The Negative Impact of Psychotropic Drug Use on Quality of Life in Nursing Home Patients at Different Stages of Dementia: Cross-Sectional Analyses from the COSMOS Trial

2020 ◽  
Vol 21 (11) ◽  
pp. 1623-1628
Author(s):  
Erika Ito ◽  
Line Iden Berge ◽  
Bettina S. Husebo ◽  
Rui Nouchi ◽  
Reidun K.N.M. Sandvik
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Negative Impact ◽  
Cross Sectional ◽  
Psychotropic Drug Use ◽  
Nursing Home Patients

Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-study

2016 ◽  
Vol 28 (10) ◽  
pp. 1589-1595 ◽  
Author(s):  
Klaas van der Spek ◽  
Debby L. Gerritsen ◽  
Martin Smalbrugge ◽  
Marjorie H. J. M. G. Nelissen-Vrancken ◽  
Roland B. Wetzels ◽  
...  
Keyword(s):  
Nursing Home ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Neuropsychiatric Symptoms ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
Psychotropic Drug Use ◽  
Nursing Home Patients ◽  
Sum Score

ABSTRACTBackground:This study explores the appropriateness of psychotropic drug (PD) use for neuropsychiatric symptoms (NPS) in nursing home patients with dementia.Methods:A cross-sectional study on 559 patients with dementia residing on dementia special care units in Dutch nursing homes was conducted. Appropriateness of PD use was assessed using the Appropriate Psychotropic drug use In Dementia (APID) index. The APID index score is calculated using information about individual PDs from patients’ medical records. The index encompasses seven (different) domains of appropriateness, i.e. indication, evaluation, dosage, drug-drug interactions, drug-disease interactions, duplications, and therapy duration.Results:A total of 578 PDs were used for NPS by 60% of the nursing home patients. Indication, evaluation, and therapy duration contributed the most to inappropriate use. Ten per cent of the PDs scored fully appropriate according to the APID index sum score, 36% scored fully appropriate for indication, 46% scored fully appropriate for evaluation, and 58% scored fully appropriate for therapy duration. Antidepressants were used the most appropriately, and antiepileptics the most inappropriately.Conclusions:The minority of the PD use was fully appropriate. The results imply that PD use for NPS in dementia can be improved; the appropriateness should be optimized with a clinical focus on the appropriate indications, evaluations, and therapy duration.

scholarly journals Prevalence and correlates of psychotropic drug use in Dutch nursing home patients with young‐onset dementia

2019 ◽  
Vol 34 (8) ◽  
pp. 1185-1193 ◽  
Author(s):  
Ans J.M.J. Mulders ◽  
Sytse U. Zuidema ◽  
Renée Leeuwis ◽  
Hans Bor ◽  
Frans R.J. Verhey ◽  
...  
Keyword(s):  
Nursing Home ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Young Onset ◽  
Psychotropic Drug Use ◽  
Nursing Home Patients ◽  
Young Onset Dementia

scholarly journals Psychotropic drug use in a group of Dutch nursing home patients with dementia: many users, long-term use, but low doses

1996 ◽  
Vol 18 (1) ◽  
pp. 42-47 ◽  
Author(s):  
R. T. C. M. Koopmans ◽  
M. A. J. H. Willekens-Bogaers ◽  
J. M. Rossum ◽  
H. J. M. Hoogen ◽  
C. Weel ◽  
...  
Keyword(s):  
Nursing Home ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Low Doses ◽  
Psychotropic Drug Use ◽  
Nursing Home Patients

scholarly journals 201 - Behavioral and Psychological Symptoms of Dementia: a symposium of the IPA BPSD Shared Interest Forum

2020 ◽  
Vol 32 (S1) ◽  
pp. 27-28
Keyword(s):  
Quality Of Life ◽  
Drug Use ◽  
Nursing Homes ◽  
Receptor Antagonist ◽  
Psychotropic Drug ◽  
Psychotropic Drugs ◽  
Psychosocial Interventions ◽  
Antipsychotic Agents ◽  
Psychotropic Drug Use

