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Au-Yeung WTM, Miller L, Beattie Z, May R, Cray HV, Kabelac Z, Katabi D, Kaye J, Vahia IV. Monitoring Behaviors of Patients With Late-Stage Dementia Using Passive Environmental Sensing Approaches: A Case Series. Am J Geriatr Psychiatry 2022; 30:1-11. [PMID: 34039534 PMCID: PMC8531172 DOI: 10.1016/j.jagp.2021.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To show the feasibility of using different unobtrusive activity-sensing technologies to provide objective behavioral markers of persons with dementia (PwD). DESIGN Monitored the behaviors of two PwD living in memory care unit using the Oregon Center for Aging & Technology (ORCATECH) platform, and the behaviors of two PwD living in assisted living facility using the Emerald device. SETTING A memory care unit in Portland, Oregon and an assisted living facility in Framingham, Massachusetts. PARTICIPANTS A 63-year-old male with Alzheimer's disease (AD), and an 80-year-old female with frontotemporal dementia, both lived in a memory care unit in Portland, Oregon. An 89-year-old woman with a diagnosis of AD, and an 85-year-old woman with a diagnosis of major neurocognitive disorder, Alzheimer's type with behavioral symptoms, both resided at an assisted living facility in Framingham, Massachusetts. MEASUREMENTS These include: sleep quality measured by the bed pressure mat; number of transitions between spaces and dwell times in different spaces measured by the motion sensors; activity levels measured by the wearable actigraphy device; and couch usage and limb movements measured by the Emerald device. RESULTS Number of transitions between spaces can identify the patient's episodes of agitation; activity levels correlate well with the patient's excessive level of agitation and lack of movement when the patient received potentially inappropriate medication and neared the end of life; couch usage can detect the patient's increased level of apathy; and periodic limb movements can help detect risperidone-induced side effects. This is the first demonstration that the ORCATECH platform and the Emerald device can measure such activities. CONCLUSION The use of technologies for monitoring behaviors of PwD can provide more objective and intensive measurements of PwD behaviors.
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Affiliation(s)
- Wan-Tai M. Au-Yeung
- Department of Neurology, Oregon Health & Science University, Portland, OR,Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR,NIA-Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University, Portland, OR
| | - Lyndsey Miller
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR,School of Nursing, Oregon Health & Science University, Portland, OR
| | - Zachary Beattie
- Department of Neurology, Oregon Health & Science University, Portland, OR,Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR,NIA-Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University, Portland, OR
| | | | | | - Zachary Kabelac
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA
| | - Dina Katabi
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland, OR,Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR,NIA-Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University, Portland, OR
| | - Ipsit V. Vahia
- McLean Hospital, Belmont, MA,Harvard Medical School, Boston, MA
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Abraha I, Rimland JM, Trotta FM, Dell'Aquila G, Cruz-Jentoft A, Petrovic M, Gudmundsson A, Soiza R, O'Mahony D, Guaita A, Cherubini A. Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series. BMJ Open 2017; 7:e012759. [PMID: 28302633 PMCID: PMC5372076 DOI: 10.1136/bmjopen-2016-012759] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/05/2016] [Accepted: 10/04/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To provide an overview of non-pharmacological interventions for behavioural and psychological symptoms in dementia (BPSD). DESIGN Systematic overview of reviews. DATA SOURCES PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO (2009-March 2015). ELIGIBILITY CRITERIA Systematic reviews (SRs) that included at least one comparative study evaluating any non-pharmacological intervention, to treat BPSD. DATA EXTRACTION Eligible studies were selected and data extracted independently by 2 reviewers.The AMSTAR checklist was used to assess the quality of the SRs. DATA ANALYSIS Extracted data were synthesised using a narrative approach. RESULTS 38 SRs and 129 primary studies were identified, comprising the following categories of non-pharmacological interventions: (1) sensory stimulation interventions (25 SRs, 66 primary studies) that encompassed: shiatsu and acupressure, aromatherapy, massage/touch therapy, light therapy, sensory garden and horticultural activities, music/dance therapy, dance therapy, snoezelen multisensory stimulation therapy, transcutaneous electrical nerve stimulation; (2) cognitive/emotion-oriented interventions (13 SRs; 26 primary studies) that included cognitive stimulation, reminiscence therapy, validation therapy, simulated presence therapy; (3) behaviour management techniques (6 SRs; 22 primary studies); (4) Multicomponent interventions (3 SR; four primary studies); (5) other therapies (5 SRs, 15 primary studies) comprising exercise therapy, animal-assisted therapy, special care unit and dining room environment-based interventions. CONCLUSIONS A large number of non-pharmacological interventions for BPSD were identified. The majority of the studies had great variation in how the same type of intervention was defined and applied, the follow-up duration, the type of outcome measured, usually with modest sample size. Overall, music therapy and behavioural management techniques were effective for reducing BPSD.
