Abstract
Objective
Use of psychotropic medication is very common in nursing home residents. Our objective was to describe the use of psychotropic drugs in all long-term nursing home residents ≥65 years of age with and without dementia in Helsinki, Finland.
Method
The study was a cross-sectional assessment of the nursing home population. The residents’ health status was assessed and data on their demographic factors, health and medication use were collected from medical charts in February 2003.
Results
Of all nursing home residents in Helsinki, 82% (n = 1987) participated in the study. The nursing home residents’ mean age was 83.7 (SD 7.7) years, 80.7% were female, and 69.5% were diagnosed with dementia. The mean number of psychotropic drugs given regularly was 7.9 (SD 3.6) per resident. Of the participants, 79.7% were regularly taking psychotropic medication. Conventional antipsychotics were administered to 18.9% of residents and atypical antipsychotics to 27.0%. Of the residents, 26.7% were on selective serotonin reuptake inhibitors (SSRIs), 3.1% on tricyclic antidepressants and 17.6% on other antidepressants. Altogether, 44.6% of residents were taking one or more antidepressant. More than a quarter (26.3%) were taking at least one anxiolytic drug. Hypnotics were used by 27.5%. However, only moderate dosages of psychotropic drugs were being taken. Only 10.4% of individuals with dementia were regularly taking cholinesterase inhibitors and four residents were taking memantine.
Conclusions
Use of psychotropic drugs is very common in nursing homes in Helsinki, Finland, with four of five nursing home residents regularly receiving psychotropic drugs. Only one in ten residents were receiving cholinesterase inhibitors. Physicians caring for nursing home residents require further education on the benefits and adverse effects of psychotropic drugs in frail elderly people.
Similar content being viewed by others
References
Snowdon J, Vaughan R, Miller R, et al. Psychotropic drug use in Sydney nursing homes. Med J Aust 1995; 163(2): 70–2
McGrath AM, Jackson GA. Survey of neuroleptic prescribing in residents of nursing homes in Glasgow. BMJ 1996; 312(7031): 611–2
Llorente MD, Olsen EJ, Leyva O, et al. Use of antipsychotic drugs in nursing homes: current compliance with OBRA regulations. J Am Geriatr Soc 1998; 46(2): 198–201
Lasser RA, Sunderland T. Newer psychotropic medication use in nursing home residents. J Am Geriatr Soc 1998; 46(2): 202–7
Snowdon J. A follow-up survey of psychotropic drug use in Sydney nursing homes. Med J Aust 1999; 170(7): 299–301
van Dijk KN, de Vries CS, van den Berg PB, et al. Drug utilisation in Dutch nursing homes. Eur J Clin Pharmacol 2000 Jan; 55(10): 765–71
Ruths S, Straand J, Nygaard HA. Psychotropic drug use in nursing homes: diagnostic indications and variations between institutions. Eur J Clin Pharmacol 2001; 57(6–7): 523–8
Sorensen L, Foldspang A, Gulmann NC, et al. Determinants for the use of psychotropics among nursing home residents. Int J Geriatr Psychiatry 2001; 16(2): 147–54
Nilsson L, Petersson C. Consumption of psychopharmaceuticals in residential facilities for the elderly: evaluation of the extent, indications and effects [in Swedish]. Lakartidningen 2001; 98(12): 1371–3
Draper B, Brodaty H, Low LF, et al. Use of psychotropics in Sydney nursing homes: associations with depression, psychosis, and behavioral disturbances. Int Psychogeriatr 2001; 13(1): 107–20
Ford GA, Ballard C, Thomas SH. Anti-psychotic drug use in older people. Age Ageing 2002; 31(4): 225–6
Oborne CA, Hooper R, Li KC, et al. An indicator of appropriate neuroleptic prescribing in nursing homes. Age Ageing 2002; 31(6): 435–9
Liperoti R, Mor V, Lapane KL, et al. The use of atypical antipsychotics in nursing homes. J Clin Psychiatry 2003; 64(9): 1106–12
Mamun K, Goh-Tan CY, Ng LL. Prescribing psychoactive medications in nursing homes: current practice in Singapore. Singapore Med J 2003; 44(12): 625–9
Holmquist IB, Svensson B, Hoglund P. Psychotropic drugs in nursing- and old-age homes: relationships between needs of care and mental health status. Eur J Clin Pharmacol 2003; 59(8–9): 669–76
Phillips VL, Diwan S. The incremental effect of dementiarelated problem behaviors on the time to nursing home placement in poor, frail, demented older people. J Am Geriatr Soc 2003; 51(2): 188–93
Avorn J, Gurwitz JH. Drug use in the nursing home. Ann Intern Med 1995; 123(3): 195–204
