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Zuccarello P, Carnazza G, Salerno M, Esposito M, Cosentino S, Giorlandino A, Sessa F, Pomara C, Barbera N. Forensic investigation on a combined death by food aspiration and acute escitalopram intoxication occurred to a psychiatric subject in a nursing home. Int J Legal Med 2024; 138:1653-1658. [PMID: 38321300 PMCID: PMC11164780 DOI: 10.1007/s00414-024-03168-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024]
Abstract
Food aspiration is one of the major health risks for elderly people in nursing homes which could lead to death. Moreover, misconducts in pharmacotherapy may represent a potential risk of adverse drug reactions. It is reported here the toxicological evaluation of a combined death by food aspiration and acute escitalopram intoxication of a psychiatric subject, occurred in a nursing home. An 89-year-old man, suffering from dysphagia and Alzheimer's, was resident in a nursing home. He was fed with a liquid diet administered directly in mouth using a syringe. The man was also being treated with escitalopram 10 mg tablet. One evening, after receiving the meal in the usual way, the man complained of sudden illness. Carried to the emergency room, the man died about 3 h later with a diagnosis of cardiogenic shock subsequentially to ab ingestis. The histological findings revealed the presence of exogenous material, probably food, up to the finest bronchial branches. The toxicological examination revealed the presence of escitalopram and its main metabolite, desmethylcitalopram: in the blood 1972 ng/ml and 285 ng/ml, in the brain 4657 ng/g and 1025 ng/g, in the gastric content 2317 ng/g and 423 ng/g, in the lung 21,771 ng/g and 468 ng/g, respectively. The bad practice of the nurses to dissolve the escitalopram tablet in the liquefied food and to administer the therapy with a syringe directly into the mouth emerged thanks this investigation. Following food aspiration, escitalopram was absorbed by inhalation route, reaching high concentrations in blood and tissues. The death occurred due to a combined mechanism between food aspiration and the escitalopram toxic action.
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Affiliation(s)
- P Zuccarello
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia, University of Catania, Catania, Italy.
| | - G Carnazza
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia, University of Catania, Catania, Italy
| | - M Salerno
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia, University of Catania, Catania, Italy
| | - M Esposito
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia, University of Catania, Catania, Italy
| | - S Cosentino
- Department of Pathological Anatomy, A.R.N.A.S. Garibaldi-Nesima, Catania, Italy
| | - A Giorlandino
- Department of Pathological Anatomy, A.R.N.A.S. Garibaldi-Nesima, Catania, Italy
| | - F Sessa
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia, University of Catania, Catania, Italy
| | - C Pomara
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia, University of Catania, Catania, Italy
| | - N Barbera
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia, University of Catania, Catania, Italy
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Hughes GA, Inacio MC, Rowett D, Lang C, Jorissen RN, Corlis M, Sluggett JK. National Trends in Antidepressant Use in Australian Residential Aged Care Facilities (2006-2019). J Am Med Dir Assoc 2024; 25:104957. [PMID: 38432647 DOI: 10.1016/j.jamda.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Antipsychotics have been the focus of reforms for improving the appropriateness of psychotropic medicine use in residential aged care facilities (RACFs). Comprehensive evaluation of antidepressant use in RACFs is required to inform policy and practice initiatives targeting psychotropic medicines. This study examined national trends in antidepressant use among older people living in RACFs from 2006 to 2019. DESIGN National repeated cross-sectional study. SETTING AND PARTICIPANTS Individuals aged 65 to 105 years who were permanent, long-term (≥100 days) residents of Australian RACFs between January 2006 and December 2019 were included. METHODS Annual age- and sex-adjusted antidepressant prevalence rates and defined daily doses (DDDs) supplied per 1000 resident-days from 2006 to 2019 were determined. Age- and sex-adjusted prevalence rate ratios (aRRs) and 95% confidence intervals (CIs) were estimated using Poisson and negative binomial regression models. RESULTS A total of 779,659 residents of 3371 RACFs were included (786,227,380 resident-days). Overall, antidepressant use increased from 46.1% (95% CI, 45.9-46.4) in 2006 to 58.5% (95% CI, 58.3-58.8) of residents in 2019 (aRR, 1.02; 95% CI, 1.02-1.02). Mirtazapine use increased from 8.4% (95% CI, 8.2-8.5) to 20.9% (95% CI, 20.7-21.1) from 2006 to 2019 (aRR, 1.07; 95% CI, 1.07-1.07). Antidepressant use increased from 350.3 (95% CI, 347.6-353.1) to 506.0 (95% CI, 502.8-509.3) DDDs/1000 resident-days (aRR, 1.03; 95% CI, 1.03-1.03), with mirtazapine utilization increasing by 6% annually (aRR, 1.06; 95% CI, 1.06-1.06). CONCLUSIONS AND IMPLICATIONS This nationwide study identified a substantial increase in antidepressant use among residents of Australian RACFs, largely driven by mirtazapine. With nearly 3 in every 5 residents treated with an antidepressant in 2019, findings highlight potential off-label use and suggest that interventions to optimize care are urgently needed.
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Affiliation(s)
- Georgina A Hughes
- University of South Australia, UniSA Clinical & Health Sciences, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
| | - Debra Rowett
- University of South Australia, UniSA Clinical & Health Sciences, Adelaide, South Australia, Australia; Southern Adelaide Local Health Network, Drug and Therapeutics Information Service, Adelaide, South Australia, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Flinders University, College of Medicine and Public Health, Bedford Park, South Australia, Australia
| | - Megan Corlis
- Australian Nursing and Midwifery Federation SA Branch, Adelaide, South Australia, Australia
| | - Janet K Sluggett
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
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Harris DA, Maclagan LC, Pequeno P, Iaboni A, Austin PC, Rosella LC, Guan J, Maxwell CJ, Bronskill SE. Variation and Correlation of Potential Unintended Consequences of Antipsychotic Reduction in Ontario Nursing Homes Over Time. Med Care 2023; 61:173-181. [PMID: 36728617 DOI: 10.1097/mlr.0000000000001814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Potentially inappropriate antipsychotic use has declined in nursing homes over the past decade; however, increases in the documentation of relevant clinical indications (eg, delusions) and the use of other psychotropic medications have raised concerns about diagnosis upcoding and medication substitution. Few studies have examined how these trends over time vary across and within nursing homes, information that may help to support antipsychotic reduction efforts. OBJECTIVE To jointly model facility-level time trends in potentially inappropriate antipsychotic use, antidepressant use, and the indications used to define appropriate antipsychotic use. RESEARCH DESIGN We conducted a repeated cross-sectional study of all nursing homes in Ontario, Canada between April 1, 2010 and December 31, 2019 using linked health administrative data (N=649). Each nursing home's quarterly prevalence of potentially inappropriate antipsychotic use, antidepressant use, and relevant indications were measured as outcome variables. With time as the independent variable, multivariate random effects models jointly estimated time trends for each outcome across nursing homes and the correlations between time trends within nursing homes. RESULTS We observed notable variations in the time trends for each outcome across nursing homes, especially for the relevant indications. Within facilities, we found no correlation between time trends for potentially inappropriate antipsychotic and antidepressant use ( r =-0.0160), but a strong negative correlation between time trends for potentially inappropriate antipsychotic use and relevant indications ( r =-0.5036). CONCLUSIONS Nursing homes with greater reductions in potentially inappropriate antipsychotics tended to show greater increases in the indications used to define appropriate antipsychotic use-possibly leading to unmonitored use of antipsychotics.
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Affiliation(s)
- Daniel A Harris
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto
| | | | | | - Andrea Iaboni
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network.,Department of Psychiatry, University of Toronto
| | - Peter C Austin
- ICES.,Sunnybrook Research Institute.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto
| | - Laura C Rosella
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto.,ICES.,Institute for Better Health, Trillium Health Partners, Mississauga.,Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto.,Vector Institute, Toronto
| | | | - Colleen J Maxwell
- ICES.,Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo
| | - Susan E Bronskill
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto.,ICES.,Sunnybrook Research Institute.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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4
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McDonald WM. The Problem With Maslow's Hammer. Am J Geriatr Psychiatry 2022; 30:1324-1326. [PMID: 35803878 PMCID: PMC9188488 DOI: 10.1016/j.jagp.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 01/25/2023]
Affiliation(s)
- William M McDonald
- Department of Psychiatry and Behavioral Sciences, JB Fuqua Chair for Late-Depression, Ruenette W. Harris Chair, Emory University School of Medicine, Atlanta, Georgia USA.
