European Journal of Clinical Pharmacology

, Volume 59, Issue 8–9, pp 669–676 | Cite as

Psychotropic drugs in nursing- and old-age homes: relationships between needs of care and mental health status

  • Ing-Britt Holmquist
  • Bengt Svensson
  • Peter Höglund
Pharmacoepidemiology and Prescription

Abstract

Objective

The aim of the present study was to map out what kind of psychotropic drugs are prescribed for elderly residents in assisted-living homes and how they relate to age, sex, form of living, psychiatric diagnosis, care needs and mental health status, and to identify factors of importance for their use; and to study the indication for treatment and the evaluation of the effects of treatment.

Method

The study had a cross-sectional design and included one-third of all patients (n=175) living in old-age homes or in nursing homes in a municipality in southern Sweden. Data concerning medication was obtained from medical records and included all psychotropic drugs prescribed the day the study started and the previous month. Need of care was assessed using Katz index, and mental health status was assessed using the Organic Brain Syndrome scale.

Results

Of the study population, 128 (73%) used one or more psychoactive drug. Prescribed drugs were neuroleptics (16%), anxiolytics (32%), hypnotics, (45%), and anti-depressants (33%). A greater prescription of neuroleptics than anti-depressants was seen for those showing signs of depression, and caution with prescription of benzodiazepines was seen for those showing signs of dementia. An indication and evaluation of treatment was lacking in half of the cases. Treatment with psychiatric drugs existed for approximately 50% of those without a determined psychiatric diagnosis.

Conclusion

We have found a frequent use of neuroleptics, anxiolytics and hypnotics in the elderly, but an underprescription of anti-depressants appears to exist. There is a lack of documentation of indications and evaluations of psychotropic medication.

Keywords

Elderly Nursing home Old-age homes 

Notes

Acknowledgements

The authors wish to thank all staff members and residents at the nursing homes and old-age homes for their collaboration. We are most grateful to Christin Tornvall for help with interviews and to Anders Håkansson, Ph.D., for revising the language. The study was supported by Capio Research Foundation.

