ABSTRACTBackground:We aimed to assess whether there were any changes in the use of psychotropic drugs in Norwegian nursing homes between 2004 and 2011. Also, we investigated whether the predictors of use of specific psychotropic drug groups have changed.
We conducted a secondary analysis of two cohort studies of two Norwegian nursing home samples (2004/05 and 2010/11). Multivariate models were applied.
We found a significant decrease in the prescription of antipsychotic drugs between 2004 and 2011 (0.63 OR, 95%CI = 0.49-0.82, p
Neuropsychiatric symptoms (NPS), such as depression, apathy, agitation, and psychotic symptoms are common in mild cognitive impairment (MCI) and dementia in Alzheimer's disease (AD). Subgroups of NPS have been reported. Yet the relationship of NPS and their subgroups to different stages of cognitive impairment is unclear. Most previous studies are based on small sample sizes and show conflicting results. We sought to examine the frequency of NPS and their subgroups in MCI and different stages of dementia in AD.
This was a cross-sectional study using data from a Norwegian national registry of memory clinics. From a total sample of 4,571 patients, we included those with MCI or AD (MCI 817, mild AD 883, moderate-severe AD 441). To compare variables across groups ANOVA or ? 2-test was applied. We used factor analysis of Neuropsychiatric Inventory Questionnaire (NPI-Q) items to identify subgroups of NPS.
The frequency of any NPS was 87.2% (AD 91.2%, MCI 79.5%; p
Pain is frequent and distressing in people with dementia, but no randomized controlled trials have evaluated the effect of analgesic treatment on pain intensity as a key outcome.
Three hundred fifty-two people with dementia and significant agitation from 60 nursing home units were included in this study. These units, representing 18 nursing homes in western Norway, were randomized to a stepwise protocol of treating pain (SPTP) or usual care. The SPTP group received acetaminophen, morphine, buprenorphine transdermal patch and pregabalin for 8 weeks, with a 4-week washout period. Medications were governed by the SPTP and each participant's existing prescriptions. We obtained pain intensity scores from 327 patients (intervention n = 164, control n = 163) at five time points assessed by the primary outcome measure, Mobilization-Observation-Behaviour-Intensity-Dementia-2 (MOBID-2) Pain Scale. The secondary outcome was activities of daily living (ADL). We used a linear intercept mixed model in a two-way repeated measures configuration to assess change over time and between groups.
The SPTP conferred significant benefit in MOBID-2 scores compared with the control group [average treatment effect (ATE) -1.388; p
To assess the use of general practitioners (GPs), in elderly home-dwelling persons in Norway and explore the impact of cognitive decline, age, and living situation.
Prospective longitudinal study.
Data were collected from municipalities in four counties in Norway in the period from January 2009 to August 2012.
Home-dwelling persons 70 years of age or older, receiving in-home care.
Use of GPs over a period of 18 months related to cognitive state, functional status, neuropsychiatric symptoms, and demographics.
A total of 599 persons were included. The mean annual number of consultations per participant was 5.6 (SD = 5.4). People with moderate to severe dementia had fewer consultations per year compared with those with mild or no dementia (3.7 versus 5.8 per year, p = 0.004). In the multivariate model higher age predicted fewer consultations while affective neuropsychiatric symptoms were associated with an increase in frequency of consultations. The most frequent reason to consult a GP was cardiovascular diseases (36.8% of all consultations), followed by musculoskeletal complaints (12.1%) and psychiatric diagnoses (8.7%).
Our study shows that the home-dwelling elderly with moderate to severe dementia in Norway consult their GP less often than persons with mild or no dementia. This could indicate a need for better interaction between the municipal care and social services and the general practitioners.
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