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Almeida OP, Patel H, Velasquez D, Kelly R, Lai R, Ford AH, Curran E, Flicker L, Chong TWH, Etherton-Beer C, LoGiudice D, Ellis KA, Martini A, Westphal A, Ekers D, Gilbody S, Lautenschlager NT. Behavioral Activation in Nursing Homes to Treat Depression (BAN-Dep): Results From a Clustered, Randomized, Single-Blinded, Controlled Clinical Trial. Am J Geriatr Psychiatry 2022; 30:1313-1323. [PMID: 35680539 DOI: 10.1016/j.jagp.2022.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine if behavioral activation (BA) delivered by trained staff decreases prevalence of clinically significant symptoms of depression among older adults living in residential aged care facilities (RACFs). METHODS Clustered, randomized, single-blinded, controlled trial of BA for adults aged over 60 years living permanently in a RACF with symptoms of depression (Patient Health Questionnaire, PHQ-9 ≥ 5). BA was delivered over 8-12 weeks using a structured workbook. The proportion of residents with PHQ-9 ≥ 10 at weeks 12, 26, and 52, as well as anxiety symptoms (GAD-7), physical (PCS), and mental (MCS) quality of life, loneliness, and loss to follow-up were main outcomes of interest RESULTS: We recruited 54 RACFs (26 intervention) and 188 of their residents (89 intervention). Participants were aged 61-100 years and 132 (70.2%) were women. PHQ-9 ≥ 10 interacted with BA at week 12 (OR = 0.34, 95%CI = 0.11-1.07), but differences between the groups were not statistically significant at any time-point. GAD-7 ≥ 10 interacted with BA at week 26 (OR = 0.12, 95%CI = 0.02-0.58), but not at any other time-point. Overall, the intervention had no effect on the scores of the PHQ-9, GAD-7, PCS, MCS, and loneliness scale. Loss to follow-up was similar between groups. Adherence to all stages of the intervention was poor (36.2%). CONCLUSIONS Disruption by the COVID-19 pandemic and staffing issues in RACFs undermined recruitment and adherence. In such a context, a BA program delivered by RACF staff was not associated with better mental health outcomes for residents over 52 weeks.
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Affiliation(s)
- Osvaldo P Almeida
- Medical School (OPA, HP, RK, AHF, LF, CE-B), University of Western Australia, Perth, Australia.
| | - Hema Patel
- Medical School (OPA, HP, RK, AHF, LF, CE-B), University of Western Australia, Perth, Australia
| | - Diana Velasquez
- Department of Psychiatry (DV, RL, EC, TWHC, KAE, AW, NTL), University of Melbourne, Melbourne, Australia
| | - Rachael Kelly
- Medical School (OPA, HP, RK, AHF, LF, CE-B), University of Western Australia, Perth, Australia
| | - Rhoda Lai
- Department of Psychiatry (DV, RL, EC, TWHC, KAE, AW, NTL), University of Melbourne, Melbourne, Australia
| | - Andrew H Ford
- Medical School (OPA, HP, RK, AHF, LF, CE-B), University of Western Australia, Perth, Australia
| | - Eleanor Curran
- Department of Psychiatry (DV, RL, EC, TWHC, KAE, AW, NTL), University of Melbourne, Melbourne, Australia; NorthWestern Mental Health (EC, NTL), Royal Melbourne Hospital, Melbourne, Australia
| | - Leon Flicker
- Medical School (OPA, HP, RK, AHF, LF, CE-B), University of Western Australia, Perth, Australia
| | - Terence W H Chong
- Department of Psychiatry (DV, RL, EC, TWHC, KAE, AW, NTL), University of Melbourne, Melbourne, Australia; St Vincent's Hospital Melbourne (TWHC), Melbourne, Australia
| | | | - Dina LoGiudice
- Department of Medicine (DL), University of Melbourne, Melbourne, Australia
| | - Kathryn A Ellis
- Department of Psychiatry (DV, RL, EC, TWHC, KAE, AW, NTL), University of Melbourne, Melbourne, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | | | - Alissa Westphal
- Department of Psychiatry (DV, RL, EC, TWHC, KAE, AW, NTL), University of Melbourne, Melbourne, Australia
| | - David Ekers
- Tees Esk and Wear Valleys NHS FT/MHARG (KAE, DE), University of York, York, UK
| | - Simon Gilbody
- Mental Health and Addictions Research Group (SG), HYMS & University of York, York, UK
| | - Nicola T Lautenschlager
- Department of Psychiatry (DV, RL, EC, TWHC, KAE, AW, NTL), University of Melbourne, Melbourne, Australia; NorthWestern Mental Health (EC, NTL), Royal Melbourne Hospital, Melbourne, Australia
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Roh E, Cota E, Lee JP, Madievsky R, Eskildsen MA. Polypharmacy in Nursing Homes. Clin Geriatr Med 2022; 38:653-666. [DOI: 10.1016/j.cger.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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7
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Nasser A. Antidepressant’s long-term effect on cognitive performance and cardiovascular system. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.23.7688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: The nature of antidepressants and their adverse effects should be considered when treating severe depression in individuals with psychotic symptoms. Antidepressant prescription rates have risen steadily over the last 30 years, affecting people of all ages. Aim: The goal of this study was to see if depression and antidepressant usage were linked to long-term changes in cognitive function and cardiovascular health. Methodology: Meta-analysis was performed using PRISMA guidelines along with using the SPIDER search framework using related keywords on different search engines i.e. Google scholars, PubMed, Scopus, ISI, etc. Total (n=2256) papers were obtained and assessed for eligibility. Altogether 15 studies were included using databases and other methods. The Newcastle-Ottawa Scale examined the grades provided by the data after numerous screenings. Result: A distinct link was found between antidepressants with cognitive performance and the cardiovascular system. Dementia and hypertension were prevailing long-term effects caused by frequent use of antidepressants in chronic and mild depression.
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8
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Geriatric Depression and Inappropriate Medication: Benefits of Interprofessional Team Cooperation in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312438. [PMID: 34886164 PMCID: PMC8657238 DOI: 10.3390/ijerph182312438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
An investigation of inappropriate medication use in treatment of depressivity in institutionalized older adults, based on a nurse-led evaluation of functional status and depressive symptoms in nursing home residents. Methods: A cross-sectional multicenter study was performed using records from 1087 residents cared for in fifteen nursing homes (NHs) in the Czech Republic. Inclusion criteria were being a permanent resident of one of the facilities, being 60 years of age or older, having a Geriatric Depression Scale score of 6 or more, and having a Mini Mental State examination score 10 or more. The final sample for analysis included 317 depressed NH residents. Results: 52 percent of NH residents with depressivity had no antidepressant treatment. Benzodiazepines were the only medication in 16 percent of depressed residents, and were added to antidepressant treatment in 18 percent of residents. Benzodiazepine users had significantly higher GDS scores compared to non-users (p = 0.007). Conclusion: More than half of depressed NH residents remained without antidepressant treatment. Residents inappropriately treated with benzodiazepines were more depressed than residents treated with antidepressants only, or even not treated at all. Cooperation of the interprofessional team in the screening of depressive symptoms has the potential to improve the quality of care.
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Clemens S, Wodchis W, McGilton K, McGrail K, McMahon M. The relationship between quality and staffing in long-term care: A systematic review of the literature 2008-2020. Int J Nurs Stud 2021; 122:104036. [PMID: 34419730 DOI: 10.1016/j.ijnurstu.2021.104036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Higher staffing levels in long-term care have been associated with better outcomes for residents in several landmark studies. However previous systematic reviews found mixed results, calling into question the effectiveness of higher levels of staff. With persistent concerns about quality, rising resident acuity, and a growing demographic of seniors requiring more services, understanding the relationship between quality and long-term care staffing is a growing concern. OBJECTIVES This review considered the following question: What is the influence of nursing and personal care staffing levels (registered nurse, licensed practical nurse, and nursing assistant) and / or skill mix on long-term care residents, measured by quality of care indicators? DESIGN Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guided the report of this systematic review. DATA SOURCES Published articles focused on quality and nursing and personal care staffing in long-term care in peer-reviewed databases (MEDLINE, CINAHL, and AGELINE) and several Cochrane databases to retrieve studies published between January 2008 and June 2020. REVIEW METHODS A systematic review was conducted. 11,096 studies were identified, of which 34 were included in this review. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to evaluate study quality and risk of bias, and five quality measures were selected for in-depth analyses: pressure ulcers, hospitalizations, physical restraints, deficiencies and catherization. RESULTS This review confirms previous review findings that evidence on the relationships between quality and long-term care staffing level and skill mix, remain mixed. Higher staffing levels and skill mix generally supported better rather than worse outcomes. Significant and consistent findings were more evident when staffing levels were further analyzed by indicator and staffing category. For example, registered nurses were consistently associated with significantly fewer pressure ulcers, hospitalizations, and urinary tract infections. Few studies examined the impact of total nursing and personal care hours compared to the impact of specific categories or classes of nursing staff on outcomes. CONCLUSIONS Evidence on the relationship between quality and long-term care staffing remains mixed, however some categories of nursing staff may be more effective at improving the quality of certain indicators. Study quality has improved minimally over the last decade. Although research continues to standardize units of measurement, and longitudinal and instrumental variable analyses are increasingly being used, very few studies controlled for endogeneity, conducted adequate risk-adjustment, and used resident-level data. Additional strides must still be made to improve the rigor of long-term care staffing research.
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Affiliation(s)
- Sara Clemens
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Ave Toronto, Ontario, Canada.
| | - Walter Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Ave Toronto, Ontario, Canada.
| | | | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Canada.
| | - Meghan McMahon
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Ave Toronto, Ontario, Canada.
