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European Journal of Clinical Pharmacology

, Volume 72, Issue 8, pp 987–994 | Cite as

Behavioral and psychological symptoms and psychotropic drugs among people with cognitive impairment in nursing homes in 2007 and 2013

  • Maria GustafssonEmail author
  • Ulf Isaksson
  • Stig Karlsson
  • Per-Olof Sandman
  • Hugo Lövheim
Pharmacoepidemiology and Prescription

Abstract

Purpose

The use of psychotropic drugs to treat behavioral and psychological symptoms among people with dementia has been widely questioned because of its limited efficacy and risk of harmful side-effects. The objectives of this study was to compare the prevalence of behavioral and psychological symptoms and the use of psychotropic drug treatments among old people with cognitive impairment living in geriatric care units in 2007 and 2013.

Methods

Two questionnaire surveys were performed in 2007 and 2013, comprising all those living in geriatric care units in the county of Västerbotten in northern Sweden. A comparison was made between 1971 people from 2007 and 1511 people from 2013. Data were collected concerning psychotropic and antidementia drug use, functioning in the activities of daily living (ADL), cognition, and behavioral and psychological symptoms, using the Multi-Dimensional Dementia Assessment Scale (MDDAS).

Results

Between 2007 and 2013, the use of antipsychotic drugs declined from 25.4 to 18.9 %, and of anxiolytic, hypnotic, and sedative drugs from 35.5 to 29.4 %. The prevalence of people prescribed antidepressant drugs remained unchanged while antidementia drug prescription increased from 17.9 to 21.5 %. When controlled for demographic changes, 36 out of 39 behavioral and psychological symptoms showed no difference in prevalence between the years.

Conclusions

The use of antipsychotic, anxiolytic, hypnotic, and sedative drugs declined considerably between 2007 and 2013 among old people with cognitive impairment living in geriatric care units. Despite this reduction, the prevalences of behavioral and psychological symptoms remained largely unchanged.

Keywords

Dementia Nursing home Behavioral and psychological symptoms Alzheimer’s disease Psychotropic drugs Antipsychotics 

Notes

Acknowledgments

This study was supported financially by grants from the Swedish Dementia Association, County Council of Västerbotten, and Swedish Brainpower.

Description of authors’ roles

M. Gustafsson and H. Lövheim analyzed and interpreted the data and prepared the manuscript. P.O. Sandman, S. Karlsson, and U. Isaksson were responsible for the study concept, design, and acquisition of subjects. All authors carried out a critical revision of the manuscript, contributed with comments, and approved the final version.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Supplementary material

228_2016_2058_MOESM1_ESM.docx (87 kb)
ESM 1 (DOCX 86 kb)