References

  1. 1.
    SCB (2001) Sweden's official statistics, statistical announcements BE 12 SM 0101. Population of the whole country, the counties and the municipalities 31 December 2000 (in Swedish). Statistiska Centralbyrån, StockholmGoogle Scholar
  2. 2.
    Fastbom J, Claesson CB, Cornelius C, Thorslund M, Winblad B (1995) The use of medicines with anticholinergic effects in older people. J Am Geriatr Soc 43:1135–1140PubMedGoogle Scholar
  3. 3.
    Burns A (1997) Psychiatric symptoms and behavioural disturbances in the dementias. J Neural Transm 51:27–35Google Scholar
  4. 4.
    Elmståhl S, Stenberg I, Annerstedt, L, Ingvad B (1998) Behavioural disturbances and pharmacological treatment of patients with dementia in family care giving: a 2-year follow up. Int Psychogeriatr 10:239–252PubMedGoogle Scholar
  5. 5.
    Thacker S, Jones R (1997) Neuroleptic prescribing to the community elderly in Nottingham. Int J Geriatr Psychiatry 12:833–837CrossRefPubMedGoogle Scholar
  6. 6.
    Furniss L, Lloyd Craig SK, Burns A (1998) Review: medication use in nursing homes for elderly people. Int J Geriatr Psychiatry 13:433–439CrossRefPubMedGoogle Scholar
  7. 7.
    Schmidt I, Claesson C, Westerholm B, Svarstad BL (1998) Resident characteristics and organizational factors influencing the quality of drug use in Sweden nursing homes. Soc Sci Med 47:961–971CrossRefPubMedGoogle Scholar
  8. 8.
    Schjott J, Opedal K, Rutledal JE (1999) A survey of hypnotic use in geriatric institutions in Sogn og Fjordane, Norway. Aging Clin Exp Res 11:50–55Google Scholar
  9. 9.
    Williams BR, Nichol MB, Lowe B, Yoon PS, McCombs JS, Margolies J (1999) Medication use in residential care facilities for the elderly. Ann Pharmacother 33:149–155PubMedGoogle Scholar
  10. 10.
    Ruths S, Straand J, Nygaard HA (2001) Psychotropic drug use in nursing homes—diagnostic indications and variations between institutions. Eur J Clin Pharmacol 57:523–528CrossRefPubMedGoogle Scholar
  11. 11.
    Sörensen L, Foldspang A, Gulmann NC, Munk-Jörgensen P (2001) Determinants for the use of psychotropics among nursing home residents. Int J Geriatr Psychiatry 16:147–154CrossRefPubMedGoogle Scholar
  12. 12.
    Katona C (2001) Psychotropics and drug interactions in the elderly patient. Int J Geriatr Psychiatry 16:86–90CrossRefGoogle Scholar
  13. 13.
    Fastbom J (2001) Elderly and drugs. Liber, StockholmGoogle Scholar
  14. 14.
    Beers MH (1997) Explicit criteria for determining inappropriate medication use by the elderly: an update. Arch Intern Med 157:1531–1536PubMedGoogle Scholar
  15. 15.
    Steffens DC, Krishnan KRR (1998) Metabolism, bioavailability and drug interactions. Clin Geriatr Med 14:17–31PubMedGoogle Scholar
  16. 16.
    Cooper JW (1996) Probable adverse drug reactions in a rural geriatric nursing home population: a four-year study. J Am Geriatr Soc 44:194–197PubMedGoogle Scholar
  17. 17.
    Turnheim K (1998) Drug dosage in the elderly. Is it rational? Drugs Aging 13:357–379PubMedGoogle Scholar
  18. 18.
    Atkin PA, Veitch PC, Veitch EM, Ogle SJ (1999) The epidemiology of serious adverse drug reactions among the elderly. Drugs Aging 14:41–52PubMedGoogle Scholar
  19. 19.
    Meador KJ (1998) Cognitive side effects of medication. Neurol Clin 16:141–155PubMedGoogle Scholar
  20. 20.
    Moore AR, O'Keeffe ST (1999) Drug-induced cognitive impairment. Drugs Aging 15:15–28PubMedGoogle Scholar
  21. 21.
    Mustard CA, Mayer T (1997) Case-control study of exposure to medication and the risk of injurious falls requiring hospitalization among nursing home residents. Am J Epidemiol 145:738–745PubMedGoogle Scholar
  22. 22.
    Thapa PB, Gideon P, Cost TW, Milam AB, Ray WA (1998) Antidepressants and the risk of falls among nursing home residents. N Engl J Med 339:875–882PubMedGoogle Scholar
  23. 23.
    Monane M, Glynn RJ, Avorn J (1996) The impact of sedative-hypnotic use on sleep symptoms in elderly nursing home residents. Clin Pharmacol Ther 59:83–92PubMedGoogle Scholar
  24. 24.
    Ersser S, Wiles A, Taylor H, Wade S, Walsh R, Bentey T (1999) The sleep of older people in hospital and nursing homes. J Clin Nurs 8:360–368CrossRefPubMedGoogle Scholar
  25. 25.
