .61). Conclusion The present study examined the role of adherence to the German Dementia Guideline recommendations in primary care. Overall, GPs reported high levels of adherence. However, major differences across guideline recommendations were found. Findings highlight the importance of guidelines for the provision of care. Dementia guidelines for GPs need to be better tailored and addressed. Further, structural changes such as more time for PwD may contribute to a sustainable change of dementia care in primary care. Trial registration The DemTab trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413). Registered 01 April 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02650-8.
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Affiliation(s)
- Sonia Lech
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany. .,Brandenburg Medical School Theodor Fontane, Department of Psychiatry, Psychotherapy and Psychosomatics, Neuruppin, Germany.
| | - Julie L O'Sullivan
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Johanna Drewelies
- Department of Psychology, Humboldt Universität zu Berlin, Berlin, Germany
| | - Wolfram Herrmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of General Practice, Berlin, Germany
| | - Robert P Spang
- Technische Universität Berlin, Quality and Usability Lab, Berlin, Germany
| | - Jan-Niklas Voigt-Antons
- Technische Universität Berlin, Quality and Usability Lab, Berlin, Germany.,Deutsches Forschungszentrum für Künstliche Intelligenz GmbH (DFKI), Speech and Language Technology, Berlin, Germany
| | - Johanna Nordheim
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Paul Gellert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
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Zhang Y, Luo H, Wong GHY, Zhao M, Lv X, Lum TYS, Chui CSL, Yu X, Wong ICK, Wang H. Prescription Patterns of Antidementia and Psychotropic Drugs in People Living With Dementia: Findings From the Clinical Pathway Study of Alzheimer's Disease in China. J Am Med Dir Assoc 2021; 23:1073-1079.e3. [PMID: 34418377 DOI: 10.1016/j.jamda.2021.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/07/2021] [Accepted: 07/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Evidence about prescribing patterns of dementia medication in China is lacking. This study aimed to examine prescribing rates of antidementia and psychotropic drugs and factors associated with drug prescription for dementia in China. DESIGN A multicenter observational study. SETTING AND PARTICIPANTS This study employed cross-sectional data from the Clinical Pathway for Alzheimer's Disease in China study that was conducted in 28 memory clinics at tertiary hospitals across 14 provinces between 2012 and 2013. Patients aged ≥45 years with a diagnosis of dementia were included. METHODS Antidementia and psychotropic drugs were classified according to the Anatomical Therapeutic Chemical codes. Odds ratios (ORs) of putative factors associated with prescription patterns were estimated using logistic regressions. RESULTS A total of 751 respondents were included in this study, 77.8% of whom were prescribed antidementia drugs, and 33.0% were prescribed at least 1 psychotropic drug. The concomitant prescription rate of antidementia and psychotropic drugs was 24.1%. Frontotemporal dementia [OR 9.92 (99.17% CI 3.08-42.70)], severe dementia [4.25 (1.88-9.79)], and apathy [1.94 (1.18-3.20)] were significantly associated with an elevated likelihood of memantine prescription. Psychotic symptoms [1.84 (1.02-3.35)], agitation [1.91 (1.08-3.40)], and depressive symptoms [2.10 (1.12-3.94)] were significantly associated with the coprescription of antidementia and psychotropic agents. CONCLUSIONS AND IMPLICATIONS The prescribing rate of antidementia drugs in the study sample was higher, whereas the rate of coprescription of psychotropic and antidementia drugs was lower than reported in Western studies. Dementia prescription practice was generally consistent with clinical guidelines in memory clinics in China, whereas the prescription of antidementia and psychotropic medication mainly depended on patients' clinical symptoms.
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Affiliation(s)
- Yingyang Zhang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Department of Computer Science, The University of Hong Kong, Hong Kong, China; Aging Research Center, Karolinska Institutet, Stockholm, Sweden; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China.
| | - Gloria H Y Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
| | - Mei Zhao
- Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China; Beijing Municipal Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China
| | - Xiaozhen Lv
- Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China; Beijing Municipal Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China; Key Laboratory for Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Terry Y S Lum
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
| | - Celine S L Chui
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong SAR, Hong Kong, China; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
| | - Xin Yu
- Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China; Beijing Municipal Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China; Key Laboratory for Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Ian C K Wong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
| | - Huali Wang
- Dementia Care & Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China; Beijing Municipal Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China; Key Laboratory for Mental Health, Ministry of Health (Peking University), Beijing, China.