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Affiliation(s)
- Iosief Abraha
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Joseph M Rimland
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Fabiana Mirella Trotta
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Giuseppina Dell'Aquila
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | | | - Mirko Petrovic
- Department of Internal Medicine (Geriatrics), Ghent University,Ghent, Belgium
| | | | - Roy Soiza
- Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, UK
| | - Denis O'Mahony
- Department of Medicine, University College Cork, Cork, Ireland
| | | | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
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Yabuki Y, Matsuo K, Hirano K, Shinoda Y, Moriguchi S, Fukunaga K. Combined Memantine and Donepezil Treatment Improves Behavioral and Psychological Symptoms of Dementia-Like Behaviors in Olfactory Bulbectomized Mice. Pharmacology 2017; 99:160-171. [PMID: 28049192 DOI: 10.1159/000452839] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/25/2016] [Indexed: 11/19/2022]
Abstract
Memantine, an uncompetitive N-methyl-D-aspartate receptor antagonist, and the cholinesterase inhibitor, donepezil, are approved in most countries for treating moderate-to-severe Alzheimer's disease (AD). These drugs have different molecular targets; thus, it is expected that the effects of combined treatment would be synergistic. Some reports do show memantine/donepezil synergy in ameliorating cognition in AD model animals, but their combined effects on behavioral and psychological symptoms of dementia (BPSD)-like behaviors have not been addressed. Here, we investigate combined memantine/donepezil effects on cognitive impairment and BPSD-like behaviors in olfactory bulbectomized (OBX) mice. Interestingly, combined administration synergistically improved both depressive-like behaviors and impaired social interaction in OBX mice, whereas only weak synergistic effects on cognitive performance were seen. To address mechanisms underlying these effects, we used in vivo microdialysis study and observed impaired nicotine-induced serotonin (5-HT) release in OBX mouse hippocampus. Combined memantine/donepezil administration, but not single administration of either, significantly antagonized the decrease in nicotine-induced 5-HT release seen in OBX mouse hippocampus. Furthermore, decreased autophosphorylation of calcium/calmodulin dependent protein kinase II (CaMKII) was rescued in hippocampal CA1 and dentate gyrus of OBX mice by combined memantine/donepezil administration. These results suggest that improvement of BPSD-like behaviors by the co-administration of both drugs is in part mediated by enhanced 5-HT release and CaMKII activity in OBX mouse hippocampus.
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Affiliation(s)
- Yasushi Yabuki
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
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Anguish I, Locca JF, Büla C, Zumbach S, Bugnon O. Pharmacologic Treatment of Behavioral and Psychological Symptoms of Dementia in Nursing Homes: Update of the 2008 JAMDA Recommendations. J Am Med Dir Assoc 2015; 16:527-32. [PMID: 25922223 DOI: 10.1016/j.jamda.2015.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Isabelle Anguish
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Lausanne, Switzerland
| | - Jean-François Locca
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, University of Lausanne Hospital Center (CHUV), Lausanne, Switzerland
| | - Serge Zumbach
- Service of Psychogeriatric Medicine, Psychiatric Hospital, Marsens, Switzerland
| | - Olivier Bugnon
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Lausanne, Switzerland
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Sawa M, Chan P, Donnelly M, McKenna M, Osaki Y, Kishimoto T, Ganesan S. A case-control study regarding relative factors for behavioural and psychological symptoms of dementia at a Canadian regional long-term extended care facility: a preliminary report. Psychogeriatrics 2014; 14:25-30. [PMID: 24397473 DOI: 10.1111/psyg.12035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 06/29/2013] [Accepted: 10/28/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Behavioural and psychological symptoms of dementia (BPSD) are prevalent and have an impact on the care of persons with dementia. Previous studies regarding predisposing factors have included pharmacotherapy, but other factors may not have been sufficiently studied. We hypothesized that psychotropic medications, past history, comorbid psychiatric disorders and other factors may be relevant factors related to BPSD. METHODS Data were collected from patients' medical charts at an extended care facility over a 2-year period from 1 May 2008 to 30 April 2010. Information obtained included the presence of BPSD, gender, age, marital status, past history, comorbid psychiatric disorder and medication use. Patients were divided into two groups: a group with BPSD (n = 29) and a group without BPSD (n = 10). A binomial logistic regression analysis was performed for the above factors. RESULTS Comorbid major depression was linked to BPSD (odds ratio = 12.57, 95% confidence interval: 1.31-120.74) as well as to the use of antidepressants (odds ratio = 6.49, 95% confidence interval: 1.02-41.25). There was a trend towards statistical significance in the relationship between greater use of antidepressants for the patients with comorbid major depression and the presence of BPSD. Past history of depression (Fisher's exact test; P = 0.03) and cerebral vascular accident (degrees of freedom = 1, χ(2) = 4.44, P = 0.04) were linked to the presence of BPSD and comorbid major depression. CONCLUSION Accurate evaluation and treatment of comorbid major depression may affect BPSD. In order to reduce the burden of BPSD on patients and caregivers, there should be a careful and thoughtful diagnosis of comorbid major depression in patients with dementia.