References

  1. 1.
    Selbaek G, Engedal K, Bergh S (2013) The prevalence and course of neuropsychiatric symptoms in nursing home patients with dementia: a systematic review. J Am Med Dir Assoc 14(3):161–169CrossRefPubMedGoogle Scholar
  2. 2.
    Wetzels RB, Zuidema SU, de Jonghe JF, Verhey FR, Koopmans RT (2010) Determinants of quality of life in nursing home residents with dementia. Dement Geriatr Cogn Disord 29(3):189–197CrossRefPubMedGoogle Scholar
  3. 3.
    Selbaek G, Kirkevold O, Engedal K (2008) The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes—a 12-month follow-up study. Am J Geriatr Psychiatry 16(7):528–536CrossRefPubMedGoogle Scholar
  4. 4.
    Nijk RM, Zuidema SU, Koopmans RT (2009) Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia. Int Psychogeriatr 21(3):485–493CrossRefPubMedGoogle Scholar
  5. 5.
    Gareri P, De Fazio P, Manfredi VG, De Sarro G (2014) Use and safety of antipsychotics in behavioral disorders in elderly people with dementia. J Clin Psychopharmacol 34(1):109–123CrossRefPubMedGoogle Scholar
  6. 6.
    Hanlon JT, Horner RD, Schmader KE, Fillenbaum GG, Lewis IK, Wall WE Jr, Landerman LR, Pieper CF, Blazer DG, Cohen HJ (1998) Benzodiazepine use and cognitive function among community-dwelling elderly. Clin Pharmacol Ther 64(6):684–692Google Scholar
  7. 7.
    Coupland CA, Dhiman P, Barton G, Morriss R, Arthur A, Sach T, Hippisley-Cox J (2011) A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database. Health Technol Assess 15(28):1–202 iii-ivCrossRefPubMedGoogle Scholar
  8. 8.
    Banerjee S, Hellier J, Dewey M, Romeo R, Ballard C, Baldwin R, Bentham P, Fox C, Holmes C, Katona C, Knapp M, Lawton C, Lindesay J, Livingston G, McCrae N, Moniz-Cook E, Murray J, Nurock S, Orrell M, O’Brien J, Poppe M, Thomas A, Walwyn R, Wilson K, Burns A (2011) Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. Lancet 378(9789):403–411CrossRefPubMedGoogle Scholar
  9. 9.
    Gustafsson M, Sandman PO, Karlsson S, Gustafson Y, Lovheim H (2013) Association between behavioral and psychological symptoms and psychotropic drug use among old people with cognitive impairment living in geriatric care settings. Int Psychogeriatr 25(9):1415–1423CrossRefPubMedGoogle Scholar
  10. 10.
    Lovheim H, Sandman PO, Kallin K, Karlsson S, Gustafson Y (2006) Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care. Int Psychogeriatr 18(4):713–726CrossRefPubMedGoogle Scholar
  11. 11.
    Gauthier S, Cummings J, Ballard C, Brodaty H, Grossberg G, Robert P, Lyketsos C (2010) Management of behavioral problems in Alzheimer’s disease. Int Psychogeriatr 22(3):346–372CrossRefPubMedGoogle Scholar
  12. 12.
    Ballard C, Waite J (2006) The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer’s disease. Cochrane Database Syst Rev (1): Cd003476Google Scholar
  13. 13.
    Declercq T, Petrovic M, Azermai M, Vander Stichele R, De Sutter AI, van Driel ML, Christiaens T (2013) Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. Cochrane Database Syst Rev 3: Cd007726Google Scholar
  14. 14.
    Lovheim H, Sandman PO, Kallin K, Karlsson S, Gustafson Y (2008) Symptoms of mental health and psychotropic drug use among old people in geriatric care, changes between 1982 and 2000. Int J Geriatr Psychiatry 23(3):289–294CrossRefPubMedGoogle Scholar
  15. 15.
    Lovheim H, Sandman PO, Karlsson S, Gustafson Y (2009) Changes between 1982 and 2000 in the prevalence of behavioral symptoms and psychotropic drug treatment among old people with cognitive impairment in geriatric care. Int Psychogeriatr 21(5):941–948CrossRefPubMedGoogle Scholar
  16. 16.
    Lovheim H, Gustafson Y, Karlsson S, Sandman PO (2011) Comparison of behavioral and psychological symptoms of dementia and psychotropic drug treatments among old people in geriatric care in 2000 and 2007. Int Psychogeriatr 23(10):1616–1622CrossRefPubMedGoogle Scholar
  17. 17.