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6
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Holthoff-Detto V, Nienaber A, Bötel N, Rapp M. [Complex treatment of severe mental illnesses in old age]. DER NERVENARZT 2021; 92:948-954. [PMID: 34142165 DOI: 10.1007/s00115-021-01150-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The needs for assistance, support and treatment of older people with severe mental illnesses (SMI) are very high and linked to additional age-associated somatic diseases and impairments. Old people prefer to live independently in their own homes and to receive necessary treatment and support there; however, a resettlement in a residential nursing home is often necessary due to a lack of alternatives. OBJECTIVE What is the current treatment reality in Germany for old people with SMI in their own homes and in residential nursing homes? How can coercive measures in this context be prevented? METHODS Selected results from the scientific literature on psychogeriatric care models in older people with SMI are summarized and discussed. RESULTS Multiprofessional psychogeriatric complex treatment models for older patients that include home visits and are adapted to the severity of mental disease are not available in Germany due to the lack of cross-sectoral network structures. Around 30% of the 730,000 nursing home residents in Germany experience coercive practices, whereas person-centered nursing concepts as well as guideline conform and individualized nonpharmacological treatment strategies and milieu therapeutic concepts are not sufficiently available. CONCLUSION The German healthcare system is in urgent need of multiprofessional psychogeriatric home treatment models in old people with severe mental illness in order to prevent worsening of psychiatric and somatic symptoms, to maintain individual social involvement, to strengthen individual autonomy and participative decision making and to protect from coercion. Multiprofessional expertise is essential as well as effective age-appropriate service models with multiprofessional teams delivering domiciliary visits and connecting complementary services for individual treatment requirements as part of the German health care system.
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Affiliation(s)
- Vjera Holthoff-Detto
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Alexianer St. Hedwig Kliniken, Krankenhaus Hedwigshöhe, Höhensteig 1, 12526, Berlin, Deutschland.
- Medizinische Fakultät, Technische Universität Dresden, Dresden, Deutschland.
| | - André Nienaber
- Münster School of Health (MSH), FH Münster - University of Applied Sciences, Münster, Deutschland
| | - Nora Bötel
- Friedrich-Husemann-KLinik, Buchenbach, Deutschland
| | - Michael Rapp
- Professur Sozial- und Präventivmedizin, Universität Potsdam, Potsdam, Deutschland
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Bohlken J, Riedel-Heller S, Steininger G, Kostev K, Michalowsky B. Trends in Dementia and Mild Cognitive Impairment Prevalence and Incidence in German General and Specialist Practices Between 2015 and 2019. J Alzheimers Dis 2021; 79:1683-1690. [PMID: 33459653 DOI: 10.3233/jad-201385] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The number of patients with dementia is forecast to grow continuously. However, there are indications that the incidence and prevalence is falling in high-income countries. OBJECTIVE To examine whether any effects of declining incidence and prevalence rates of dementia and mild cognitive impairment (MCI) were evident in Germany between 2015 and 2019. METHODS The analysis was based on 797 general and 132 specialists (neurological/psychiatric) practices and included 10.1 million patients aged 18 years and older who visited between January 2014 and December 2019 one of the practitioners. The prevalence and incidence of dementia and MCI were demonstrated descriptively. RESULTS Between 2015 and 2019, the prevalence (incidence) of dementia decreased from 2.18%(0.44%) in 2015 to 2.07%(0.35%) in 2019. A relatively large decrease in the prevalence (incidence) of dementia was observed in patients aged 80 and older, at -1.47%(-0.62%), compared to younger patients, at -0.40%(-0.18%). By contrast, the prevalence and incidence of MCI have remained constant over the years (0.19%to 0.22%and 0.06%, respectively). Overall, the number of patients diagnosed with dementia decreased slightly by 1%while the number of patients diagnosed with MCI increased by 17%. CONCLUSION Our results confirmed the reduction in the prevalence and incidence of dementia and revealed a decrease in the number of patients with dementia despite continued demographic changes. Future studies are warranted to determine whether the results are caused by changing risk and lifestyle factors or changes in medical diagnosis and treatment behavior of the practitioners.
