Drugs & Aging

, Volume 25, Issue 4, pp 335–342 | Cite as

Use of Antipsychotics in Older Home Care Patients in Finland

  • Hanna-Mari Alanen
  • Harriet Finne-Soveri
  • Anja Now
  • Esa Leinonen
Original Research Article



To investigate the use of antipsychotic medications, and factors associated with such use, in elderly patients in home care in Finland.


A retrospective study was designed using cross-sectional data gathered between 1 July and 31 December 2004 in Finland. Data were extracted from the Resident Assessment Instrument (RAI) database, based on Minimum Data Set for Home Care (MDS-HC) assessments. Patients aged ≥65 years from five home care units in different parts of Finland (urban and rural) were included, yielding a total of 1106 patient assessments.


The prevalence of antipsychotic use was 11% among home care patients. Factors independently associated with use of antipsychotics in the logistic regression model were: any psychiatric diagnosis (odds ratio [OR] 6.62, 95% CI 4.19, 10.45), delusions (OR 4.19, 95% CI 2.22, 7.90), parkinsonism (OR 3.08, 95% CI 1.07, 8.87), not at ease interacting with others (OR 1.88, 95% CI 1.06, 3.36) and moderate-to-severe cognitive impairment (OR 1.47, 95% CI 1.06, 2.04). By contrast, patients aged ≥85 years (OR 0.59, 95% CI 0.43, 0.81) were significantly less likely to be taking antipsychotics. Use of atypical antipsychotic medication was associated in the logistic regression model with delusions (OR 4.05, 95% CI 2.01, 8.17), parkinsonism (OR 3.66, 95% CI 1.10, 12.19), any psychiatric diagnosis (OR 3.06, 95% CI 1.66, 5.63), moderate-to-severe cognitive impairment (OR 2.0, 95% CI 1.32, 3.03) and age ≥85 years (OR 0.66, 95% CI 0.44, 0.99). However, use of conventional antipsychotics was associated only with any psychiatric diagnosis (OR 8.88, 95% CI 5.05, 15.61) and age ≥85 years (OR 0.65, 95% CI 0.44, 0.98).


The prevalence of antipsychotic medication use in elderly home care patients was higher than that previously reported among elderly people living in the community in Finland and Sweden (3–9%). Several predictive factors such as psychiatric diagnosis, delusions and cognitive impairment were associated with use of antipsychotics whereas there was a negative association between age ≥85 years and use of antipsychotics.



No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.


