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Change in psychotropic drug use in Norwegian nursing homes between 2004 and 2011.

https://arctichealth.org/en/permalink/ahliterature297761
Source
Int Psychogeriatr. 2018 03; 30(3):385-394
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
03-2018
Author
G Selbæk
S I M Janus
S Bergh
K Engedal
S Ruths
A S Helvik
J Šaltyte Benth
S U Zuidema
Author Affiliation
Norwegian National Advisory Unit on Ageing and Health,Vestfold Hospital Trust,Tønsberg,Norway.
Source
Int Psychogeriatr. 2018 03; 30(3):385-394
Date
03-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Aged, 80 and over
Antipsychotic Agents - therapeutic use
Behavioral Symptoms - drug therapy - psychology
Cognition Disorders - drug therapy - psychology
Cohort Studies
Dementia - drug therapy - psychology
Drug Utilization - statistics & numerical data
Female
Homes for the Aged
Humans
Length of Stay - statistics & numerical data
Male
Norway - epidemiology
Nursing Homes - statistics & numerical data
Psychotic Disorders - drug therapy - epidemiology
Psychotropic Drugs - administration & dosage - therapeutic use
Abstract
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
PubMed ID
28988552 View in PubMed
Less detail

The course of neuropsychiatric symptoms in patients with dementia in Norwegian nursing homes.

https://arctichealth.org/en/permalink/ahliterature133198
Source
Int Psychogeriatr. 2011 Oct;23(8):1231-9
Publication Type
Article
Date
Oct-2011
Author
Sverre Bergh
Knut Engedal
Irene Røen
Geir Selbæk
Author Affiliation
Centre of Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway. Sverre.bergh@sykehuset-innlandet.no
Source
Int Psychogeriatr. 2011 Oct;23(8):1231-9
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Dementia - drug therapy - psychology
Disease Progression
Female
Homes for the Aged - statistics & numerical data
Humans
Incidence
Male
Neuropsychological Tests
Norway
Nursing Homes - statistics & numerical data
Prevalence
Psychotropic Drugs - therapeutic use
Severity of Illness Index
Time Factors
Abstract
Neuropsychiatric symptoms (NPS) are common in patients with dementia, and cause distress for patients. Studies on the prevalence, incidence, persistence and resolution of NPS in patients living in nursing homes are sparse. The aim of this study was to evaluate the course of NPS in patients with dementia living in Norwegian nursing homes.
169 patients from seven Norwegian nursing homes were assessed five times over a period of 16 months with the Neuropsychiatric Inventory (NPI). The severity and the frequency of the NPI were analyzed.
91.7% of the patients had at least one clinically significant NPS at one or more assessments over the 16 months. Irritability (63.5%), agitation (51.0%) and disinhibition (50.0%) had the highest cumulative prevalence, while irritability (42.6%), disinhibition (37.8%) and depression (31.5%) showed the highest cumulative incidence. Delusion, agitation and irritability were enduring symptoms while the other symptoms had high resolution rates. The severity of the NPS did not vary significantly over time.
Almost every patient in Norwegian nursing homes had at least one clinically significant NPS over 16 months, but individual NPS show a fluctuating course. This should influence how we monitor and treat NPS in patients with dementia.
PubMed ID
21729409 View in PubMed
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Direct and indirect risk associated with the use of dietary supplements among persons with dementia in a Norwegian memory clinic.

https://arctichealth.org/en/permalink/ahliterature285209
Source
BMC Complement Altern Med. 2017 May 12;17(1):261
Publication Type
Article
Date
May-12-2017
Author
Hilde Risvoll
Trude Giverhaug
Kjell H Halvorsen
Marit Waaseth
Frauke Musial
Source
BMC Complement Altern Med. 2017 May 12;17(1):261
Date
May-12-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Dementia - drug therapy - psychology
Dietary Supplements - adverse effects - utilization
Drug Interactions
Humans
Memory - drug effects
Middle Aged
Norway
Surveys and Questionnaires
Young Adult
Abstract
The use of dietary supplements (DS) is common among persons with dementia. Direct risks associated with DS use include adverse events and DS-drug interactions. A direct risk is a risk caused by the treatment itself. Indirect risks are related to the treatment setting, such as the conditions of use, and not to the treatment itself. Because dementia symptoms may reduce a person's ability to cope with the administration of DS, the use of DS may pose a threat to safety as an indirect risk. The aim of this study was to describe the extent of DS use among persons with dementia in ambulatory care and to identify some relevant direct and indirect risks related to DS use.
We conducted a survey among 151 persons with dementia attending an outpatient memory clinic in Northern Norway. Study measurements included: the participants' characteristics, cognitive functioning, functioning in the activities of daily living (ADL), and the use of DS and prescription drugs (PD). We assessed direct risks by evaluating potential DS-drug interactions and indirect risks by evaluating the conditions under which it was used.
Forty-six percent (n = 70) of the persons with dementia used DS. Ninety-seven percent (n = 147) used PD. We found potentially clinically relevant DS-drug interactions representing a direct risk in eight persons with dementia (11% of users). While only 36% (n = 26) of the participants received assistance with the administration of DS, 73% (n = 106) received assistance with the administration of PD. Persons with dementia living alone were at risk of not receiving assistance, as home care service seldom was involved in DS administration. Data indicated that assistance with DS administration was not provided for all persons with dementia in need, representing an indirect risk to these persons. Only one-third of the persons with dementia and half of the caregivers were aware of the general risks of adverse events and interactions associated with the use of DS.
Persons with dementia use DS frequently, yet DS use may be associated with direct and indirect risks to patient safety as potentially clinically relevant interactions were discovered and DS intake often was unsupervised.
Notes
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PubMed ID
28494750 View in PubMed
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Long-term treatment of elderly individuals with emotional disturbances: an open study with citalopram.