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Armijo-Olivo S, Craig R, Corabian P, Guo B, Souri S, Tjosvold L. Nursing Staff Time and Care Quality in Long-Term Care Facilities: A Systematic Review. THE GERONTOLOGIST 2020; 60:e200-e217. [PMID: 31115444 DOI: 10.1093/geront/gnz053] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In long-term care (LTC) facilities, nursing staff are important contributors to resident care and well-being. Despite this, the relationships between nursing staff coverage, care hours, and quality of resident care in LTC facilities are not well understood and have implications for policy-makers. This systematic review summarizes current evidence on the relationship between nursing staff coverage, care hours, and quality of resident care in LTC facilities. RESEARCH DESIGN AND METHODS A structured literature search was conducted using four bibliographic databases and gray literature sources. Abstracts were screened by two independent reviewers using Covidence software. Data from the included studies were summarized using a pretested extraction form. The studies were critically appraised, and their results were synthesized narratively. RESULTS The systematic searched yielded 15,842 citations, of which 54 studies (all observational) were included for synthesis. Most studies (n = 53, 98%) investigated the effect of nursing staff time on resident care. Eleven studies addressed minimum care hours and quality of care. One study examined the association between different nursing staff coverage models and resident outcomes. Overall, the quality of the included studies was poor. DISCUSSION AND IMPLICATIONS Because the evidence was inconsistent and of low quality, there is uncertainty about the direction and magnitude of the association between nursing staff time and type of coverage on quality of care. More rigorously designed studies are needed to test the effects of different cutoffs of care hours and different nursing coverage models on the quality of resident care in LTC facilities.
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Affiliation(s)
- Susan Armijo-Olivo
- Institute of Health Economics (IHE), Edmonton, Alberta, Canada.,Faculty of Rehabilitation Medicine, Department of Physical Therapy/Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Rodger Craig
- Institute of Health Economics (IHE), Edmonton, Alberta, Canada
| | - Paula Corabian
- Institute of Health Economics (IHE), Edmonton, Alberta, Canada
| | - Bing Guo
- Institute of Health Economics (IHE), Edmonton, Alberta, Canada
| | - Sepideh Souri
- Institute of Health Economics (IHE), Edmonton, Alberta, Canada
| | - Lisa Tjosvold
- Institute of Health Economics (IHE), Edmonton, Alberta, Canada.,John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
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11
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Giovannini S, Onder G, van der Roest HG, Topinkova E, Gindin J, Cipriani MC, Denkinger MD, Bernabei R, Liperoti R. Use of antidepressant medications among older adults in European long-term care facilities: a cross-sectional analysis from the SHELTER study. BMC Geriatr 2020; 20:310. [PMID: 32854659 PMCID: PMC7457305 DOI: 10.1186/s12877-020-01730-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/23/2020] [Indexed: 11/12/2022] Open
Abstract
Background Late-life depression is common among older adults living in nursing homes (NHs). Over the last 30 years there has been an increase in the rates of prescription of antidepressant medications across all ages, with the largest rise reported in older adults. This study aimed to describe the pattern of antidepressant medication use among NH residents from 7 European countries and Israel and to examine patient and facilities characteristics that may account for it. Methods We conducted a cross-sectional analysis of data from the SHELTER study, an observational longitudinal cohort study that collected comprehensive resident data using the interRAI Long-Term Care Facility instrument in 7 European Countries and Israel. Descriptive statistics were used to examine sample characteristics. Potential correlates of antidepressant medication use were identified using multiple logistic regression modeling. Results Among 4023 residents entering the study, 32% had depressive symptoms and nearly half of these individuals used antidepressants. Antidepressant medication use varied by country, with a prevalence in the overall sample of 35.6% (n = 1431). Among antidepressant users, 59.9% were receiving selective serotonin reuptake inhibitors (SSRI). The strongest correlates of antidepressant use included reported diagnosis of anxiety, depression, bipolar disorder, pain, falls and high level of social engagement. Age over 85 years, living in facilities located in rural areas and a diagnosis of schizophrenia reduced the likelihood of being prescribed with an antidepressant. Conclusions A large proportion of residents in European long-term care facilities receive antidepressant medications. The decision to prescribe antidepressants to NH residents seems to be influenced by both patient and facility characteristics. Future longitudinal studies should evaluate the efficacy and safety of antidepressant use in NHs thus providing evidence for recommendations for clinical practice.
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Affiliation(s)
- Silvia Giovannini
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | | | - Henriëtte G van der Roest
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jacob Gindin
- The Centre for Standards in Health and Disability, Research Authority, University of Haifa, Haifa, Israel
| | - Maria Camilla Cipriani
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michael D Denkinger
- AGAPLESION Bethesda Clinic, Competence Centre of Geriatrics, University of Ulm, Ulm, Germany
| | - Roberto Bernabei
- Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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12
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Crick M, Devey-Burry R, Hu J, Angus DE, Backman C. The role of regulation in the care of older people with depression living in long-term care: a systematic scoping review. BMC Geriatr 2020; 20:273. [PMID: 32758157 PMCID: PMC7409447 DOI: 10.1186/s12877-020-01675-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 07/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background This aim of this study was to explore the role of regulation on the quality of care of older people living with depression in LTC, which in this paper is a domestic environment providing 24-h care for people with complex health needs and increased vulnerability. Methods We conducted a systematic scoping review. A peer reviewed search strategy was developed in consultation with a specialist librarian. Several databases were searched to identify relevant studies including: Embase (using the OVID platform); MEDLINE (using the OVID platform); Psych info (using the OVID platform); Ageline (using the EBSCO platform); and CINHAL (using the EBSCO platform). Articles were screened by three reviewers with conflicts resolved in consultation with authors. Data charting was completed by one reviewer, with a quality check performed by a second reviewer. Key themes were then derived from the included studies. Results The search yielded 778 unique articles, of which 20 were included. Articles were grouped by themes: regulatory requirements, funding issues, and organizational issues. Conclusion The highly regulated environment of LTC poses significant challenges which can influence the quality of care of residents with depression. Despite existing evidence around prevalence and improved treatment regimens, regulation appears to have failed to capture the best practice and contemporary knowledge available. This scoping review has identified a need for further empirical research to explore these issues.
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Affiliation(s)
- Michelle Crick
- University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada.
| | - Robin Devey-Burry
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada
| | - Jiale Hu
- Department of Nurse Anaesthesia, Virginia Commonwealth University, Richmond, USA
| | - Douglas E Angus
- Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada
| | - Chantal Backman
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa, Ontario, K1H 8L1, Canada
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Basnet P, Acton GJ, Requeijo P. Psychotropic Medication Prescribing Practice Among Residents With Dementia in Nursing Homes: A Person-Centered Care Approach. J Gerontol Nurs 2020; 46:9-17. [PMID: 31978235 DOI: 10.3928/00989134-20200108-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 09/19/2019] [Indexed: 12/27/2022]
Abstract
Despite multiple national initiatives to improve quality of life in nursing home (NH) residents with dementia, inefficiencies still exist regarding inappropriate psychotropic medication use to manage communication of distress. The goals of the current article are to: (a) create a person-centered care plan/process for NH community staff to manage challenging dementia behaviors; (b) provide guidelines for geriatric practitioners (GPs) to decrease psychotropic medication use in residents with dementia; (c) discuss organizational culture and its relationship to the management of non-cognitive neuropsychiatric symptoms (NPS) of dementia; and (d) emphasize nonpharmacological approaches as first-line treatment of NPS in NH residents with dementia. [Journal of Gerontological Nursing, 46(2), 9-17.].
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Briesacher B, Oliveri-Mui B, Chhabra B, Koethe B. Adequacy of Prescription Drug Coverage in Long-term Care. Med Care 2020; 58:427-432. [PMID: 31985585 DOI: 10.1097/mlr.0000000000001291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RESEARCH OBJECTIVE Affordable access to medications is important to Medicare enrollees in long-term care (LTC), yet, it is unknown if prescription drug coverage is universal and adequate to meet their high medication needs. STUDY DESIGN We assessed enrollment in prescription drug coverage, out-of-pocket (OOP) payments and medication use in a nationwide LTC database of prescription-level, resident-level, and facility-level data for the period 2011-2013. Inadequate drug coverage was defined as ≥50% medications paid for OOP. Risk-adjusted generalized estimation equations models were estimated to identify predictors of inadequate drug coverage and total prescription fills. POPULATION STUDIED A nationwide sample of 332,087 Medicare enrollees observed >100 days in LTC. PRINCIPAL FINDINGS We found Medicare Part D was the main source of drug coverage (82.4%), followed by private insurance (8.5%), and Veterans Administration (0.2%). No drug coverage could be detected for 8.9% (n=29,378) who paid for all of their medications OOP or received only temporary drug payment assistance. Inadequate drug coverage was identified in another 2721 persons. LTC Medicare enrollees without drug coverage or who had private insurance received significantly fewer prescriptions than if they had been enrolled in Medicare Part D. CONCLUSION A substantial proportion of Medicare enrollees in LTC have inadequate or no drug coverage and are receiving less medication than indicated by their health needs. POLICY IMPLICATIONS Medicare Part D is an important policy for ensuring affordable access to medications in LTC. However, expansions are needed to increase enrollment and decrease inadequate drug coverage.
