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Psychotropic and analgesic drug use among old people: with special focus on people living in institutional geriatric care
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Old people in general, and those affected by dementia disorders in particular, are more sensitive to drug side effects than younger people. Despite this, the use of nervous system drugs and analgesics among old people is common, and has increased in recent years.

Institutional geriatric care accommodates people who need round-the-clock supervision and care, due to somatic, psychiatric, cognitive or behavioral symptomatology. A majority of those living in institutional geriatric care suffers from dementia disorders.

This thesis is based on three different data collections. Two large cross-sectional studies, the AC1982 and AC2000 data collections, including all those living in institutional geriatric care in the county of Västerbotten in May 1982 and 2000 respectively (n=3195 and n=3669) and one study, the GERDA/Umeå 85+ data collection, including a sample of very old people, living at home and in institutions (n=546), in the municipalities of Umeå, Sweden and Vaasa and Mustasaari, Finland, in 2005-2006.

The use of psychotropic drugs and analgesics was common among old people living in geriatric care and among very old people in general. A higher proportion of people with dementia received certain nervous system drugs, such as antipsychotic drugs. The use of antipsychotic drugs among people with cognitive impairment living in geriatric care was found to be correlated to several behaviors and symptoms that are not proper indications for antipsychotic drug use, and also factors related more to the staff and the caring situation.

Over the course of eighteen years, from 1982 to 2000, there has been a manifold increase in the use of antidepressants, anxiolytics and hypnotics in geriatric care, but the use of antipsychotics had decreased slightly. During the same time, the prevalence of several depressive symptoms decreased significantly, correcting for demographical changes. One analysis of calculated numbers needed to treat, however, indicated poor remission rates, suggesting that even better results might be achievable. The prevalence of depressive symptoms among people with moderate cognitive impairment remained unchanged between 1982 and 2000, despite the fact that about 50% were receiving treatment with antidepressants in 2000. One possible explanation might be that depressive symptoms have different etiologies in different stages of a dementia disorder.

Approximately a quarter of the people experiencing pain in geriatric care were not receiving any regular analgesic treatment. One possible reason might be misconceptions among the caring staff regarding whether or not the residents were receiving analgesic treatment. Such misconceptions were found to be common.

In conclusion, psychotropic and analgesic drug use among old people in geriatric care, and very old people in general, was found to be common and in many cases possibly inappropriate. The use of antipsychotics among people with dementia deserves particular concern, because of the high risk of severe adverse events and the limited evidence for positive effects. The use of antidepressants, on the other hand, might have contributed to a lower prevalence of depressive symptoms among old people.

Place, publisher, year, edition, pages
Umeå: Samhällsmedicin och rehabilitering , 2008. , 109 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1157
Keyword [en]
dementia, depression, pain, nursing Home, old, analgesics, antidepressants, anti-psychotics, behavioral and psychological symptoms of dementia, inappropriate drugs
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:umu:diva-1608ISBN: 978-91-7264-504-2 (print)OAI: oai:DiVA.org:umu-1608DiVA: diva2:141547
Public defence
2008-04-25, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2008-04-08 Created: 2008-04-08 Last updated: 2014-01-16Bibliographically approved
List of papers
1. Poor staff awareness of analgesic treatment jeopardises adequate pain control in the care of older people
Open this publication in new window or tab >>Poor staff awareness of analgesic treatment jeopardises adequate pain control in the care of older people
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2006 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 35, no 3, 257-261 p.Article in journal (Refereed) Published
Abstract [en]

Background: undertreatment of pain is a common problem in geriatric care. The aim of this study was to compare the caring staff 's answers concerning the resident's pain treatment with actual pharmacological pain treatment in a cross-sectional survey of the geriatric care population in the county of Vasterbotten, Sweden. Methods: a cross-sectional study in all geriatric care units in the county of Vasterbotten, Sweden, including 3,724 inhabitants aged 65 years and over. The mean age was 83.3 and the number of cognitively impaired 2,047 (55.0%). Medication data were obtained from prescription records. The member of staff who knew the resident best judged their pain based on observations the preceding week. Results: the reported pain prevalence in the sample was 56.7%. Of those residents reported to suffer from pain, 27.9% received no analgesics as regular medication. In 72.7% of those cases with reported pain and no pharmacological treatment, the staff member who knew the resident best still thought that the resident was receiving treatment for her/his pain. Conclusion: a large proportion of the old people in geriatric care settings suffer from pain, and undertreatment of pain appears to be a significant problem. Even when the resident was not receiving pharmacological treatment for their pain, the assessor, who was expected to know the resident best, still believed in a majority of cases that the resident was receiving treatment. This highlights the need for better communication between the various professional categories involved in geriatric care.

Keyword
pain, analgesics, geriatrics, residential facilities, interdisciplinary communication, elderly
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-6782 (URN)10.1093/ageing/afj067 (DOI)000237318900010 ()16547117 (PubMedID)
Available from: 2008-01-16 Created: 2008-01-16 Last updated: 2013-10-22Bibliographically approved
2. Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care.
Open this publication in new window or tab >>Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care.
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2006 (English)In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 18, no 4, 713-726 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) commonly occur among cognitively impaired people in geriatric care. BPSD are often managed with antipsychotic drugs, despite the associated serious health risks. The aim of the present study was to discover factors associated with the use of antipsychotics.

METHODS: A cross-sectional study in all geriatric care units in the county of Västerbotten, Sweden, which included 2017 residents aged 65 years and over with cognitive impairment (mean age was 83.5 years). Data were collected from prescription records and observations made by care staff of BPSD among residents during the preceding week. A multivariate regression model was constructed to find factors independently associated with antipsychotic drug use.