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Affiliation(s)
- Minoru Sawa
- Department of Psychiatry, Kameda Medical Center, Kamogawa, Japan; Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
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Liperoti R, Landi F. The Management of Behavioral and Psychological Symptoms of Dementia: The Need for Tailored Interventions. J Am Med Dir Assoc 2013; 14:306-7. [DOI: 10.1016/j.jamda.2013.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
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Cohen-Mansfield J, Jensen B, Resnick B, Norris M. Knowledge of and attitudes toward nonpharmacological interventions for treatment of behavior symptoms associated with dementia: a comparison of physicians, psychologists, and nurse practitioners. THE GERONTOLOGIST 2011; 52:34-45. [PMID: 22075773 DOI: 10.1093/geront/gnr081] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY Behavior problems are common in nursing homes. Current guidelines recommend nonpharmacological interventions (NPHIs) as first-line treatment, but pharmacological regimens (PIs) continue to be used. Given differences in background and training of those who treat behavior problems in residents, we compared attitudes of physicians (MDs), psychologists (PhDs), and nurse practitioners (NPs) concerning PI and NPHI usage as well as knowledge of NPHIs. DESIGN AND METHODS One hundred and eight MDs, 36 PhDs, and 89 NPs responded to a web-based questionnaire that captured level of agreement with statements concerning treatment of behavior symptoms and familiarity with NPHIs. RESULTS NPs were the most favorable toward NPHIs. MDs were significantly more favorable to the use of PIs than were PhDs, with attitudes of NPs falling in between. All felt that NPHI usage should increase and that NPHIs should be implemented before using PIs but also believed that PIs work well for behavior problems. MDs had significantly lower knowledge of NPHIs than PhDs or NPs. Overall, NPHI knowledge was similar for PhDs and NPs, although they differed on their use of specific interventions. IMPLICATIONS As levels of knowledge and familiarity with NPHIs differed among providers, it is conceivable that all might benefit from training and experience with a wider range of NPHIs. Future studies might evaluate the impact of a uniform understanding of NPHI on communication and teamwork in nursing homes and examine ways to enhance a multidisciplinary approach that would allow for the tailoring and individualization that is required of successful interventions.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Department of Health Care Sciences, George Washington University Medical Center, Washington, DC, USA.
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9
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Rhodes-Kropf J, Cheng H, Castillo EH, Fulton AT. Managing the patient with dementia in long-term care. Clin Geriatr Med 2011; 27:135-52. [PMID: 21641502 DOI: 10.1016/j.cger.2011.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The majority of residents in a nursing home have some degree of dementia. The prevalence is commonly from 70% to 80% of residents. This article covers the following topics on caring for patients with dementia in long-term care: (1) the efficacy of cholinesterase inhibitors and memantine, (2) the optimal environment for maintenance of function in moderate dementia, (3) the treatment of depression and agitation, and (4) the evaluation and management of eating problems.
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Affiliation(s)
- Jennifer Rhodes-Kropf
- Division of Geriatrics, Center Communities of Brookline, Hebrew SeniorLife and Beth Israel Deaconess Medical Center, Harvard University Medical School, Boston, MA 02446, USA.