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Affiliation(s)
- Becky Briesacher
- Bouvé College of Health Sciences, Northeastern University, Boston, MA
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15
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Velasquez Reyes D, Patel H, Lautenschlager N, Ford AH, Curran E, Kelly R, Lai R, Chong T, Flicker L, Ekers D, Gilbody S, Etherton-Beer C, Lo Giudice D, Ellis KA, Martini A, Almeida OP. Behavioural activation in nursing homes to treat depression (BAN-Dep): study protocol for a pragmatic randomised controlled trial. BMJ Open 2019; 9:e032421. [PMID: 31676658 PMCID: PMC6830697 DOI: 10.1136/bmjopen-2019-032421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/06/2019] [Accepted: 10/11/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Depression is a common disorder among older people living in residential aged care facilities. Several trials have demonstrated the effectiveness of behavioural therapies in treating depressive symptoms in older adults living in the community and in residential aged care. Behavioural Activation is demonstrably effective even when delivered by non-specialists (staff without formal psychological training), although strategies for adapting its use in residential aged care facilities are yet to be explored. This study will determine whether training residential care staff in the use of a structured Behavioural Activation programme is more effective at decreasing depressive symptoms among older residents than internet-based training about depression recognition and management alone. METHOD AND ANALYSIS The behavioural activation in nursing homes to treat depression (BAN-Dep) trial is a pragmatic two-arm parallel clustered randomised controlled trial. It will recruit 666 residents aged 60 or older from 100 residential aged care facilities, which will be randomly assigned to the Behavioural Activation or control intervention. Staff in both treatment groups will be encouraged to complete the Beyondblue Professional Education to Aged Care e-learning programme to improve their recognition of and ability to respond to depression in older adults. Selected staff from intervention facilities will undergo additional training to deliver an 8-module Behavioural Activation programme to residents with subthreshold symptoms of depression-they will receive ongoing Mental support from trained Behavioural Activation therapists. Outcome measures will be collected by blind research officer at baseline and after 3, 6 and 12 months. The Patient Health Questionnaire-9 is the primary outcome measure of the study. ETHICS AND DISSEMINATION The trial will comply with the principles of the Declaration of Helsinki for Human Rights and is overseen by the University of Western Australia (reference RA/4/20/4234) and Melbourne Health (reference number HREC/18/MH/47) Ethics Committees. The results of this research project will be disseminated through publications and/or presentations in a variety of media to health professionals, academics, clinicians and the public. Only de-identified group data will be presented. TRIAL REGISTRATION ACTRN12618000634279.
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Affiliation(s)
| | - Hema Patel
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | | | - Andrew H Ford
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | - Eleanor Curran
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachael Kelly
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | - Rhoda Lai
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Terence Chong
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leon Flicker
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | | | | | - Christopher Etherton-Beer
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | | | - Kathryn A Ellis
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angelita Martini
- Brightwater Care Group, Osborne Park, Western Australia, Australia
| | - Osvaldo P Almeida
- Medical School, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
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Abdeljalil AB, Arbus C, Montastruc F, de Souto Barreto P, André L, Vellas B, Rolland Y. Antidepressants in nursing homes for dependent older patients: the cross-sectional associations of institutional factors with prescription conformance. Eur Geriatr Med 2019; 10:421-430. [DOI: 10.1007/s41999-019-00189-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/02/2019] [Indexed: 11/25/2022]
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Roitto HM, Kautiainen H, Aalto UL, Öhman H, Laurila J, Pitkälä KH. Fourteen-Year Trends in the Use of Psychotropic Medications, Opioids, and Other Sedatives Among Institutionalized Older People in Helsinki, Finland. J Am Med Dir Assoc 2019; 20:305-311. [DOI: 10.1016/j.jamda.2018.12.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
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18
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Bobo WV, Grossardt BR, Lapid MI, Leung JG, Stoppel C, Takahashi PY, Hoel RW, Chang Z, Lachner C, Chauhan M, Flowers L, Brue SM, Frye MA, St. Sauver J, Rocca WA, Sutor B. Frequency and predictors of the potential overprescribing of antidepressants in elderly residents of a geographically defined U.S. population. Pharmacol Res Perspect 2019; 7:e00461. [PMID: 30693088 PMCID: PMC6344796 DOI: 10.1002/prp2.461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/07/2018] [Accepted: 12/18/2018] [Indexed: 12/20/2022] Open
Abstract
The purpose of this study was to estimate the extent of potential antidepressant overprescribing in a geographically defined U.S. population, and to determine the indications and factors that account for it. We conducted a cohort study of new antidepressant prescriptions for elderly residents of Olmsted County, Minnesota, 2005-2012, using the Rochester Epidemiology Project medical records-linkage system. Indications for antidepressants were abstracted from health records for all cohort members. Potential antidepressant overprescribing was defined based on regulatory approval, the level of evidence identified from a standardized drug information database, and multidisciplinary expert review. Predictors of potential antidepressant overprescribing were investigated using logistic regression models, stratified by general antidepressant indication (general medical indication, specific psychiatric diagnosis, and non-specific psychiatric symptoms). Potential antidepressant overprescribing occurred in 24% of 3199 incident antidepressant prescriptions during the study period, and involved primarily newer antidepressants that were prescribed for non-specific psychiatric symptoms and subthreshold diagnoses. Potential antidepressant overprescribing was associated with nursing home residence, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, having greater use of urgent or acute care services in the year preceding the index antidepressant prescription, and being prescribed antidepressants via telephone, e-mail, or patient portal. In conclusion, potential antidepressant overprescribing occurred in elderly persons and involved mainly newer antidepressants used for non-specific psychiatric symptoms and subthreshold diagnoses, and was associated with indicators of higher clinical complexity or severity and with prescribing without face-to-face patient contact.
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Affiliation(s)
- William V. Bobo
- Department of Psychiatry & PsychologyMayo ClinicJacksonvilleFlorida
| | - Brandon R. Grossardt
- Division of Biomedical Statistics and InformaticsDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesota
| | - Maria I. Lapid
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | | | - Cynthia Stoppel
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | - Paul Y. Takahashi
- Department of Primary Care Internal MedicineMayo ClinicRochesterMinnesota
| | - Robert W. Hoel
- Department of Pharmacy ServicesMayo ClinicRochesterMinnesota
| | - Zheng Chang
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | | | - Mohit Chauhan
- Department of Psychiatry & PsychologyMayo ClinicJacksonvilleFlorida
| | - Lee Flowers
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | - Scott M. Brue
- Biomedical Informatics Support SystemMayo ClinicRochesterMinnesota
| | - Mark A. Frye
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
| | - Jennifer St. Sauver
- Division of EpidemiologyDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesota
| | - Walter A. Rocca
- Division of EpidemiologyDepartment of Health Sciences ResearchMayo ClinicRochesterMinnesota
- Department of NeurologyMayo ClinicRochesterMinnesota
| | - Bruce Sutor
- Department of Psychiatry & PsychologyMayo ClinicRochesterMinnesota
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Bathena SPR, Leppik IE, Kanner AM, Birnbaum AK. Antiseizure, antidepressant, and antipsychotic medication prescribing in elderly nursing home residents. Epilepsy Behav 2017; 69:116-120. [PMID: 28242474 PMCID: PMC5464952 DOI: 10.1016/j.yebeh.2017.01.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The incidence of epilepsy is highest in the elderly and the prevalence of epilepsy is higher in nursing home residents than in other cohorts. Co-medications that act in the central nervous system (CNS) are frequently prescribed in this population. The objective was to identify the most commonly prescribed antiseizure drugs (ASDs) and determine the frequency of use of antipsychotic and antidepressant medications in elderly nursing home residents receiving ASDs. METHODS Data were obtained from a pharmacy database serving 18,752 patients in Minnesota and Wisconsin nursing homes. Prescribing information was available on ASD, antidepressant, and antipsychotic drugs on one day in October 2013. The frequency distribution by age, formulation, trademarked/generic drugs, route of administration, and multiple drug combinations were determined. RESULTS Overall, 66.8% of 18,752 residents received at least one CNS-active drug as classified by the Generic Product Identifier classification system. For those 65years and older, ASDs were prescribed for 14.3% residents. Gabapentin comprised 7.3%; valproate 3.0%; levetiracetam 1.8%; and phenytoin 0.9%. An antidepressant was used in 64.2% of persons prescribed an ASD. Antidepressant use varied for specific ASDs and ranged from 50 to 75%. An antipsychotic medication was used in 30% of persons prescribed an ASD and ranged from 16.8 to 54.2% for specific ASDs. Both antidepressant and antipsychotic use occurred in 22.2% of persons prescribed an ASD, respectively. SIGNIFICANCE The pattern of CNS-active drug use has changed from previous years in this geographic region. Use of phenytoin has declined markedly, but antidepressant use has increased substantially. The CNS side effect profile of these medications and the possible long-term consequences in this population can greatly complicate their therapy.
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Affiliation(s)
- Sai Praneeth R Bathena
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, United States
| | - Ilo E Leppik
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, United States; MINCEP Epilepsy Care, Minneapolis, MN, United States; Department of Neurology, School of Medicine, University of Minnesota, United States
| | - Andres M Kanner
- Department of Neurology, Miller School of Medicine, University of Miami, United States
| | - Angela K Birnbaum
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, United States.
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20
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Helvik AS, Šaltytė Benth J, Wu B, Engedal K, Selbæk G. Persistent use of psychotropic drugs in nursing home residents in Norway. BMC Geriatr 2017; 17:52. [PMID: 28193181 PMCID: PMC5307887 DOI: 10.1186/s12877-017-0440-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/02/2017] [Indexed: 08/23/2023] Open
Abstract
Background The prevalence of psychotropic drug (PTD) use in NH residents is high, but few have explored prevalence and persistency in PTD in NH residents and factors associated with persistency. This at the same time as we know that risk of side events may be higher with long- term use in older adults. Thus, the aim of this study was to describe the prevalence and persistence in use of PTD and to explore factors associated with persistence in use of PTD at two consecutive time points in nursing home (NH) residents. Methods We included 1163 NH residents in a 72-month longitudinal study with five assessments. Use of PTD, neuropsychiatric symptoms (NPS), severity of dementia and physical health were assessed each time. Results The prevalence over time and persistent use of antipsychotic drugs, antidepressants, anxiolytics and sedatives at two consecutive time points were high in residents with and without dementia. There was an association between greater NPS at the first time point, and persistent use of these drugs, but changes in NPS between time points, did not explain such use. A longer NH stay increased the odds for persistent use of antipsychotics. Conclusion Psychotropic drugs are frequently used as a long-term treatment among NH residents and are associated with severity of neuropsychiatric symptoms, but not with severity of dementia. Closer attention should be paid to follow-up of psychotropic drug treatment, and especially for long –term use of antipsychotics, since the duration of such treatment should be as short as possible.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postboks 8905, NO-7491, Trondheim, Norway. .,St Olavs University Hospital, Trondheim, Norway. .,Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway.