    Sandman PO, Adolfsson R, Norberg A, Nystrom L, Winblad B (1988) Long-term care of the elderly. A descriptive study of 3600 institutionalized patients in the county of Vasterbotten. Sweden Compr Gerontol A 2(3):120–132PubMedGoogle Scholar
  18. 18.
    Adolfsson R, Gottfries CG, Nystrom L, Winblad B (1981) Prevalence of dementia disorders in institutionalized Swedish old people. The work load imposed by caring for these patients. Acta Psychiatr Scand 63(3):225–244CrossRefPubMedGoogle Scholar
  19. 19.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198CrossRefPubMedGoogle Scholar
  20. 20.
    The National Board of Health and Welfare (2010) Indikatorer för utvärdering av kvaliteten i äldres läkemedelsterapi. [Eng. Indicators for evaluating the quality of older people’s drug therapy]. http://www.socialstyrelsen.se/publikationer2010/2010-6-29/. Accessed 1 September 2015
  21. 21.
    Medical products agency (2008) Läkemedelsverkets behandlingsrekommendationer: Läkemedelsbehandling och bemötande vid Beteendemässiga och Psykiska Symtom vid Demenssjukdom—BPSD. [Eng. Drug therapy and treatment for Behavioral and Psychological Symptoms of Dementia—BPSD]. http://www.lakemedelsverket.se/malgrupp/Halso—sjukvard/Behandlings–rekommendationer/Behandlingsrekommendation—listan/Beteendemassiga-och-psykiska-symtom-vid-demenssjukdom–BPSD/. Accessed 17 June 2015
  22. 22.
    EMA - European Medicines Agency (2010). http://www.ema.europa.eu/docs/en_GB/document_library/Report/2010/01/WC500054057.pdf/. Accessed 4 September 2015
  23. 23.
  24. 24.
    Schulze J, van den Bussche H, Glaeske G, Kaduszkiewicz H, Wiese B, Hoffmann F (2013) Impact of safety warnings on antipsychotic prescriptions in dementia: nothing has changed but the years and the substances. In: Eur Neuropsychopharmacoled. 2013 Elsevier B.V. and ECNP, pp1034–1042Google Scholar
  25. 25.
    Gallini A, Andrieu S, Donohue JM, Oumouhou N, Lapeyre-Mestre M, Gardette V (2014) Trends in use of antipsychotics in elderly patients with dementia: impact of national safety warnings. Eur Neuropsychopharmacol 24(1):95–104CrossRefPubMedGoogle Scholar
  26. 26.
    Hovstadius B, Petersson G, Hellstrom L, Ericson L (2014) Trends in inappropriate drug therapy prescription in the elderly in Sweden from 2006 to 2013: assessment using national indicators. Drugs Aging 31(5):379–386CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Gustafsson M, Sandman PO, Karlsson S, Isaksson U, Schneede J, Sjolander M, Lovheim H (2015) Reduction in the use of potentially inappropriate drugs among old people living in geriatric care units between 2007 and 2013. Eur J Clin Pharmacol 71(4):507–515CrossRefPubMedGoogle Scholar
  28. 28.
    Porsteinsson AP, Drye LT, Pollock BG, Devan and DP, Frangakis C, Ismail Z, Marano C, Meinert CL, Mintzer JE, Munro CA, Pelton G, Rabins PV, Rosenberg PB, Schneider LS, Shade DM, Weintraub D, Yesavage J, Lyketsos CG (2014) Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA 311(7):682–691CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Cumbo E, Ligori LD (2014) Differential effects of current specific treatments on behavioral and psychological symptoms in patients with Alzheimer’s disease: a 12-month, randomized, open-label trial. J Alzheimers Dis 39(3):477–485PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Maria Gustafsson
    • 1
    • 2
    Email author
  • Ulf Isaksson
    • 3
    • 4
  • Stig Karlsson
    • 3
  • Per-Olof Sandman
    • 3
    • 5
  • Hugo Lövheim
    • 2
  1. 1.Department of Pharmacology and Clinical Neuroscience, Division of Clinical PharmacologyUmeå UniversityUmeåSweden
  2. 2.Department of Community Medicine and Rehabilitation, Geriatric MedicineUmeå UniversityUmeåSweden
  3. 3.Department of NursingUmeå UniversityUmeåSweden
  4. 4.Arctic Research Centre at Umeå UniversityUmeåSweden
  5. 5.Department of Neurobiology, Care Sciences and Society, Division of NursingKarolinska InstitutetStockholmSweden

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