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Affiliation(s)
- Jens Bohlken
- Institute for Social Medicine, Occupational Medicine, and Public Health (ISAP) of the Medical Faculty at the University of Leipzig, Leipzig, Germany.,Professional Association of German Neurologists, Germany
| | - Steffi Riedel-Heller
- Institute for Social Medicine, Occupational Medicine, and Public Health (ISAP) of the Medical Faculty at the University of Leipzig, Leipzig, Germany
| | - Gilles Steininger
- Department of Medicine, University Clinic of Marburg, Marburg, Germany
| | | | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Greifswald, Germany
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8
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Rapp MA, Tschorn M, Supprian T, Thomas C, Kreisel S, Benninghoff J, Schumann G, Heinz A. [Potentials and limits of aging cohort studies for geriatric psychiatry]. DER NERVENARZT 2020; 92:219-227. [PMID: 33242121 DOI: 10.1007/s00115-020-01035-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 11/29/2022]
Abstract
The sizeable number of population-based cohort studies of aging in Germany have provided highly valuable contributions for the specification of risk factors and predictors for frequent mental disorders in old age, especially dementia and depression. The results from these cohort studies enable the specification of mechanisms for the development of and preventative interventions for common mental disorders in old age. On the other hand, there is a significant paucity of clinical cohort studies investigating disease trajectories and possible markers for specific individualized interventions of frequent mental disorders in old age. In this article, we report selected key findings from cohort studies of aging and discuss novel approaches for the integration and harmonization of population-based and clinical cohort studies.
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Affiliation(s)
- M A Rapp
- Sozial- und Präventivmedizin, Department Sport- und Gesundheitswissenschaften, Strukturbereich Kognitionswissenschaften, Universität Potsdam, Am Neuen Palais 10, 14469, Potsdam, Deutschland.
| | - M Tschorn
- Sozial- und Präventivmedizin, Department Sport- und Gesundheitswissenschaften, Strukturbereich Kognitionswissenschaften, Universität Potsdam, Am Neuen Palais 10, 14469, Potsdam, Deutschland
| | - T Supprian
- Abteilung Gerontopsychiatrie, LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - C Thomas
- Klinik für Psychiatrie und Psychotherapie für Ältere, Klinikum Stuttgart, Stuttgart, Deutschland
| | - S Kreisel
- Abteilung Gerontopsychiatrie, Campus Bielefeld-Bethel, Universitätsklinikum Ostwestfalen-Lippe, Bielefeld, Deutschland
| | - J Benninghoff
- Zentrum für Altersmedizin und Entwicklungsstörungen, kbo-Isar-Amper-Klinikum München-Ost, Haar, Deutschland
| | - G Schumann
- Klinik für Psychiatrie und Psychotherapie, PONS Zentrum, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - A Heinz
- Klinik für Psychiatrie und Psychotherapie, PONS Zentrum, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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9
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Bustin J, Rojas G, O'Neill S, Sarasola D, Triskier F, Urtasun M, Cañás M, Mastai R, Demey I. What is happening with not recommended drugs for dementia in Argentina? Prescription patterns and direct costs analysis. Int J Geriatr Psychiatry 2020; 35:270-275. [PMID: 31755128 DOI: 10.1002/gps.5242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 11/07/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The only recommended pharmacological treatments for specific dementias are donepezil, galantamine, rivastigmine, and memantine (recommended drugs, RD). However, other drugs without recommendations (not recommended drugs, NRD) are often used to treat patients with cognitive impairment (CI) in Argentina. The INSSJyP is the largest health insurance in Argentina. The objective of this study is to analyze the prescription pattern, cost, and implications of NRD used for the treatment of CI in the INSSJyP. MATERIALS This is a retrospective, population-based study of the INSSJyP outpatients' prescriptions database for drugs usually prescribed for CI during 2015. These data were compared with the same database in 2009. The number of "prescriptions" always refers to dispensed packages. RESULTS A total of 3 255 438 packages of drugs usually indicated for CI were prescribed during 2015: 1 912 476 packages of RD (59%) and 1 342 962 packages of NRD (41%).Comparing the results with those obtained in 2009, there is a 148% gross increase in the prescription of both RD and NRD for CI, although the rates/1000 affiliates/year show a lesser rise for NRD (70.1%) compared to RD (103.9 %).The expenditure on CI drugs prescribed during 2015 was 77 million USD. NRD cost represented approximately 20 million USD. CONCLUSION Inappropriate drug use increases health costs in developing countries. We found a high number of patients with a probable diagnosis of CI treated with NRD. It is extremely relevant that all the healthcare professionals can update their knowledge and modify behavioral insights about appropriate prescription for specific dementias.