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NC, USA
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Bernal DR, Becker Herbst R, Lewis BL, Feibelman J. Ethical Care for Vulnerable Populations Receiving Psychotropic Treatment. ETHICS & BEHAVIOR 2016. [DOI: 10.1080/10508422.2016.1224187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Aspinall SL, Zhao X, Semla TP, Cunningham FE, Paquin AM, Pugh MJ, Schmader KE, Stone RA, Hanlon JT. Epidemiology of drug-disease interactions in older veteran nursing home residents. J Am Geriatr Soc 2014; 63:77-84. [PMID: 25537124 DOI: 10.1111/jgs.13197] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the prevalence of and factors associated with drug-disease interactions (DDIs) in older nursing home residents according to the American Geriatrics Society 2012 Beers Criteria. DESIGN Cross-sectional. SETTING Fifteen Veterans Affairs Community Living Centers. PARTICIPANTS Individuals aged 65 and older with a diagnosis of dementia or cognitive impairment, a history of falls or hip fracture, heart failure (HF), a history of peptic ulcer disease (PUD), or Stage IV or V chronic kidney disease (CKD). MEASUREMENTS Medications that could exacerbate the above conditions (DDIs). RESULTS Three hundred sixty-one of 696 (51.9%) eligible residents had one or more DDIs. None involved residents with a history of PUD, one involved a resident with CKD, and four occurred in residents with HF. Of 540 residents with dementia or cognitive impairment, 50.7% took a drug that could exacerbate these conditions; the most commonly involved medications were antipsychotics (35.4%) and benzodiazepines (14.4%). Of 267 with a history of falls or hip fracture, 67.8% received an interacting medication, with selective serotonin reuptake inhibitors (33.1%), antipsychotics (30.7%), and anticonvulsants (25.1%) being most commonly involved. Using separate multivariable logistic regression models, factors associated with DDIs in dementia or cognitive impairment and falls or fractures included age 85 and older (adjusted odds ratio (aOR) = 0.38, 95% confidence interval (CI) = 0.24-0.60 and aOR = 0.48, 95% CI = 0.24-0.96, respectively), taking five to eight medications (aOR = 2.06, 95% CI = 1.02-4.16 and aOR = 4.76, 95% CI = 1.68-13.5, respectively), taking nine or more medications (aOR = 1.99, 95% CI = 1.03-3.85 and aOR = 3.68, 95% CI = 1.41-9.61, respectively), and being a long-stay resident (aOR = 1.80, 95% CI = 1.04-3.12 and aOR = 2.35, 95% CI = 1.12-4.91, respectively). CONCLUSION DDIs were common in older nursing home residents with dementia or cognitive impairment or a history of falls or fractures.
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Affiliation(s)
- Sherrie L Aspinall
- Veterans Affairs Pharmacy Benefits Management Services, Hines, Illinois; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
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Rodriguez-Monguio R, Seoane-Vazquez E. Potentially inappropriate antipsychotic use in a nationally representative US nursing homes sample: a safety concern. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2014. [DOI: 10.1111/jphs.12074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rosa Rodriguez-Monguio
- School of Public Health and Health Sciences; University of Massachusetts, Amherst; Amherst MA USA
| | - Enrique Seoane-Vazquez
- International Center for Pharmaceutical Economics and Policy; Massachusetts College of Pharmacy and Health Sciences; Boston MA USA
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Wei YJ, Simoni-Wastila L, Zuckerman IH, Huang TYJ, Brandt N, Moyo P, Lucas JA. Quality of Psychopharmacological Medication Prescribing and Mortality in Medicare Beneficiaries in Nursing Homes. J Am Geriatr Soc 2014; 62:1490-504. [DOI: 10.1111/jgs.12939] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yu-Jung Wei
- Department of Pharmaceutical Health Services Research; School of Pharmacy; University of Maryland; Baltimore Maryland
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research; School of Pharmacy; University of Maryland; Baltimore Maryland
| | - Ilene H. Zuckerman
- Department of Pharmaceutical Health Services Research; School of Pharmacy; University of Maryland; Baltimore Maryland
| | - Ting-Ying J. Huang
- Department of Pharmaceutical Health Services Research; School of Pharmacy; University of Maryland; Baltimore Maryland
| | - Nicole Brandt
- Department of Pharmacy Practice and Science; School of Pharmacy; University of Maryland; Baltimore Maryland
| | - Patience Moyo
- Department of Pharmaceutical Health Services Research; School of Pharmacy; University of Maryland; Baltimore Maryland
| | - Judith A. Lucas
- Department of Behavioral and Community Health; College of Nursing; Seton Hall University South Orange; South Orange New Jersey
- Institute for Health; Health Care Policy and Aging Research; Rutgers University; New Brunswick New Jersey
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McKee BD, Larose-Pierre M, Rappa LR. A survey of community pharmacists and final-year student pharmacists and their perception of psychotherapeutic agents. J Pharm Pract 2013; 28:166-74. [PMID: 24346959 DOI: 10.1177/0897190013515709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The World Health Organization has estimated that as many as 450 million people worldwide have mental disorders. More than 44 million people in the United States have a mental disorder annually, estimating the annual direct costs of mental illness to exceed US$69 billion. Psychotherapeutic agents are used to treat mental illnesses and improve quality of life. The purpose of the study is to assess the knowledge and knowledge perception of community pharmacists and final-year student pharmacists regarding psychotherapeutic agents dispensed to their community of patients with mental illness. METHODS A survey was distributed to pharmacists and final-year student pharmacists regarding psychotherapeutic agents. RESULTS In all, 100 pharmacists and 40 final-year student pharmacists completed the survey. Upon analysis of surveys returned by pharmacists, knowledge deficiency was assessed regarding anxiolytics and mood stabilizers. The analysis of student participant surveys demonstrated knowledge deficiency regarding antidepressants and anxiolytics. CONCLUSIONS Final-year student pharmacists would benefit from the curricular incorporation of courses and advanced pharmacy practice experiences in Psychiatry. Community pharmacists caring for customers with psychiatric disorders should take advantage of continuing education series that highlight updates and new developments regarding psychotherapeutic agents in order to improve clinical outcomes of patients.
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Affiliation(s)
- Brian D McKee
- Pharmacy Department, Atlanta VA Medical Center, Decatur, GA, USA
| | | | - Leonard R Rappa
- Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Davie Instructional Site, Davie, FL, USA
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Bourgeois J, Elseviers MM, Van Bortel L, Petrovic M, Vander Stichele RH. The use of antidepressants in Belgian nursing homes: focus on indications and dosages in the PHEBE study. Drugs Aging 2013; 29:759-69. [PMID: 23018612 DOI: 10.1007/s40266-012-0003-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Since antidepressants are prescribed for multiple indications, the use of an antidepressant cannot be equated with a diagnosis of depression. OBJECTIVE The objective of this study was to examine the quality of antidepressant prescribing in Belgian nursing homes, with a critical evaluation of indications and dosages, to see whether depression was appropriately treated in terms of drug choice, the indications for which antidepressants were being prescribed and whether there was underdosing. METHODS This analysis was based on data obtained in the Prescribing in Homes for the Elderly in Belgium (PHEBE) study, a cross-sectional, descriptive study of a representative, stratified, random sample of 1,730 residents from 76 Belgian nursing homes. The PHEBE study investigated overall drug utilization in Belgian nursing homes in 2006. Clinical and medication data for the present study were obtained from this study. A 28-item checklist of clinical conditions was designed ad hoc for the PHEBE study and sent to the residents' general practitioners (GPs) to collect clinical information. We copied the residents' medication charts, classified the drugs using the Anatomical Therapeutic Chemical (ATC) classification system codes and transferred the drug names and dosages into a database. Information on indications was retrospectively obtained from the GPs, so that we could link the indication to each medication. Minimum effective doses (MEDs) of antidepressants to treat major depression were obtained from the literature to assess underdosing. RESULTS The overall use of antidepressants in nursing homes was 39.5 % (95 % CI 37.2, 41.8). The physicians classified 34.2 % (95 % CI 32.0, 36.4) of the residents as having depression, and 80.9 % of these patients were treated with an antidepressant. Indications among the single antidepressant users (n = 551) were depression (66.2 %), insomnia (13.4 %), anxiety (6.2 %) and neuropathic pain (1.6 %). In the indication of depression, 74.8 % used a selective serotonin reuptake inhibitor (SSRI), predominantly citalopram, sertraline and escitalopram. Venlafaxine was used by 10.7 % of the residents. Dosages for these antidepressants were equal to or higher than the MED. But when trazodone, amitriptyline or mirtazapine were used to treat depression, respectively, 92.3, 55.5 and 44.5 % of prescribed dosages were below the MED. In the indication of insomnia, most of the time, trazodone (90.5 %) or mirtazapine (5.4 %) were used, and in lower dosages than those required for depression treatment (<MED). Tricyclic antidepressants were predominantly used for the treatment of neuropathic pain and were also used at lower dosages. Of all the residents receiving a medication for anxiety, only 13.9 % received an antidepressant (mostly an SSRI), and the remaining received a benzodiazepine. CONCLUSIONS The number one indication for the use of an antidepressant was depression. Within this indication, mostly the recommended SSRIs were used, in dosages equal to or higher than the MED. Furthermore, we noticed that there was substantial use of sedative antidepressants for insomnia and that the physicians preferred to prescribe benzodiazepines over the recommended SSRIs to treat anxiety chronically.