  1. 1.
    Alexopoulos GS, Streim J, Carpenter D, et al. Expert consensus panel for using antipsychotic drugs in older patients. J Clin Psychiatry 2004; 65Suppl. 2: 5–99; discussion 100–2; quiz 103–4PubMedGoogle Scholar
  2. 2.
    Giron MS, Forsell Y, Bernsten C, et al. Psychotropic drug use in elderly people with and without dementia. Int J Geriatr Psychiatry 2001; 16: 900–6PubMedCrossRefGoogle Scholar
  3. 3.
    Linjakumpu T, Hartikainen S, Klaukka T, et al. Psychotropics among the home-dwelling elderly: increasing trends. Int J Geriatr Psychiatry 2002; 17: 874–83PubMedCrossRefGoogle Scholar
  4. 4.
    Hartikainen S, Rahkonen T, Kautiainen H, et al. Use of psychotropics among home-dwelling nondemented and demented elderly. Int J Geriatr Psychiatry 2003; 18: 1135–41PubMedCrossRefGoogle Scholar
  5. 5.
    STAKES (National Research and Development Centre for Welfare and Health). Statistical summary 13/2004 [online]. Available from URL: http://www.stakes.info/2/10A/index.asp. [Accessed 2006 Nov 30]
  6. 6.
    Landi F, Onder G, Cesari M, et al. Comorbidity and social factors predicted hospitalization in frail elderly patients. J Clin Epidemiol 2004; 57: 832–6PubMedCrossRefGoogle Scholar
  7. 7.
    Lobo A, Launer LJ, Fratiglioni L, et al. Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 2000; 54Suppl. 5: S4–9PubMedGoogle Scholar
  8. 8.
    Finkel SI, Costa e Silva J, Cohen G, et al. Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. Int Psychogeriatr 1996; 8Suppl. 3: 497–500PubMedGoogle Scholar
  9. 9.
    Jeste DV, Finkel SI. Psychosis of Alzheimer’s disease and related dementias: diagnostic criteria for a distinct syndrome. Am J Geriatr Psychiatry 2000; 8: 29–34PubMedCrossRefGoogle Scholar
  10. 10.
    Ritchie K, Artero S, Beluche I, et al. Prevalence of DSM-IV psychiatric disorder in the French elderly population. Br J Psychiatry 2004; 184: 147–52PubMedCrossRefGoogle Scholar
  11. 11.
    Henderson AS, Korten AE, Levings C, et al. Psychotic symptoms in the elderly: a prospective study in a population sample. Int J Geriatr Psychiatry 1998; 13: 484–92PubMedCrossRefGoogle Scholar
  12. 12.
    Forseil Y, Henderson AS. Epidemiology of paranoid symptoms in an elderly population. Br J Psychiatry 1998; 172: 429–32CrossRefGoogle Scholar
  13. 13.
    Targum SD, Abbott JL. Psychoses in the elderly: a spectrum of disorders. J Clin Psychiatry 1999; 60Suppl. 8: 4–10PubMedGoogle Scholar
  14. 14.
    Morris JN, Brant E, Steel K, et al. Comprehensive clinical assessment in community setting: applicability of the MDSHC. Am Geriatr Soc 1997; 45: 1017–24Google Scholar
  15. 15.
    Kwan CW, Chi I, Lam TP, et al. Validation of the Minimum Data Set for Home Care Assessment Instrument for Hong Kong Chinese Elders. Clin Gerontol 2000; 21(14): 35–48CrossRefGoogle Scholar
  16. 16.
    Landi F, Tua E, Onder G, et al. Minimum data set for home care: a valid instrument to assess frail older people living in the community. Med Care 2000; 38: 1184–90PubMedCrossRefGoogle Scholar
  17. 17.
    Schatzberg AF, Nemeroff CB. Essentials of clinical psycho-pharmacology. Washington, DC: American Psychiatry Publishing, 2005Google Scholar
  18. 18.
    Morris JN, Fries BE, Morris SA. Scaling ADLs within the MDS. J Gerontol A Biol Sci Med Sci 1999; 54(11): M546–53PubMedCrossRefGoogle Scholar
  19. 19.
    Morris JN, Fries BE, Mehr DR, et al. MDS Cognitive Performance Scale. J Gerontol 1994; 49: M174–82PubMedCrossRefGoogle Scholar
  20. 20.
    Snowdon J, Day S, Baker W. Why and how antipsychotic drugs are used in 40 Sydney nursing homes. Int J Geriatr Psychiatry 2005; 20: 1146–52PubMedCrossRefGoogle Scholar
  21. 21.
    Wang PS, Schneeweiss S, Avorn J, et al. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med 2005; 353: 2335–41PubMedCrossRefGoogle Scholar
  22. 22.
    Aarsland D, Larsen JP, Cummings JL, et al. Prevalence and clinical correlates of psychotic symptoms in Parkinson disease: a community-based study. Arch Neurol 1999; 56: 595–601PubMedCrossRefGoogle Scholar
  23. 23.
    Fenelon G, Mahieux F, Huon R, et al. Hallucinations in Parkinson’s disease: prevalence, phenomenology and risk factors. Brain 2000; 123 (Pt 4): 733–45PubMedCrossRefGoogle Scholar
  24. 24.
    Depp CA, Jeste DV. Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies. Am J Geriatr Psychiatry 2006; 14: 6–20PubMedCrossRefGoogle Scholar
  25. 25.
    Hartikainen S, Rahkonen T, Kautiainen H, et al. Kuopio 75+ study: does advanced age predict more common use of psychotropics among the elderly? Int Clin Psychopharmacol 2003; 18: 163–7PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Hanna-Mari Alanen
    • 1
  • Harriet Finne-Soveri
    • 2
  • Anja Now
    • 2
  • Esa Leinonen
    • 1
    • 3
  1. 1.Medical SchoolUniversity of TampereTampereFinland
  2. 2.Center for Health Economics CHESSSTAKESHelsinkiFinland
  3. 3.Department of PsychiatryTampere University HospitalPitkäniemiFinland

Personalised recommendations