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Affiliation(s)
- Julian Bustin
- INSSJYP, Buenos Aires, Argentina.,INCyT, Buenos Aires, Argentina.,INECO, Buenos Aires, Argentina
| | - Galeno Rojas
- Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina.,Fundación Favaloro, Buenos Aires, Argentina.,Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Fabian Triskier
- INSSJYP, Buenos Aires, Argentina.,INECO, Buenos Aires, Argentina
| | - Martín Urtasun
- Área Farmacología Fundación FEMEBA, La Plata, Argentina.,Instituto de Ciencias de la Salud-UNAJ, La Plata, Argentina
| | - Martín Cañás
- Área Farmacología Fundación FEMEBA, La Plata, Argentina.,Instituto de Ciencias de la Salud-UNAJ, La Plata, Argentina
| | | | - Ignacio Demey
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina.,FLENI, Buenos Aires, Argentina
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Abstract
Background: Studies on prevalence or the therapy of dementia are rare or non-existent in Russia. Objective: The purpose of this study was to analyze the prescription patterns of antidementia therapy in Russia in 2018. Methods: This retrospective cross-sectional study was based on the IQVIA Russia LRx database, which covers approximately 11% of all patients enrolled in federal or regional reimbursement state healthcare programs. We descriptively analyzed the proportions of patients treated with antidementia drugs, antipsychotics, antidepressants, and benzodiazepines. Results: A total of 12,051 dementia patients were available for analysis. Of those, 6,394 patients had a vascular dementia (VaD) diagnosis, while 3,413 were diagnosed with dementia in other diseases (DOD), 1,128 with Alzheimer’s disease (AD), and 1,116 with unspecified dementia (UD). The therapy with the highest patient proportion was antipsychotics, with 74% of VaD patients, 73% of UD patients, and 47% of DOD patients receiving these drugs. The proportion of patients treated with antidementia drugs was 68% in AZ, 56% in VaD, 45% in UD, and only 9% in DOD. Antidepressants were a relatively rare therapy in dementia patients (between 4% and 12%), and 30% of DOD patients received benzodiazepines, while the proportions of patients receiving this therapy class in other dementias was low (7–10%). Most patients were treated with old-generation drugs. Conclusion: The proportion of older drugs prescribed in Russia is higher than in Western Europe, which may likely be due to their low prices, resulting in a higher chance for successful health insurance reimbursement claims.
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Abstract
AIMS The use of Alzheimer disease medication for the treatment of dementia symptoms has shown significant benefits with regards to functional and cognitive outcomes as well as nursing home placement (NHP) and mortality. Hospitalisations in these patient groups are characterised by extended length of stays (LOS), frequent readmissions, frequent NHP and high-mortality rates. The impact of Alzheimer disease medication on the aforementioned outcomes remains still unknown. This study assessed the association of Alzheimer disease medication with outcomes of hospitalisation among patients with Alzheimer disease and other forms of dementia. METHODS A dynamic retrospective cohort study from 2004 to 2015 was conducted which claims data from a German health insurance company. People with dementia (PWD) were identified using ICD-10 codes and diagnostic measures. The main predictor of interest was the use of Alzheimer disease medication. Hospitalisation outcomes included LOS, readmissions, NHP and mortality during and after hospitalisation across four hospitalisations. Confounding was addressed using a propensity score throughout all analyses. RESULTS A total of 1380 users of Alzheimer disease medication and 6730 non-users were identified. The use of Alzheimer disease medication was associated with significantly shorter LOS during the first hospitalisations with estimates for the second, third and fourth showed a tendency towards shorter hospital stays. In addition, current users of Alzheimer disease medication had a lower risk of hospital readmission after the first two hospitalisations. These associations were not significant for the third and fourth hospitalisations. Post-hospitalisation NHP and mortality rates also tended to be lower among current users than among non-users but differences did not reach statistical significance. CONCLUSIONS Our results indicate that Alzheimer disease medication might contribute to a reduction of the LOS and the number of readmissions in PWD.