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Morley JE. JAMDA Impact Factor. J Am Med Dir Assoc 2013; 14:629-31. [DOI: 10.1016/j.jamda.2013.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 07/03/2013] [Indexed: 01/10/2023]
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Brandt NJ, Pythtila J. Psychopharmacological medication use among older adults with dementia in nursing homes. J Gerontol Nurs 2013; 39:8-14. [PMID: 23616986 DOI: 10.3928/00989134-20130315-05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Historically, the use of psychopharmacological medications, such as antipsychotic, antidepressant, and anxiolytic agents, have been scrutinized due to concerns with safety and efficacy especially in older adults with dementia. Over the past year, the Centers for Medicare & Medicaid Services launched a national initiative to improve the behavioral health of older adults residing in America's nursing homes with a focus on reducing the inappropriate use of these medications to inform the practitioner of the importance of not just evaluating antipsychotic agents but all medications that an older person with dementia may be prescribed. This is critical due to the increased vulnerability of this population to adverse effects coupled with varying degrees of efficacy. Online national resources are also provided.
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Affiliation(s)
- Nicole J Brandt
- University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.
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Azermai M, Bourgeois J, Somers A, Petrovic M. Inappropriate use of psychotropic drugs in older individuals: implications for practice. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/ahe.13.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Frailty at old age and institutionalization in nursing homes are often associated with multiple chronic diseases (multimorbidity) requiring multiple medications (polypharmacy). Among these chronic conditions, mental health problems (e.g., dementia, depression and insomnia) are common. Psychotropic drugs are frequently used as a treatment approach for these conditions, and the prevalence of their use is high among community-dwelling older adults, but even higher in nursing homes. Furthermore, within the problem of polypharmacy and inappropriate prescribing, psychotropic drugs (defined in this article as antipsychotics, benzodiazepines and antidepressants) constitute a significant proportion. The use of psychotropics in older adults remains controversial given the risk of adverse effects, in contrast to the limited effectiveness. Guidelines advise a thorough risk–benefit analysis before the initiation of psychotropics, in addition to time-limited use and discontinuation. In the future, serious efforts should be undertaken to tackle the burden of inappropriate psychotropic prescribing in older adults by incorporating a multidisciplinary approach and by offering credible alternatives.
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Affiliation(s)
- Majda Azermai
- Heymans Institute of Pharmacology, Division of Clinical Pharmacology, Ghent University, De Pintelaan 185 (1 Blok B), 9000 Gent, Belgium.
| | - Jolyce Bourgeois
- Heymans Institute of Pharmacology, Division of Clinical Pharmacology, Ghent University, De Pintelaan 185 (1 Blok B), 9000 Gent, Belgium
| | - Annemie Somers
- Department of Pharmacy, Ghent University Hospital, Gent, Belgium
| | - Mirko Petrovic
- Heymans Institute of Pharmacology, Division of Clinical Pharmacology, Ghent University, De Pintelaan 185 (1 Blok B), 9000 Gent, Belgium
- Department of Geriatrics, Ghent University Hospital, Gent, Belgium
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Galik E, Resnick B. Psychotropic medication use and association with physical and psychosocial outcomes in nursing home residents. J Psychiatr Ment Health Nurs 2013; 20:244-52. [PMID: 22500725 DOI: 10.1111/j.1365-2850.2012.01911.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Psychotropic medications are commonly prescribed for older adults living in long-term care settings. Use of these medications has been associated with negative functional outcomes. The purpose of this study was to describe the prevalence of psychotropic medication use among nursing home residents, and to explore the relationship of psychotropic medication use on physical and psychosocial outcomes. A secondary data analysis was done using baseline measures from the Res-Care Intervention Study. The sample included 419 residents from 12 nursing homes. There were 288 participants (69%) who were prescribed at least one psychotropic medication, with 81 participants (19%) receiving antipsychotics, 248 (59%) receiving antidepressants, 50 (12%) receiving anxiolytics and 37 (9%) receiving sedative/hypnotics. Controlling for gender, age and cognition, physical outcomes were significantly lower in residents receiving psychotropic medications (F= 3.2, P= 0.01) compared to those not receiving psychotropic medications. Psychosocial outcomes were significantly lower in those residents receiving psychotropic mediations (F= 2.0, P= 0.04). The findings from this study provide additional support for the prevalence of psychotropic medication use among nursing home residents and suggest that residents receiving psychotropic medications may be less likely to engage in functional activities and experience decreased quality of life.
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Affiliation(s)
- E Galik
- University of Maryland School of Nursing, Baltimore, MD 21201, USA.
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Echt MA, Samelson EJ, Hannan MT, Dufour AB, Berry SD. Psychotropic drug initiation or increased dosage and the acute risk of falls: a prospective cohort study of nursing home residents. BMC Geriatr 2013; 13:19. [PMID: 23432790 PMCID: PMC3606594 DOI: 10.1186/1471-2318-13-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 02/20/2013] [Indexed: 12/03/2022] Open
Abstract
Background Previous studies suggest that psychotropic drug changes may signal an acute period of time whereby a person is highly vulnerable to fall. It is unknown whether certain classes of psychotropic agents are less safe with respect to the acute risk of falls. Our purpose was to compare fall rates in the 7 days following a change of an antidepressant, antipsychotic, or benzodiazepine. We also identified specific times when residents are at high risk for falls with respect to a psychotropic drug change. Methods Residents in our one-year study included 851 long term care residents from two nursing home facilities in Boston, MA, U.S.A. (May 2010 - May 2011). Drug changes (i.e., new prescriptions or increased dose of a previously used drug) were ascertained using the computerized provider order entry system, whereas falls were ascertained by incident reports. Negative binomial regression was used to compare the rate of falls following a drug change between medication classes. Further, we calculated the rate of falls for each of the 7 days before and 7 days after a psychotropic drug change. Results Forty-eight percent of residents were prescribed a new prescription or increased dose of a psychotropic drug during the study. The rate of falls was similar in the 7 days following a change to a SSRI versus non-SSRI antidepressant (11.9 versus 14.4 falls/1,000 person years; p = 0.58), a typical versus an atypical antipsychotic (25.4 versus 17.1 falls/1,000 person years; p = 0.10), or a short versus long acting benzodiazepine (15.2 versus 13.9 falls/1,000 person years; p = 0.23). Fall risk was highest on day 4 before the drug change (19.0 falls/1,000 person days), on the day of the drug change through 2 days after the drug change (17.6-20.3 falls/1,000 person days), and 5-6 days after the drug change (17.6-19.0 falls/1,000 person days). Conclusions In the nursing home, risk of falls was similar following a psychotropic drug change of any class. We observed higher fall risk in the days before, but mostly after the drug change. We recommend that nursing home residents be closely monitored following a psychotropic drug change in an effort to reduce falls.
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Affiliation(s)
- Murray A Echt
- Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131, USA
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Cestac P, Tavassoli N, Vellas B, Rolland Y. Improving Medication Use in the Nursing Homes: A European Perspective. J Am Med Dir Assoc 2013; 14:6-9. [DOI: 10.1016/j.jamda.2012.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 09/11/2012] [Indexed: 11/26/2022]
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The incidence of depression and its risk factors in Dutch nursing homes and residential care homes. Am J Geriatr Psychiatry 2012; 20:932-42. [PMID: 22828203 DOI: 10.1097/jgp.0b013e31825d08ac] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Although it is known that depression is highly prevalent in institutionalized older adults, little is known about its incidence and risk factors in nursing homes and residential care homes. The aim of this study was to investigate and compare the incidence and associated risk factors for depression in Dutch nursing homes and residential care homes. DESIGN Data on depression were extracted from the Vrije Universiteit naturalistic cohort on routine care monitoring with the Minimum Data Set of the Resident Assessment Instrument. PARTICIPANTS A total of 1,324 residents in six nursing homes and 1,723 residents in 23 residential care homes with an average follow-up of 1.2 years. MEASUREMENTS Depression was defined as a clinical diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and the use of antidepressants. Residents with prevalent depression at baseline were excluded. RESULTS The incidence rate was 13.6 per 100 person years in the nursing homes and 10.2 per 100 person years in the residential care homes. The independent risk factors for in-home depression for residents in nursing homes included dementia (OR: 1.7; 95% CI: 1.02-2.95) and a score of 3 or more on the Depression Rating Scale (odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.23-3.70). A protective effect was seen on the use of a hearing aid (OR: 0.3; 95% CI: 0.12-0.80). In the residential care homes, being male (OR: 2.1; 95% CI: 1.27-3.30), having cancer (OR: 2.9; 95% CI: 1.64-4.95), and a score of 2 or higher on the Cognitive Performance Scale (OR: 1.5; 95% CI: 1.05-2.22) increased the risk to develop depression. Age greater than 85 years (OR: 0.5; 95% CI: 0.31-0.67) and hearing impairment (OR: 0.8; 95% CI: 0.60-1.00) appeared to be protective. CONCLUSIONS The incidence rate for depression in residents of Dutch nursing homes and residential care homes was high and the associated risk factors found may have important implications for staff.