Snowden M, Roy-Byrne P. Mental illness and nursing home reform: OBRA-87 ten years later. Omnibus Budget Reconciliation Act. Psychiatr Serv 1998; 49(2): 229–33
Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999; 47(1): 30–9
Cumming RG. Epidemiology of medication-related falls and fractures in the elderly. Drugs Aging 1998; 12(1): 43–53
Gurwitz JH, Field TS, Avorn J, et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med 2000; 109(2): 87–94
Jeste DV, Rockwell E, Harris MJ, et al. Conventional vs newer antipsychotics in elderly patients. Am J Geriatr Psychiatry 1999; 7(1): 70–6
Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003 Dec; 163(22): 2716–24
Noro A, Finne-Soveri H, Björkgren M, et al. Quality and productivity in institutional care for elderly residents: benchmarking with the RAI. 1st ed. Helsinki: National Research and Development Centre for Welfare and Health (STAKES), 2005
Pedone C, Lapane KL, Mor V, et al. Donepezil use in US nursing homes. Aging Clin Exp Res 2004; 16(1): 60–7
Suominen M, Muurinen S, Routasalo P, et al. Malnutrition and associated factors among aged residents in all nursing homes in Helsinki. Eur J Clin Nutr 2005; 59(4): 578–83
WHO. Guidelines for ATC classification and DDD assignment. Oslo: WHO Collaborating Centre for Drug Statistics Methodology, 1998
Sink KM, Holden KF, Yaffe K. Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA 2005; 293(5): 596–608
Linjakumpu T, Hartikainen S, Klaukka T, et al. Psychotropics among the home-dwelling elderly: increasing trends. Int J Geriatr Psychiatry 2002; 17(9): 874–83
Linden M, Bar T, Helmchen H. Prevalence and appropriateness of psychotropic drug use in old age: results from the Berlin Aging Study (BASE). Int Psychogeriatr 2004; 16(4): 461–80
Giron MS, Forsell Y, Bernsten C, et al. Psychotropic drug use in elderly people with and without dementia. Int J Geriatr Psychiatry 2001; 16(9): 900–6
Hughes CM, Lapane KL, Mor V. Influence of facility characteristics on use of antipsychotic medications in nursing homes. Med Care 2000; 38(12): 1164–73
Pitkala KH, Laurila JV, Strandberg TE, et al. Behavioral symptoms and the administration of psychotropic drugs to aged patients with dementia in nursing homes and in acute geriatric wards. Int Psychogeriatr 2004; 16(1): 61–74
Herrmann N, Mamdani M, Lanctot KL. Atypical antipsychotics and risk of cerebrovascular accidents. Am J Psychiatry 2004; 161(6): 1113–5
Raivio MM, Laurila JV, Strandberg TE, et al. Psychotropic medication and stroke outcome. Am J Psychiatry 2005; 162(5): 1027–8
Thorgrimsen L, Spector A, Wiles A, et al. Aroma therapy for dementia. Cochrane Database of Systematic Reviews 2003; (3): CD003150
Burns A, Byrne J, Ballard C, et al. Sensory stimulation in dementia. BMJ 2002; 325(7376): 1312–3
Spector A, Orrell M, Davies S, et al. Reality orientation for dementia. Cochrane Database of Systematic Reviews 2000; (4): CD001119
Forbes DA. Strategies for managing behavioural symptomatology associated with dementia of the Alzheimer type: a systematic overview. Can J Nurs Res 1998 Summer; 30(2): 67–86
Tariot PN. Medical management of advanced dementia. J Am Geriatr Soc 2003; 51 (5 Suppl. Dementia): S305–13
Rosler M. The efficacy of cholinesterase inhibitors in treating the behavioural symptoms of dementia. Int J Clinical Pract Suppl 2002; (127): 20–36
McKeith I, Del Ser T, Spano P, et al. Efficacy of rivastigmine in dementia with Lewy bodies: a randomised, double-blind, placebo-controlled international study. Lancet 2000; 356(9247): 2031–6
Tariot PN, Solomon PR, Morris JC, et al. A 5-month, randomized, placebo-controlled trial of galantamine in AD: the Galantamine USA-10 Study Group. Neurology 2000; 54(12): 2269–76
Elmstahl S, Stenberg I, Annerstedt L, et al. Behavioral disturbances and pharmacological treatment of patients with dementia in family caregiving: a 2-year follow-up. Int Psychogeriatr 1998; 10(3): 239–52
Acknowledgements
This study was supported by the city of Helsinki. The authors have no conflicts of interest that are directly relevant to the content of this study.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hosia-Randell, H., Pitkälä, K. Use of Psychotropic Drugs in Elderly Nursing Home Residents with and without Dementia in Helsinki, Finland. Drugs Aging 22, 793–800 (2005). https://doi.org/10.2165/00002512-200522090-00008
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002512-200522090-00008