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Kiel S, Zimak C, Schmidt CO, Chenot JF. Effekt der ambulanten geriatrischen Komplexbehandlung auf Polypharmazie und potenziell inadäquate Arzneimittel – eine Beobachtungsstudie. Z Gerontol Geriatr 2019; 53:416-422. [DOI: 10.1007/s00391-019-01589-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
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Kalamägi J, Lavikainen P, Taipale H, Tanskanen A, Tiihonen J, Hartikainen S, Tolppanen AM. Predictors of high hospital care and medication costs and cost trajectories in community-dwellers with Alzheimer's disease. Ann Med 2019; 51:294-305. [PMID: 31322423 PMCID: PMC7877886 DOI: 10.1080/07853890.2019.1642507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objectives: We studied the determinants of high healthcare costs (highest decile of hospital care and medication costs) and cost trajectories among all community-dwellers with clinically verified Alzheimer's disease (AD), diagnosed during 2005-2011 in Finland (N = 70,531). Methods: The analyses were done separately for hospital care costs, medication costs and total healthcare costs that were calculated for each 6-month period from 5 years before to 3 years after AD diagnosis. Results: Total healthcare costs were driven mainly by hospital care costs. The definition of "high-cost person" was time-dependent as 63% belonged to the highest 10% at some timepoint during the study period and six distinct cost trajectories were identified. Strokes, cardiovascular diseases, fractures and mental and behavioural disorders were most strongly associated with high hospital care costs. Conclusions: Although persons with AD are often collectively considered as expensive patient group, there is large temporal and inter-individual variation in belonging to the highest decile of hospitalization and/or medication costs. It would be important to assess whether hospitalization rate could be decreased by, e.g., comprehensive outpatient care with more efficient management of comorbidities. In addition, other interventions that could decrease hospitalization rate in persons with dementia should be studied further in this context. Key messages Persons with AD had large individual fluctuation in hospital care costs and medication costs over time. Hospital care costs were considerably larger than medication costs, with fractures, cardiovascular diseases and mental and behavioural disorders being the key predictors. Antidementia medication was associated with lower hospital care costs.
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Affiliation(s)
- Joosep Kalamägi
- School of Pharmacy, University of Eastern Finland , Kuopio , Finland
| | - Piia Lavikainen
- School of Pharmacy, University of Eastern Finland , Kuopio , Finland
| | - Heidi Taipale
- School of Pharmacy, University of Eastern Finland , Kuopio , Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland , Kuopio , Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland , Kuopio , Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland , Kuopio , Finland
| | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland , Kuopio , Finland.,Kuopio Research Centre of Geriatric Care, University of Eastern Finland , Kuopio , Finland
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Lohmann H, Kulessa F, Holling H, Johnen A, Reul S, Lueg G, Duning T. [Implementation of the German S3 guidelines on dementia in clinical practice: wish or reality?]. DER NERVENARZT 2018; 88:895-904. [PMID: 28429077 DOI: 10.1007/s00115-017-0325-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Published in 2009, the German S3 guidelines on dementia define a milestone in quality improvement of the diagnostics and treatment of dementia. In clinical practice patients suffering from dementia are primarily treated by physicians in private practice; therefore, this study examined how the guidelines are implemented in outpatient clinical settings. Furthermore, it aimed at the identification of behavioral determinants that govern the actual diagnostic and therapeutic approach in clinical practice. METHODS Physicians involved in the primary care of dementia patients were asked to participate in a nationwide internet survey. The questionnaire covered aspects on the diagnostic and therapeutic care of dementia patients as recommended