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Messinger-Rapport BJ, Cruz-Oliver DM, Thomas DR, Morley JE. Clinical Update on Nursing Home Medicine: 2012. J Am Med Dir Assoc 2012; 13:581-94. [DOI: 10.1016/j.jamda.2012.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 01/24/2023]
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Antipsychotics Do Not Have To Be Used “Off Label” in Dementia. J Am Med Dir Assoc 2012; 13:495-6. [DOI: 10.1016/j.jamda.2012.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 04/12/2012] [Accepted: 04/12/2012] [Indexed: 11/20/2022]
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Rolland Y, Andrieu S, Crochard A, Goni S, Hein C, Vellas B. Psychotropic Drug Consumption at Admission and Discharge of Nursing Home Residents. J Am Med Dir Assoc 2012; 13:407.e7-12. [DOI: 10.1016/j.jamda.2011.12.056] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 12/09/2011] [Accepted: 12/15/2011] [Indexed: 10/14/2022]
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Boyce RD, Handler SM, Karp JF, Hanlon JT. Age-related changes in antidepressant pharmacokinetics and potential drug-drug interactions: a comparison of evidence-based literature and package insert information. ACTA ACUST UNITED AC 2012; 10:139-50. [PMID: 22285509 DOI: 10.1016/j.amjopharm.2012.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 12/27/2011] [Accepted: 01/03/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Antidepressants are among the most commonly prescribed psychotropic agents for older patients. Little is known about the best source of pharmacotherapy information to consult about key factors necessary to safely prescribe these medications to older patients. OBJECTIVE The objective of this study was to synthesize and contrast information in the package insert (PI) with information found in the scientific literature about age-related changes of antidepressants in systemic clearance and potential pharmacokinetic drug-drug interactions (DDIs). METHODS A comprehensive search of two databases (MEDLINE and EMBASE from January 1, 1975 to September 30, 2011) with the use of a combination of search terms (antidepressants, pharmacokinetics, and drug interactions) was conducted to identify relevant English language articles. This information was independently reviewed by two researchers and synthesized into tables. These same two researchers examined the most up-to-date PIs for the 26 agents available at the time of the study to abstract quantitative information about age-related decline in systemic clearance and potential DDIs. The agreement between the two information sources was tested with κ statistics. RESULTS The literature reported age-related clearance changes for 13 antidepressants, whereas the PIs only had evidence about 4 antidepressants (κ < 0.4). Similarly, the literature identified 45 medications that could potentially interact with a specific antidepressant, whereas the PIs only provided evidence about 12 potential medication-antidepressant DDIs (κ < 0.4). CONCLUSION The evidence-based literature compared with PIs is the most complete pharmacotherapy information source about both age-related clearance changes and pharmacokinetic DDIs with antidepressants. Future rigorously designed observational studies are needed to examine the combined risk of antidepressants with age-related decline in clearance and potential DDIs on important health outcomes such as falls and fractures in older patients.
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Affiliation(s)
- Richard D Boyce
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Morley JE. Anemia in the nursing homes: a complex issue. J Am Med Dir Assoc 2012; 13:191-4. [PMID: 22261540 DOI: 10.1016/j.jamda.2011.12.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 12/20/2011] [Indexed: 01/17/2023]
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Geriatric Principles: Evidence-Based Medicine at Its Best. J Am Med Dir Assoc 2012; 13:1-2.e1-2. [DOI: 10.1016/j.jamda.2011.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 10/14/2011] [Indexed: 11/20/2022]
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Conti R, Busch AB, Cutler DM. Overuse of antidepressants in a nationally representative adult patient population in 2005. PSYCHIATRIC SERVICES (WASHINGTON, D.C.) 2011. [PMID: 21724783 DOI: 10.1176/appi.ps.62.7.720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Concerns have been raised that antidepressants may be overused. This study aimed to provide an estimate of antidepressant overuse in a more recent, nationally representative sample of adults and with a more contemporary set of antidepressants than has been covered in prior studies. METHODS The data set included adult (weighted N=23,026,608) respondents who self-reported antidepressant treatment in the household and prescription drug components of the 2005 Medical Expenditure Panel Survey. Overuse was defined as off-label antidepressant prescribing with limited or no scientific support for use as a treatment for the diagnosis, according to the Physicians' Desk Reference, the United States Pharmacopeia-National Formulary, and the Micromedex DrugDx data system. Stratification and multivariate logistic regression was used to examine clinical and socioeconomic predictors of overuse. RESULTS Overuse was estimated at 20%, with the majority concentrated in newer-generation antidepressants (74% of overuse). Another 30%-40% of overuse was associated with documented diagnoses that may represent a reasonable clinical rationale for antidepressant use or suggest underdiagnosis of possible depressive and anxiety syndromes. Older age (odds ratio [OR]=.95, p=.03) and self-report of poor mental health (OR=.80, p=.02) were negatively associated with overuse. CONCLUSIONS Antidepressant overuse among adults is less common than previously reported. Our results suggest that the actual extent of overuse may be lower than 20%. To improve treatment quality and the efficiency of the U.S. health care system, nationally representative data collection efforts on prescription drug use should aim to include enhanced measures of need in order to further refine future estimates of antidepressant overuse.
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Affiliation(s)
- Rena Conti
- Department of Pediatrics and the Center for Health and the Social Sciences, University of Chicago, 5481 S. Maryland Ave., Chicago, IL 60610, USA.
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Karkare SU, Bhattacharjee S, Kamble P, Aparasu R. Prevalence and predictors of antidepressant prescribing in nursing home residents in the United States. ACTA ACUST UNITED AC 2011; 9:109-19. [PMID: 21565710 DOI: 10.1016/j.amjopharm.2011.03.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Late-life depression is a common psychiatric disorder associated with increased morbidity and mortality. Depression is often under-detected and undertreated in elderly nursing home residents. OBJECTIVES The aim of this study was to examine the prevalence of antidepressant drug use and to identify the factors associated with its use among elderly nursing home residents. METHODS The study involved the analysis of a nationally representative sample of prescription and resident files from the 2004 National Nursing Home Survey (NNHS). The study sample included all elderly nursing home residents ≥65 years of age. The analysis focused on prescribing from any antidepressant class, including selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), serotonin modulators, serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and others. Descriptive weighted analysis was performed to examine antidepressant use prevalence patterns in elderly nursing home residents. Multiple logistic regression analysis within the conceptual framework of Anderson's behavioral model was used to examine the predisposing, enabling, and need characteristics associated with antidepressant use. RESULTS According to the 2004 NNHS, overall prevalence of antidepressant use among elderly nursing home residents was 46.22% (95% CI, 45.16-47.27). Most antidepressant users were ≥85 years of age (49.7%), female (75.7%), non-Hispanic (96.4%), and white (91.1%). The most prescribed class of antidepressants was SSRIs (31.09%; 95% CI, 30.12-32.07), followed by serotonin modulators (4.65%; 95% CI, 4.22-5.09), SNRIs (2.78%; 95% CI, 2.45-3.12), TCAs (2.34%; 95% CI, 2.03-2.65), and MAOIs (0.01%; 95% CI, 0.00-0.03). Citalopram (12.92%; 95% CI, 12.21-13.63) was the most prescribed individual antidepressant, followed by mirtazapine (10.19%; 95% CI, 9.55-10.84). Among the predisposing characteristics, age, race, and marital status were significantly associated with antidepressant use. The odds of receiving an antidepressant were lower for those aged ≥85 years and those who were unmarried elderly residents, when compared with their counterparts; whites were more likely to receive an antidepressant than nonwhites. Enabling factors such as Medicaid and bed capacity significantly predicted antidepressant use. Having Medicaid was positively associated with antidepressant prescription, whereas an increase in the total number of beds decreased the probability of an antidepressant prescription. Among need characteristics, the likelihood of antidepressant prescription use decreased with increased dependence in decision-making ability and out-of-bed mobility. The presence of depressed mood indicators and a history of falls/fractures increased the likelihood of antidepressant prescription use. The odds of receiving an antidepressant increased with diagnosis of depression but decreased with diagnosis of anxiety. CONCLUSION Nearly half of elderly nursing home residents received antidepressants. In addition to need factors, predisposing and enabling factors played an important role in influencing the use of antidepressants in elderly nursing home residents.