    Opedal K, Schjott J, Eide E (1998) Use of hypnotics among patients in geriatric institutions. Int J Geriatr Psychiatry 13:846–851CrossRefPubMedGoogle Scholar
  26. 26.
    Evans DL, Staab JP, Petitto JM, et al (1999) Depression in the medical setting: biopsychological interactions and treatment considerations. J Clin Psychiatry 60:40–55PubMedGoogle Scholar
  27. 27.
    Henderson AS, Korten AE, Jorm AF, et al (1994) Are nursing homes depressing? Lancet 344:1091Google Scholar
  28. 28.
    Arthur A, Matthews R, Jagger C, Lindesay J (2002) Factors associated with antidepressant treatment in residential care: changes between 1990 and 1997. Int J Geriatr Psychiatry 17:54–60CrossRefPubMedGoogle Scholar
  29. 29.
    Katz S, Downs TD, Cash HR, Grotz RC (1970) Progress in the development of an index of ADL. Gerontologist 10:20–30PubMedGoogle Scholar
  30. 30.
    Katz S, Ford AB, Moskowits RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919Google Scholar
  31. 31.
    Brorsson B, Hulter Åsberg K (1984) Katz index of independence in ADL: reliability and validity in short-term care. Scand J Rehabil Med 16:125–132PubMedGoogle Scholar
  32. 32.
    Jensen E, Dehlin O, Gustafson G (1993) A comparison between three psychogeriatric rating scales. Int J Geriatr Psychiatry 8:215–229Google Scholar
  33. 33.
    WHO Collaborating Centre for Drugs Statistics and Methodology (2000) Anatomical therapeutic chemical (ATC) classification index. World Health Organisation, OsloGoogle Scholar
  34. 34.
    The National Board of Health and Welfare (1997) International classification of diseases and related health problems, tenth revision (ICD-10). StockholmGoogle Scholar
  35. 35.
    SPSS (1993) Base system users guide. SPSS, Inc., ChicagoGoogle Scholar
  36. 36.
    The National Board of Health and Welfare (1998) Ädelparadoxen: sjukhemmen före och efter Ädelreformen (in Swedish). StockholmGoogle Scholar
  37. 37.
    Isacsson G (2000) Suicide prevention—a medical breakthrough? Acta Psychiatr Scand 102:113–117CrossRefPubMedGoogle Scholar
  38. 38.
    Lasser RA, Sunderland T (1998) Newer psychotropic medication use in nursing home residents. J Am Geriatr Soc 46:202–207PubMedGoogle Scholar
  39. 39.
    Brorson S, Scanlan JM, Doane K, Gray S (2002) Antidepressant prescribing in nursing homes: is there a place for tricyclics? Int J Geriatr Psychiatry 17:1140–1145CrossRefPubMedGoogle Scholar
  40. 40.
    Roberts MS, King M, Stokes JA, et al (1998) Medication prescribing and administration in nursing homes. Age Ageing 27:385–392Google Scholar
  41. 41.
    Newman SC, Hassan AI (1999) Antidepressant use in the elderly population in Canada: results from a national survey. J Gerontol A Biol Sci Med Sci 54:527–530Google Scholar
  42. 42.
    Burrows AB, Morris JN, Simon SE, Hirdes JP, Phillips C (2000) Development of a minimum data set-based depression rating scale for use in nursing homes. Age Ageing 29:165–172CrossRefPubMedGoogle Scholar
  43. 43.
    Lader M (1997) Hypnotics in the elderly. Int J Geriatr Psychopharmacol 1:10–14Google Scholar
  44. 44.
    Bachman DL (1992) Sleep disorders with aging: evaluation and treatment. Geriatrics 47:53–61Google Scholar
  45. 45.
    Kennedy MM, Mion LC (1996) Neuroleptic therapy: how much do nurses know? J Gerontol Nurs 22:7–13Google Scholar
  46. 46.
    Elon R, Pawlson LG (1992) The impact of OBRA on medical practice within nursing facilities. J Am Geriatr Soc 40:958–963PubMedGoogle Scholar
  47. 47.
    Miller SW (1993) Cost savings and reduction of medication related problems as a result of consultant pharmacy. Clin Pharm 8:1265–1271Google Scholar
  48. 48.
    Kane R, Garrard J (1994) Changing physician prescribing practices: regulation vs education. JAMA 271:393–394CrossRefPubMedGoogle Scholar
  49. 49.
    Avorn J, Soumerai SB, Everitt DE, et al (1992) A randomized trial of program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med 327:168–173PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Ing-Britt Holmquist
    • 1
  • Bengt Svensson
    • 1
  • Peter Höglund
    • 2
  1. 1.Department of NursingLund UniversitySweden
  2. 2.Department of Clinical PharmacologyLund University HospitalLundSweden

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