by the S3 guidelines. Behavioral determinants of the implementation of the guidelines (e. g. treatment decisions) were derived from an established psychological prediction model. RESULTS Out of a total of 2755 physicians contacted, the data of 225 participants could be used in this study. The diagnostic recommendations of the S3 guidelines were implemented in satisfactory measures (e.g. combined cognitive screening in at least 68%, cerebral neuroimaging in at least 93% and specific laboratory diagnostics in at least 27% of cases); however, only two thirds of the patients with indications for a guideline-conform therapy were treated in accordance with the S3 guidelines. There was a substantial prescription of non-recommended drugs and a notable long-term use of antipsychotic drugs (prescription by at least 14% of non-neurological medical specialists and by 8% of neurologists and psychiatrists). When considering the behavioral determinants in the implementation of the guidelines, normative assumptions ("my colleagues and patients expect me to comply with the guidelines") surprisingly had the highest impact, which was then followed by attitudes towards the behavior ("utilization of the guidelines improves diagnostics and therapy"). CONCLUSION The German S3 guidelines on dementia were satisfactorily implemented in outpatient clinical practice; however, deficits existed in the frequency of the pharmaceutical treatment of patients with indications for therapy, the prescription of non-recommended drugs and the relatively common use of permanent neuroleptic medications. Interestingly, the motivation for implementation of the guidelines was not primarily influenced by the physicians' personal convictions but mainly stimulated by the expectations of others.
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Affiliation(s)
- H Lohmann
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
| | - F Kulessa
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
- Institut für Psychologie, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - H Holling
- Institut für Psychologie, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - A Johnen
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - S Reul
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - G Lueg
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - T Duning
- Klinik für Allgemeine Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
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15
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Hessmann P, Dodel R, Baum E, Müller MJ, Paschke G, Kis B, Zeidler J, Klora M, Reese JP, Balzer-Geldsetzer M. Antipsychotic treatment of community-dwelling and institutionalised patients with dementia in Germany. Int J Psychiatry Clin Pract 2018; 22:232-239. [PMID: 29235398 DOI: 10.1080/13651501.2017.1414269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE A restrictive use of antipsychotic drugs in patients with Alzheimer's disease (AD) is recommended due to an increased risk of cerebrovascular events and mortality. We hypothesise that the prescription of antipsychotics is associated with the patients' socio-demographic and clinical status (e.g., dementia severity). METHODS The prescription of antipsychotics was cross-sectionally evaluated in 272 community-dwelling and 123 institutionalised patients with AD across all severity stages of dementia. The patients' clinical characteristics covered the cognitive status, neuropsychiatric symptoms, daily activities, and quality of life (HrQoL). To determine associations with the use of antipsychotics bivariate and logistic regression analyses were conducted. RESULTS Totally, 25% of the patients were treated with antipsychotics. significantly less frequently than nursing home inhabitants (15.1% vs. 45.5%). Severely demented patients (MMSE 0-9) received antipsychotics most often (51.5%). Additionally, multiple regression analyses revealed a higher chance of prescription for participants with depressive symptoms (OR 2.3, 95% CI: 1.019-5.160) and those treated by neuropsychiatric specialists (OR 3.4, 95% CI: 1.408-8.328). CONCLUSIONS Further longitudinal studies are required to assess the appropriateness of indications for antipsychotics and the reasons for a higher use in nursing home inhabitants and patients with severe dementia and depression.