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Morley JE. Depression in nursing home residents. J Am Med Dir Assoc 2010; 11:301-3. [PMID: 20511093 DOI: 10.1016/j.jamda.2010.03.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 03/30/2010] [Indexed: 10/19/2022]
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Morley JE. Anorexia, weight loss, and frailty. J Am Med Dir Assoc 2010; 11:225-8. [PMID: 20439039 DOI: 10.1016/j.jamda.2010.02.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 02/03/2010] [Indexed: 10/19/2022]
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Abstract
With the aging of the world's population there has become a major need for the development of nursing homes throughout the world. While some countries provide high quality care for the disabled elderly, in others this is not the case. Education of a medical director has been shown to improve the quality of the nursing home. Physicians need to have knowledge of how to implement continuous quality improvement and culture change. Key medical issues include moving to a restraint free environment, subsyndromal delirium, behavioral disturbances, weight loss, pain management, pressure ulcers, falls, hip fractures, polypharmacy, depression and frailty.
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Affiliation(s)
- J E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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Rolland Y, Abellan van Kan G, Hermabessiere S, Gerard S, Guyonnet Gillette S, Vellas B. Descriptive study of nursing home residents from the REHPA network. J Nutr Health Aging 2009; 13:679-83. [PMID: 19657550 DOI: 10.1007/s12603-009-0197-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION To date, very little research has been carried out in nursing homes and it is difficult to make recommendations for quality of care that are based on actual data. The Réseau de Recherche en Etablissement d'Hébergement pour Personnes Agées (REHPA) is a functional network established in collaboration between the geriatric department of Toulouse University Hospital and 240 nursing homes with the aim of compensating for the lack of evidence-based recommendations and of enhancing research. MATERIALS AND METHODS A cross-sectional observational study was conducted between January and March 2008. The number of residents included (randomly selected by birth date) depended on the total number of residents of the facility. Demography, medical and drug history, disabilities and care practices were assessed by geriatrician. RESULTS We report the findings in 4896 residents of 240 nursing homes. Residents were 73.9% women, mean age 85.7 +/- 8.8 years, mean weight 61.9 +/- 14.8 kg, with a mean ADL score of 2.8 +/- 2.1. Dementia was diagnosed in 43.5% (of whom only 50.9% were treated), 19.6% showed aggressive behaviours, 10.8% exhibited disruptive vocalization and 10.9% were wanderers, 27.4% were treated with antipsychotic medications, 54.4% had hypertension, 8.7% had diabetes, 14.8% were osteoporotic, 4.1% had fallen during the previous week, 37.9% were in pain and 19.8% had lost weight. The mean Charlson index score was 1.6 +/- 1.4. Finally, 13.5% had been admitted to hospital within the previous three months. CONCLUSION The survey identifies specific issues in order to target future research in the nursing home setting.
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Affiliation(s)
- Y Rolland
- Gérontopôle de Toulouse, Service de Médecine Interne et de Gérontologie Clinique, Pavillon Junot, 170 avenue de Casselardit, Hôpital La Grave-Casselardit, 31300 Toulouse, France.
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Morley JE. Polypharmacy in the nursing home. J Am Med Dir Assoc 2009; 10:289-91. [PMID: 19497538 DOI: 10.1016/j.jamda.2009.03.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 03/23/2009] [Indexed: 12/11/2022]
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Flaherty JH. Nursing Homes in China? J Am Med Dir Assoc 2009; 10:453-5. [DOI: 10.1016/j.jamda.2009.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022]
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Morley JE. Editor's Response to Letters about Rappaport et al. J Am Med Dir Assoc 2009. [DOI: 10.1016/j.jamda.2009.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Diarrhea in long-term care: a messy problem. J Am Med Dir Assoc 2009; 10:213-7. [PMID: 19426933 DOI: 10.1016/j.jamda.2009.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 01/21/2009] [Indexed: 01/30/2023]