RESULTS: Eleven factors were independently associated with the use of antipsychotics. Aggressive, verbally disruptive and wandering behavior, hallucinatory and depressive symptoms, male sex, living in a group dwelling for people with dementia, imposed mental workload, the ability to rise from a chair, activities of daily living (ADL) dependency and lower age all correlated significantly.

CONCLUSIONS: Antipsychotic drug treatment of old people with cognitive impairment in geriatric care is common, and determined not only by the patient's symptoms but also by factors related more closely to the caregiver and the caring situation. These findings raise important questions about the indications for drug treatment in relation to the patient's quality of life.

National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-22324 (URN)10.1017/S1041610206003930 (DOI)16879762 (PubMedID)
Available from: 2009-05-05 Created: 2009-05-05 Last updated: 2013-11-21Bibliographically approved
3. Symptoms of mental health and psychotropic drug use among old people in geriatric care, changes between 1982 and 2000.
Open this publication in new window or tab >>Symptoms of mental health and psychotropic drug use among old people in geriatric care, changes between 1982 and 2000.
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2007 (English)In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, Vol. 23, no 3, 289-294 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-6861 (URN)doi:10.1002/gps.1876 (DOI)17645282 (PubMedID)
Available from: 2008-01-16 Created: 2008-01-16 Last updated: 2013-10-17Bibliographically approved
4. One-week prevalence of depressive symptoms and psychotropic drug treatments among old people with different levels of cognitive impairment living in institutional care: changes between 1982 and 2000
Open this publication in new window or tab >>One-week prevalence of depressive symptoms and psychotropic drug treatments among old people with different levels of cognitive impairment living in institutional care: changes between 1982 and 2000
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2010 (English)In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 22, no 7, 1154-1160 p.Article in journal (Refereed) Published
Abstract [en]

Background: Dementia and depression are common in advanced age, and often co-exist. There are indications of a decreased prevalence of depressive symptoms among old people in recent years, supposedly because of the manifold increase in antidepressant treatment. Whether the prevalence of depressive symptoms has decreased among people in different stages of dementia disorders has not yet been investigated.Methods: A comparison was undertaken of two cross-sectional studies, conducted in 1982 and 2000, comprising 6864 participants living in geriatric care units in the county of Västerbotten, Sweden. Depressive symptoms were measured using the Multi-Dimensional Dementia Assessment Scale (MDDAS), and the cognitive score was measured with Gottfries' cognitive scale. Drug data were obtained from prescription records.Results: There was a significant decrease in depressive symptom score between 1982 and 2000 in all cognitive function groups except for the group with moderate cognitive impairment. Antidepressant drug use increased in all cognitive function groups.Conclusion: The prevalence of depressive symptoms decreased between 1982 and 2000, in all levels of cognitive impairment except moderate cognitive impairment. This might possibly be explained by the depressive symptoms having different etiologies in different stages of a dementia disorder, which in turn might not be equally susceptible to antidepressant treatment.

Place, publisher, year, edition, pages
Cambridge University Press, 2010
Keyword
Depression, dementia, nursing home, old age, Alzheimer´s disease, SSRI
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-34589 (URN)10.1017/S104161021000061X (DOI)000284026200014 ()20478102 (PubMedID)
Funder
Swedish Research Council
Note

Först publicerad i avhandling med annan titel: On depression in dementia.

First published in thesis with the title: On depression in dementia.

Available from: 2010-06-09 Created: 2010-06-09 Last updated: 2014-01-16Bibliographically approved
5. The use of central nervous system drugs and analgesics among very old people with and without dementia
Open this publication in new window or tab >>The use of central nervous system drugs and analgesics among very old people with and without dementia
2008 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 17, no 9, 912-918 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Old people in general, and particularly those with dementia, are more sensitive to adverse drug effects than younger people. Despite this, the use of central nervous system (CNS) drugs among old people is common. The aim of the present study was to compare the use of central nervous system drugs and analgesics among people aged 85 years or older, with and without dementia. METHODS: One half of all people aged 85 years old and all those aged 90, 95 and above in Umeå, Sweden and Vaasa and Mustasaari, Finland, were asked to participate in this part of the GERDA/Umeå 85+ study. Both those living in their own homes and those in institutions were included. Trained investigators performed structured interviews and assessments. Medication data were obtained from the participants and medical records. Dementia disorders were diagnosed according to DSM-IV. RESULTS: Dementia was diagnosed in 247/546 participants (45.2%). A higher proportion of the participants with dementia used paracetamol (50.6% compared to 21.4%, p < 0.001), antipsychotics (22.3% and 2.7%, p < 0.001), antidepressants (33.6% and 11.4%, p < 0.001) and anxiolytics (19.0% and 8.0%, p < 0.001). There were no differences in the use of opioid analgesics, anticonvulsants and hypnotics. CONCLUSIONS: The use of CNS drugs and analgesics was common among this population of very old people. Furthermore, the prescription of CNS drugs was more common among people with dementia. The use of antipsychotics in people with dementia should arouse particular concern, because of the high risk of severe adverse events and the limited evidence of positive effects.

Keyword
very old, dementia, Alzheimer's diseased, drug use, antipsychotics, antidepressants, benzodiazepines, pain, CNS drugs, analgesics
National Category
Pharmacology and Toxicology
Identifiers
urn:nbn:se:umu:diva-22325 (URN)10.1002/pds.1600 (DOI)000259217700009 ()18398935 (PubMedID)
Available from: 2009-05-05 Created: 2009-05-05 Last updated: 2013-10-22Bibliographically approved

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Lövheim, Hugo

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