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Affiliation(s)
- Philipp Hessmann
- a Department of Psychiatry and Psychotherapy , University Medical Center Goettingen , Goettingen , Germany.,b Center for Health Economics Research Hannover (CHERH) , Leibniz University Hannover , Hannover , Germany
| | - Richard Dodel
- c Department of Neurology , Philipps-University Marburg , Marburg , Germany.,d Chair of Geriatrics , University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH , Essen , Germany
| | - Erika Baum
- e Department of General Practice , Philipps-University Marburg , Marburg , Germany
| | - Matthias J Müller
- f Oberberg Clinics Berlin , Berlin , Germany.,g Faculty of Medicine , Justus-Liebig-University Giessen , Giessen , Germany
| | - Greta Paschke
- h Practice for General Medicine , Wiesbaden , Germany
| | - Bernhard Kis
- a Department of Psychiatry and Psychotherapy , University Medical Center Goettingen , Goettingen , Germany
| | - Jan Zeidler
- b Center for Health Economics Research Hannover (CHERH) , Leibniz University Hannover , Hannover , Germany
| | - Mike Klora
- b Center for Health Economics Research Hannover (CHERH) , Leibniz University Hannover , Hannover , Germany
| | - Jens-Peter Reese
- i Coordinating Center for Clinical Trials , Philipps-University Marburg , Marburg , Germany
| | - Monika Balzer-Geldsetzer
- c Department of Neurology , Philipps-University Marburg , Marburg , Germany.,d Chair of Geriatrics , University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH , Essen , Germany
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Bohlken J, Jacob L, van den Bussche H, Kostev K. The Influence of Polypharmacy on the Initiation of Anti-Dementia Therapy in Germany. J Alzheimers Dis 2018; 64:827-833. [PMID: 29889071 DOI: 10.3233/jad-180382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Jens Bohlken
- Praxis für Neurologie und Psychiatrie, Berlin, Germany
| | - Louis Jacob
- Faculty of Medicine, University of Paris 5, Paris, France
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Okumura Y, Sakata N. Antidementia drug use in Japan: Bridging the research-to-practice gap. Int J Geriatr Psychiatry 2018; 33:1286-1287. [PMID: 29781202 PMCID: PMC6099269 DOI: 10.1002/gps.4892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/15/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Yasuyuki Okumura
- Research DepartmentInstitute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and WelfareTokyoJapan
| | - Nobuo Sakata
- Research DepartmentInstitute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and WelfareTokyoJapan
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18
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Abstract
The objective of this study was to evaluate the use of antidementia drugs (ADDs) in patients with Alzheimer's disease (AD) regarding German guideline recommendations and to assess correlations between the use of ADDs and the patients' characteristics. A total of 395 community-dwelling and institutionalized patients with AD across all severity stages of dementia were recruited in this cross-sectional study. Associations between the prescription of ADDs and patients' sociodemographic and clinical parameters (neuropsychiatric symptoms, cognitive capacity, daily activities, and health-related quality of life) were analyzed in multiple logistic regression analyses. ADDs were prescribed in 46.6% of all participants and less often in institutionalized patients (38.2 vs. 50.4%, P=0.025). Patients with mild-to-moderate dementia had a higher chance of receiving ADDs [odds ratio (OR)=3.752, 95% confidence interval (CI): 1.166-12.080 and OR=3.526, 95% CI: 1.431-8.688] as well as those treated by neurologists/psychiatrists (OR=2.467, 95% CI: 1.288-4.726). Overall, 39% of the patients with mild cognitive deficits (Mini-Mental Status Examination 27-30) received ADDs and 21% of the mildly demented patients (Mini-Mental Status Examination 20-26) received memantine. The treatment with ADDs was in part not in line with German guideline recommendations. Particularly, the lower use of ADDs in patients not attending neuropsychiatric specialists should be further evaluated.
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Hager K, Henneges C, Schneider E, Lieb M, Kraemer S. Alzheimer-Demenz: Verlauf und Belastung der Pflegepersonen. DER NERVENARZT 2017; 89:431-442. [DOI: 10.1007/s00115-017-0371-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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Griep Y, Hanson LM, Vantilborgh T, Janssens L, Jones SK, Hyde M. Can volunteering in later life reduce the risk of dementia? A 5-year longitudinal study among volunteering and non-volunteering retired seniors. PLoS One 2017; 12:e0173885. [PMID: 28301554 PMCID: PMC5354395 DOI: 10.1371/journal.pone.0173885] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/28/2017] [Indexed: 12/02/2022] Open
Abstract
We propose that voluntary work, characterized by social, physical and cognitive activity in later life is associated with fewer cognitive problems and lower dementia rates. We test these assumptions using 3-wave, self-reported, and registry data from the 2010, 2012, and 2014 Swedish National Prescribed Drug Register. We had three groups of seniors in our data: 1) no volunteering (N = 531), 2) discontinuous volunteering (N = 220), and 3) continuous volunteering (N = 250). We conducted a path analysis in Mplus to investigate the effect of voluntary work (discontinuously and continuously) on self-reported cognitive complaints and the likelihood of being prescribed an anti-dementia treatment after controlling for baseline and relevant background variables. Our results indicated that seniors, who continuously volunteered, reported a decrease in their cognitive complaints over time, whereas no such associations were found for the other groups. In addition, they were 2.44 (95%CI [1.86; 3.21]) and 2.46 (95%CI [1,89; 3.24]) times less likely to be prescribed an anti-dementia treatment in 2012 and 2014, respectively. Our results largely support the assumptions that voluntary work in later life is associated with lower self-reported cognitive complaints and a lower risk for dementia, relative to those who do not engage, or only engage episodically in voluntary work.