Section A. Psychotropic drug use (20 minutes)1) Sytse Zuidema: The RID (Reduction of inappropriate psychotropic drugs in dementia) study Nursing home residents with dementia and neuropsychiatric symptoms are prescribed psychotropic drugs too often and also sometimes inappropriate. Multidisciplinary interventions can help to facilitate better care by using psychosocial interventions and help to decrease inappropriate psychotropic drug use. We supported implementation of such interventions through participatory action research, to facilitate nursing homes to design, and implement their own local interventions. The results of the RCT (including a process evaluation) will be presented.2) Tzung-Jeng Hwang: dextromethorphan for treating agitationAgitation is highly prevalent in patients with dementia and associated with significant impairment of quality of life, early institutionalization, and higher mortality. Although no pharmacotherapy has been approved by the US FDA for dementia patients with agitation, off-label use of antipsychotic agents is common. But antipsychotic agents are clearly associated with increased adverse effects, including stroke and death. Dextromethorphan (DXM) is a low-affinity uncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, a high-affinity sigma-1 receptor agonist, a serotonin and norepinephrine reuptake inhibitor, and a nicotinicα3β4 receptor antagonist. The combination of DXM and low dose quinidine (Q) has been approved for the treatment of pseudobulbar affect in 2010. A recent study found that DXM/Q may be effective for the management of agitation in patients with Alzheimer disease (AD). In this talk, a pilot study on using DXM alone to treat agitation in dementia will be reported. Overall, the use of DXM 60-240 mg/day resulted in a high proportion of improvement (CGI-agitation: 69% much improved, 25% minimally improved). No severe adverse events were found. The results support DXM may be efficacious and safe.3) Marie Andree Bruneau: OPUS-APOPUS-AP aims at improving resident care through increased staff’s knowledge and competency, resident-centered approaches, nonpharmacologic interventions, and antipsychotic deprescribing in inappropriate indications. OPUS-AP is implemented through integrated knowledge translation and mobilization activities. Antipsychotic, benzodiazepine, antidepressant prescriptions and BPSD were evaluated every 3 months for 9 months. Phase 2 of OPUS-AP was conducted in 129 LTC centres in Quebec, Canada, from April to December 2019. At baseline (April 2019), 10,601 residents were admitted on OPUS-AP participating wards from which 74% had a diagnosis of major neurocognitive disorder (MNCD) and 47% an antipsychotic prescription. The follow-up cohort included 4,087 residents with both MNCD and antipsychotic prescription. Among the 1381 residents in whom antipsychotic deprescribing was attempted between baseline and 9 months and still included at 9 months, successful deprescribing was achieved in 79,2% (cessation 44,8% or dose decrease 34,5%)). No increase in benzodiazepine or antidepressant prescriptions nor worsening of BPSD were observed.Section B. Updates on BPSD (20 minutes)1) Kathrin Schmuedderich: Severe agitation and quality of lifeA secondary data analysis was performed on the relationships between the severity of agitation (NPI-Q) and the single dimensions of quality of life (QUALIDEM) in people with dementia living in German nursing homes. In order to determine the differences between people with severe agitation and the group of people with mild or no agitation, a matching method and regression analyses were used. The findings show that severe agitation is related to lower quality of life in five out of six dimensions of quality of life.2) Wai-chi Chan: BPSD as a predictor of cognitive declineDescription will follow3) Huali Wang: Challenging behavior in ChinaDescription will followSection C. Measurement of BPSD (25 minutes)1) Wendy Moyle: Measurement of agitationThis presentation demonstrates how the use of video observation/coding, standardised measures of agitation (CMAI-SF), and physiological measures (actigraphy) produced different outcome results related to agitated behaviours following the introduction of a social robot. When measuring agitation, we need to consider using different types of measures to ensure data reliability and validity and longitudinal research methods to identify efficacy of psychosocial interventions and effective measurement of agitation when using social robots.2) Discussion on measurement of agitation, discussing and making plans for datasharing based on a template for datastructuresSection D. ECT (15 minutes)1) Rob Kok: short intro on ECT in BPSDThe majority of patients with dementia develop agitation or aggression in the course of their disease. In some severe cases, pharmacological and other interventions are not effective in improving these symptoms. A recent systematic review suggested that electroconvulsive therapy (ECT) could be an effective treatment for severe and treatment-refractory agitation and aggression in dementia, with few adverse consequences. We need to have controlled studies, address the stigma of ECT and develop professional guidelines for the application of ECT for agitation and aggression in dementia, particularly because most patients are not able to provide informed consent.2) Discussion and making plan for international survey on application of ECT in BPSD