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Affiliation(s)
- Swapna U Karkare
- Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Texas Medical Center
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Hanlon JT, Wang X, Castle NG, Stone RA, Handler SM, Semla TP, Pugh MJ, Berlowitz DR, Dysken MW. Potential underuse, overuse, and inappropriate use of antidepressants in older veteran nursing home residents. J Am Geriatr Soc 2011; 59:1412-20. [PMID: 21824120 DOI: 10.1111/j.1532-5415.2011.03522.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To examine prevalence and resident- and site-level factors associated with potential underuse, overuse, and inappropriate use of antidepressants in older Veterans Affairs (VA) Community Living Center (CLC) residents. DESIGN Longitudinal study. SETTING One hundred thirty-three VA CLCs. PARTICIPANTS Three thousand six hundred ninety-two veterans aged 65 and older admitted between January 1, 2004, and June 3, 2005, with long stays (≥ 90 days). MEASUREMENTS Prevalence of potential underuse, inappropriate use, and overuse of antidepressants in residents with and without depression (as documented according to International Classification of Diseases, Ninth Revision, Clinical Modification, codes or Depression Rating Scale). RESULTS Selective serotonin reuptake inhibitors were the most commonly prescribed antidepressant. Of the 877 residents with depression, 25.4% did not receive an antidepressant, suggesting potential underuse. Of residents with depression who received antidepressants, 57.5% had potential inappropriate use due primarily to problems seen with drug-drug and drug-disease interactions. Of the 2,815 residents who did not have depression, 1,190 (42.3%) were prescribed one or more antidepressants; only 48 (4.0%) of these had a Food and Drug Administration-approved labeled indication, suggesting potential overuse. Overall, only 17.6% of antidepressant use was appropriate (324/1,844). The only consistent resident factor associated with potential underuse and overuse use was taking an antipsychotic without evidence of schizophrenia (underuse: adjusted relative risk ratio (ARRR)=0.56, 95% confidence interval (CI)=0.33-0.94; overuse: adjusted odds ratio=1.52, 95% CI=1.21-1.91). Having moderate to severe pain (ARRR=1.54, 95% CI=1.08-2.20) and the prescribing of an anxiolytic or hypnotic (ARRR=1.33, 95% CI=1.02-1.74) increased the risk of potential inappropriate antidepressant use. CONCLUSION Potential problems with the use of antidepressants were frequently observed in older U.S. veteran CLC residents. Future studies are needed to examine the true risks and benefits of antidepressant use in CLC and non-VA nursing homes.
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Affiliation(s)
- Joseph T Hanlon
- Geriatric Research, Education and Clinical Center, and Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania, USA.
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Berry SD, Zhang Y, Lipsitz LA, Mittleman MA, Solomon DH, Kiel DP. Antidepressant prescriptions: an acute window for falls in the nursing home. J Gerontol A Biol Sci Med Sci 2011; 66:1124-30. [PMID: 21764842 DOI: 10.1093/gerona/glr113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although many studies have implicated antidepressants as a risk factor for falls, it is not clear if risk accrues with duration of use or if there are acute risks associated with initiation of the prescription. We conducted a case-crossover study of nursing home residents with a fall to determine the effect of an antidepressant change (defined as the new prescription of an antidepressant or increasing the dose of a previously used antidepressant) on fall risk. METHODS Among 1,181 nursing home fallers, we compared the frequency of antidepressant changes during the hazard period (1-7 days before the fall) with the frequency of antidepressant changes during the control period (8-14 days before the fall). Odds ratios were estimated using conditional logistic regression models. Results were estimated for non-selective serotonin reuptake inhibitors (SSRI) and SSRI prescriptions, separately. RESULTS Mean age was 88 years, and 71% were females. Seventy participants experienced an antidepressant change during the hazard and/or control periods. The maximum effect of falling occurred within 2 days of a non-SSRI change (odds ratio: 4.7, 95% confidence interval, 1.3-16.2). The effect on falling was no longer significant at 5 days (odds ratio: 1.9, 95% confidence interval, 0.9-4.0). No association was found between SSRI changes and falls. CONCLUSIONS Nursing home residents are at high risk of falls during the days following a new prescription or increased dose of a non-SSRI antidepressant. Increased surveillance should occur, particularly during the first 48 hours, in an effort to decrease falls.
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Affiliation(s)
- Sarah D Berry
- Hebrew Rehabilitation Center, IFAR, 1200 Centre Street, Boston, MA 02131, USA.
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Conti R, Busch AB, Cutler DM. Overuse of antidepressants in a nationally representative adult patient population in 2005. Psychiatr Serv 2011; 62:720-6. [PMID: 21724783 PMCID: PMC4594842 DOI: 10.1176/ps.62.7.pss6207_0720] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Concerns have been raised that antidepressants may be overused. This study aimed to provide an estimate of antidepressant overuse in a more recent, nationally representative sample of adults and with a more contemporary set of antidepressants than has been covered in prior studies. METHODS The data set included adult (weighted N=23,026,608) respondents who self-reported antidepressant treatment in the household and prescription drug components of the 2005 Medical Expenditure Panel Survey. Overuse was defined as off-label antidepressant prescribing with limited or no scientific support for use as a treatment for the diagnosis, according to the Physicians' Desk Reference, the United States Pharmacopeia-National Formulary, and the Micromedex DrugDx data system. Stratification and multivariate logistic regression was used to examine clinical and socioeconomic predictors of overuse. RESULTS Overuse was estimated at 20%, with the majority concentrated in newer-generation antidepressants (74% of overuse). Another 30%-40% of overuse was associated with documented diagnoses that may represent a reasonable clinical rationale for antidepressant use or suggest underdiagnosis of possible depressive and anxiety syndromes. Older age (odds ratio [OR]=.95, p=.03) and self-report of poor mental health (OR=.80, p=.02) were negatively associated with overuse. CONCLUSIONS Antidepressant overuse among adults is less common than previously reported. Our results suggest that the actual extent of overuse may be lower than 20%. To improve treatment quality and the efficiency of the U.S. health care system, nationally representative data collection efforts on prescription drug use should aim to include enhanced measures of need in order to further refine future estimates of antidepressant overuse.
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Affiliation(s)
- Rena Conti
- Department of Pediatrics and the Center for Health and the Social Sciences, University of Chicago, 5481 S. Maryland Ave., Chicago, IL 60610, USA.
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Gaboda D, Lucas J, Siegel M, Kalay E, Crystal S. No longer undertreated? Depression diagnosis and antidepressant therapy in elderly long-stay nursing home residents, 1999 to 2007. J Am Geriatr Soc 2011; 59:673-80. [PMID: 21410441 DOI: 10.1111/j.1532-5415.2011.03322.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the evolution of depression identification and use of antidepressants in elderly long-stay nursing home residents from 1999 through 2007 and the associated sociodemographic and facility characteristics. DESIGN Annual cross-sectional analysis of merged resident assessment data from the Minimum Data Set (MDS) and facility characteristics from the Online Survey Certification and Reporting data. SETTING Nursing homes in eight states (5,445 facilities). PARTICIPANTS Long-stay nursing home residents aged 65 and older (2,564,687 assessments). MEASUREMENTS Physician-documented depression diagnoses recorded in the MDS were used to identify residents with depression; antidepressant use was measured using MDS information about residents' receipt of an antidepressant in the 7 days before assessment. RESULTS Diagnosis of depression and antidepressant therapy in residents diagnosed increased at a rapid rate. By 2007, 51.8% of residents were diagnosed with depression, 82.8% of whom received an antidepressant. Adjusted odds of treatment were higher for younger residents, whites, and those with moderate impairment of cognitive function. CONCLUSION This study demonstrates striking increases in depression diagnosis and treatment with antidepressant medications, but disparities persist without clear evidence about underlying mechanisms. More research is needed to assess effectiveness of antidepressant prescribing.
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Affiliation(s)
- Dorothy Gaboda
- Center for State Health Policy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey.
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Harris T, Carey IM, Shah SM, DeWilde S, Cook DG. Antidepressant prescribing in older primary care patients in community and care home settings in England and Wales. J Am Med Dir Assoc 2010; 13:41-7. [PMID: 21450211 DOI: 10.1016/j.jamda.2010.09.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Revised: 09/16/2010] [Accepted: 09/16/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the prevalence and predictors of antidepressant prescribing in older care home and community residents in England and Wales. DESIGN Retrospective analysis of primary care consultation and antidepressant prescribing data. SETTING The setting included 326 general (family) practices in England and Wales supplying data to The Health Improvement Network database between 2008 and 2009. PARTICIPANTS Participants were 10,387 care home and 403,259 community residents aged 65 to 104. MAIN OUTCOME MEASURE Antidepressant prescription in the last 3 months of recorded data for each patient. RESULTS Prevalence rates for antidepressant prescribing were 10.3% (95% confidence interval 10%-10.6%) for community and 37.5% (36.2%-38.9%) for care home residents. After excluding low-dose tricyclics (often used for other indications) prevalences were 7.3% (7.1%-7.5%) and 33.6% (32.3%-34.9%) respectively; of these, 21.7% (20.8%-22.6%) of community and 4.8% (3.9%-5.6%) of care home prescriptions were for antidepressants advised as best avoided in this age group. After indirect standardization for age, sex, and chronic disease prevalence, the ratio for prescribing was 2.4 (2.3-2.5) in care homes compared with the community; 28.3% (26.6%-30.1%) of community and 42.5% (39.4%-45.7%) of care home residents prescribed antidepressants had no appropriate recorded indication. CONCLUSIONS This national sample confirms the high prevalence of antidepressant prescribing to older people, particularly in care homes, frequently without a documented indication. The strong association found between chronic disease and antidepressant prescribing did not explain the higher care home prescribing rate. Widespread community use of nonrecommended antidepressants is also a concern.
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Affiliation(s)
- Tess Harris
- Division of Population Health Sciences & Education, St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK.
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Taipale HT, Hartikainen S, Bell JS. A comparison of four methods to quantify the cumulative effect of taking multiple drugs with sedative properties. ACTA ACUST UNITED AC 2010; 8:460-71. [DOI: 10.1016/j.amjopharm.2010.10.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2010] [Indexed: 01/22/2023]
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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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