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Affiliation(s)
- Yannick Griep
- Department of Psychology, University of Calgary, Calgary, Canada
| | | | - Tim Vantilborgh
- Work and Organizational Psychology (WOPs), Vrije Universiteit Brussel, Brussel, Belgium
| | | | | | - Martin Hyde
- Centre for Innovative Ageing, Swansea University, Swansea, United Kingdom
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21
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[Treatment with psychotropic agents in patients with dementia and delirium : Gap between guideline recommendations and treatment practice]. Z Gerontol Geriatr 2017; 50:106-114. [PMID: 28124100 DOI: 10.1007/s00391-016-1176-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/05/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Psychiatric symptoms in dementia and delirium are associated with a substantially reduced quality of life of patients and their families and often challenging for professionals. Pharmacoepidemiological surveys have shown that, in particular, patients living in nursing homes receive prescriptions of psychotropic agents in significant higher frequency than recommended by current guidelines. This article focuses on a critical appraisal of this gap from the point of view of German healthcare services. MATERIAL AND METHODS Narrative review with special reference to the German dementia guideline from 2016 and recently published practice guidelines for delirium in old age in German and English language. RESULTS The indications for use of psychotropic agents, especially antipsychotics, are defined narrowly in the German dementia guideline. According to this guideline for several psychopathological symptoms evidence based recommendations cannot be given, currently. For delirium several practice guidelines related to different treatment settings have been published recently. Comparable to the German dementia guideline they recommend general medical interventions and nonpharmacological treatment as first line measures and the use of psychotropic agents only under certain conditions. These guidelines differ to some extent regarding the strength of recommendation for psychopharmacological treatment. CONCLUSION The guidelines discussed here advocate well-founded a cautious prescription of psychotropic agents in patients with dementia and delirium. This contrasts to everyday practice which is characterized by significantly higher prescription rates. This gap may explained partially by a lack of evidence-based recommendations regarding certain psychopathological symptoms. Most notably, however, epidemiological data disclose an unacceptable rate of hazardous overtreatment with psychotropic agents, especially in long-term care of persons with dementia. In this situation counteractive measures by consequent implementation of the principles of good clinical practice in geriatrics are required urgently.
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22
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Hüll M. [Are physicians treating dementia too often with antipsychotics?]. MMW Fortschr Med 2016; 158:43. [PMID: 27221428 DOI: 10.1007/s15006-016-8271-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
Sleep-wake disruption is frequently observed and often one of the earliest reported symptoms of many neurodegenerative disorders. This provides insight into the underlying pathophysiology of these disorders, as sleep-wake abnormalities are often accompanied by neurodegenerative or neurotransmitter changes. However, in addition to being a symptom of the underlying neurodegenerative condition, there is also emerging evidence that sleep disturbance itself may contribute to the development and facilitate the progression of several of these disorders. Due to its impact both as an early symptom and as a potential factor contributing to ongoing neurodegeneration, the sleep-wake cycle is an ideal target for further study for potential interventions not only to lessen the burden of these diseases but also to slow their progression. In this review, we will highlight the sleep phenotypes associated with some of the major neurodegenerative disorders, focusing on the circadian disruption associated with Alzheimer's disease, the rapid eye movement behavior disorder and sleep fragmentation associated with Parkinson's disease, and the insomnia and circadian dysregulation associated with Huntington's disease.
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Affiliation(s)
- Sabra M Abbott
- Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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