scholarly journals Frailty decreases physical health domain of quality of life in nursing home elderly

2016 ◽  
Vol 34 (3) ◽  
pp. 213 ◽  
Author(s):  
Yvonne Suzy Handajani ◽  
Nelly Tina Widjaja ◽  
Yuda Turana
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Physical Health ◽  
Psychological Health ◽  
Negative Impact ◽  
Frailty Syndrome ◽  
Cross Sectional ◽  
Health Domain ◽  
Physical Health Domain

BACKGROUND <br />Approximately 10-27% of the population aged &gt;65 years suffers from frailty. The percentage increases with age so that the prevalence of frailty in the population aged &gt;85 years reaches 45%. The objective of this study was to determine the relationship between   frailty and quality of life (QOL) in nursing home elderly. <br /><br />METHODS <br />This was a cross-sectional study of 138 subjects aged &gt;60 years who were recruited from 4 nursing homes in West Jakarta. Participants with frailty status were evaluated by the Survey of Health, Ageing and Retirement in Europe (SHARE) instrument and QOL was evaluated by the WHOQOL-BREF questionnaire. One-way ANOVA and chi-square tests were used to find relations between the frailty syndrome and QOL. <br /><br />RESULTS<br />The percentages of respondents with pre-frail, frail, and non-frail status were 30.4%, 52.2%, and 17.4%, respectively. A decline in QOL scores of pre-frail and frail respondents was found for almost all QOL domains (physical, psychological and environment domains), except social relationships. The subdomains most influenced were “energy and fatigue” in the physical health domain, “thinking, learning, memory and concentration” in psychological health, and “opportunities for acquiring new information and skills” in the environment domain.<br /><br />CONCLUSIONS <br />More than half of the nursing home elderly were frail and one-third were pre-frail. The main factor of frailty was weakness. The frailty syndrome in the elderly has a negative impact on QOL, especially in the physical health, psychological and environment domains in nursing home elderly.<br /><br />

Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia

2009 ◽  
Vol 21 (03) ◽  
pp. 485 ◽  
Author(s):  
Renate M. Nijk ◽  
Sytse U. Zuidema ◽  
Raymond T. C. M. Koopmans
Keyword(s):  
Nursing Home ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Psychotropic Drug Use ◽  
Nursing Home Patients

Quality of Life in People Living With HIV: An Exploratory Cross-Sectional Survey in Belgium

2021 ◽  
Vol 33 (3) ◽  
pp. 249-264
Author(s):  
Gert Scheerder ◽  
Sandra Van den Eynde ◽  
Patrick Reyntiens ◽  
Ria Koeck ◽  
Jessika Deblonde ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Negative Impact ◽  
Sexual Life ◽  
People Living With Hiv ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Related Stigma ◽  
Living With Hiv ◽  
The Impact

This cross-sectional survey explored the quality of life in 505 people living with HIV in Belgium. Several domains of quality of life were impaired: 26% had been diagnosed with depression and 43% had weak social support. HIV-related stigma is still widespread, with 49% believing most people with HIV are rejected and 65% having experienced discrimination due to HIV. The impact of HIV was limited on professional life, but 40% experienced a negative impact on life satisfaction and 41% a negative impact on sexual life. For several domains, people with a recent diagnosis of HIV and long-term survivors had significantly worse scores. This survey also uncovered strengths of people living with HIV, such as positive coping and HIV self-image. Expanding the scope of quality of life in people living with HIV may provide a more complete picture of relevant life domains that may be impacted by living with HIV, but this needs further validation.

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