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Wolter DK. Risiken von Antipsychotika im Alter, speziell bei Demenzen 1Prof. Dr. Hans Gutzmann zum 60. Geburtstag gewidmet. ACTA ACUST UNITED AC 2009. [DOI: 10.1024/1011-6877.22.1.17] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Antipsychotika werden häufig zur Behandlung von herausforderndem Verhalten bei Demenz eingesetzt. Antipsychotika der zweiten Generation («atypische Neuroleptika») spielen dabei mittlerweile eine größere Rolle als die älteren Substanzen. Der nur mäßigen Wirksamkeit stehen schwerwiegende Risiken gegenüber: so ist unter allen Antipsychotika die Mortalität insgesamt erhöht, aber auch das Risiko für plötzlichen Herztod, Schlaganfallereignisse oder venöse Thrombosen. Die Unterschiede zwischen Antipsychotika der ersten und der zweiten Generation sind dabei gering: hochpotente Antipsychotika der ersten Generation führen häufiger zu extrapyramidalmotorischen Symptomen, unter Antipsychotika der zweiten Generation ist das allgemeine Mortalitätsrisiko wahrscheinlich etwas geringer, andererseits wahrscheinlich venöse Thrombosen und metabolische Nebenwirkungen häufiger. Für die übrigen Nebenwirkungen bestehen keine gesicherten Unterschiede. Angesichts der großen Heterogenität der Antipsychotika erscheint der Nutzen einer pauschalen Aufteilung in Antipsychotika der ersten und zweiten Generation fragwürdig. Für die Auswahl einer Substanz sind substanzspezifische Nebenwirkungen, Dosierung, Aufdosierungsgeschwindigkeit sowie Beachtung von Komorbidität, Kontraindikationen und Arzneimittelinteraktionen in Relation zum individuellen Patienten erheblich wichtiger als die Wahl nach bloßer pauschaler Zuordnung zu einer dieser beiden Gruppen. Am wichtigsten ist aber, dass Antipsychotika nur bei klarer Indikation zur Anwendung kommen!
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Affiliation(s)
- Dirk K. Wolter
- Fachbereich Gerontopsychiatrie, Inn-Salzach-Klinikum, Wasserburg a. Inn
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Abstract
Delirium is a common, serious medical and often life-threatening condition in elderly in-patients. Delirium can develop primarily or secondarily related to other medical conditions and lead to hospital admission. The pathogenesis is still not fully known and is usually addressed as multifactorial. Alterations in neurotransmitters have a key role in this process. The incidence varies by setting up to 90%. Delirium is associated with increased short- and long-term mortality, iatrogenic complications, functional decline, and future development of cognitive impairment or dementia. Delirium is also associated with longer hospital stays, higher hospital and total health system costs, and an increasing rate of nursing home admissions. A structured diagnostic and therapeutic process is recommended. Delirium should become a quality indicator for hospital medicine; however, many research questions still exist.
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Locca JF, Ruggli M, Buchmann M, Huguenin J, Bugnon O. Development of pharmaceutical care services in nursing homes: practice and research in a Swiss canton. ACTA ACUST UNITED AC 2008; 31:165-73. [PMID: 19067223 DOI: 10.1007/s11096-008-9273-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 11/16/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to assess the implementation process and economic impact of a new pharmaceutical care service provided since 2002 by pharmacists in Swiss nursing homes. SETTING The setting was 42 nursing homes located in the canton of Fribourg, Switzerland under the responsibility of 22 pharmacists. METHOD We developed different facilitators, such as a monitoring system, a coaching program, and a research project, to help pharmacists change their practice and to improve implementation of this new service. We evaluated the implementation rate of the service delivered in nursing homes. We assessed the economic impact of the service since its start in 2002 using statistical evaluation (Chow test) with retrospective analysis of the annual drug costs per resident over an 8-year period (1998-2005). MAIN OUTCOME MEASURES The description of the facilitators and their implications in implementation of the service; the economic impact of the service since its start in 2002. RESULTS In 2005, after a 4-year implementation period supported by the introduction of facilitators of practice change, all 42 nursing homes (2,214 residents) had implemented the pharmaceutical care service. The annual drug costs per resident decreased by about 16.4% between 2002 and 2005; this change proved to be highly significant. The performance of the pharmacists continuously improved using a specific coaching program including an annual expert comparative report, working groups, interdisciplinary continuing education symposia, and individual feedback. This research project also determined priorities to develop practice guidelines to prevent drug-related problems in nursing homes, especially in relation to the use of psychotropic drugs. CONCLUSION The pharmaceutical care service was fully and successfully implemented in Fribourg's nursing homes within a period of 4 years. These findings highlight the importance of facilitators designed to assist pharmacists in the implementation of practice changes. The economic impact was confirmed on a large scale, and priorities for clinical and pharmacoeconomic research were identified in order to continue to improve the quality of integrated care for the elderly.
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Affiliation(s)
- Jean-François Locca
- Community Pharmacy Practice Research Unit, Universities of Lausanne and Geneva, Pharmacie de la PMU, Rue du Bugnon 44, 1011 Lausanne, Switzerland
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