https://arctichealth.org/en/permalink/ahliterature46473
Source
Int Psychogeriatr. 1996;8(4):659-68
Publication Type
Article
Date
1996
Author
H. Ragneskog
S. Eriksson
I. Karlsson
C G Gottfries
Author Affiliation
Department of Clinical Neuroscience, Göteborg University, Mölndal, Sweden.
Source
Int Psychogeriatr. 1996;8(4):659-68
Date
1996
Language
English
Publication Type
Article
Keywords
Affective Symptoms - drug therapy - psychology
Aged
Alzheimer Disease - drug therapy - psychology
Antidepressive Agents - administration & dosage - adverse effects
Anxiety Disorders - drug therapy - psychology
Citalopram - administration & dosage - adverse effects
Comorbidity
Dementia - drug therapy - psychology
Depressive Disorder - drug therapy - psychology
Female
Humans
Long-Term Care
Male
Sweden
Treatment Outcome
Abstract
In the present open study, the long-term safety, tolerability, and efficacy of citalopram in the treatment of elderly people with emotional disturbances were studied. One hundred twenty-three elderly patients with symptoms of depression-anxiety were included. Most of the patients (76%) were demented. Fifty-two patients completed a 12-month treatment. Irritability, depressed mood, anxiety, restlessness, and fear-panic were significantly reduced. The severity of illness from baseline to Month 9 was rated as significantly improved. The side effects were infrequent and mostly mild.
PubMed ID
9147178 View in PubMed
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Mental and physical capacity and consumption of neuroleptic drugs in residents of homes for aged people.

https://arctichealth.org/en/permalink/ahliterature230432
Source
Acta Psychiatr Scand. 1989 Aug;80(2):170-3
Publication Type
Article
Date
Aug-1989
Author
H A Nygaard
K J Bakke
K. Breivik
Author Affiliation
Fyllingsdalen Nursing Home, Bergen, Norway.
Source
Acta Psychiatr Scand. 1989 Aug;80(2):170-3
Date
Aug-1989
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Antipsychotic Agents - administration & dosage
Arousal - drug effects
Dementia - drug therapy - psychology
Dose-Response Relationship, Drug
Female
Homes for the Aged
Humans
Male
Mental Processes - drug effects
Middle Aged
Norway
Abstract
The mental and physical capacity of all residents in homes for aged people were estimated, and their neuroleptic drug consumption and duration of stay were registered. One third was moderately to severely mentally impaired and 38% demanded more extensive nursing care. Physical dependence was significantly associated with mental decline, and less with age. One quarter of severely mentally impaired people had stayed for less than one year; 23% of the residents received neuroleptic drugs. Treatment was more common in physically incapacitated people together with wandering and aggressive ones. Lack of psychogeriatric services may enhance the use of neuroleptic drugs in homes for aged people.
PubMed ID
2572147 View in PubMed
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Potentially inappropriate medications and drug-drug interactions in home-dwelling people with mild dementia.

https://arctichealth.org/en/permalink/ahliterature294470
Source
Int J Geriatr Psychiatry. 2017 02; 32(2):183-192
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
02-2017
Author
Ragnhild Oesterhus
Dag Aarsland
Hogne Soennesyn
Arvid Rongve
Geir Selbaek
Svein R Kjosavik
Author Affiliation
Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
Source
Int J Geriatr Psychiatry. 2017 02; 32(2):183-192
Date
02-2017
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Aged, 80 and over
Cross-Sectional Studies
Dementia - drug therapy - psychology
Drug Interactions
Female
Humans
Inappropriate Prescribing - statistics & numerical data
Male
Middle Aged
Multivariate Analysis
Norway
Polypharmacy
Psychotropic Drugs - therapeutic use
Risk factors
Abstract
The objectives of this study were to describe the use of psychotropic drugs among home-dwelling people with mild dementia, to identify potentially inappropriate medications (PIM) and drug-drug interactions (DDI), and to analyze potential variables associated with having PIM and DDI.
Patients (n?=?251) with a first-time diagnosis of mild dementia (defined as a mini-mental state examination score >20) were included from outpatient clinics. Prevalence of psychotropic drug use, polypharmacy, and psychotropic polypharmacy were investigated. The prevalence of PIM and DDI were defined using the Norwegian general practice criteria and an interactions database, respectively. Variables associated with having PIM and DDI were assessed using a multivariable logistic regression analysis adjusting for relevant demographic and clinical variables.
Almost 96% of the patients used one or more medications. Polypharmacy was found in 45% of the patients, and nearly 70% of the patients were using one or more psychotropic drugs. Psychotropic polypharmacy was found in seven patients. PIM were identified in 35 patients (14%), while only four severe DDI were found. Female sex and number of medications were significantly associated with having PIM, whereas only number of medications was significantly associated with having DDI.
Few patients had PIM or severe DDI, indicating that the quality of prescribing was acceptable. However, psychotropic drug use was common in home-dwelling people with mild dementia despite limited evidence of benefit in dementia. More knowledge is needed about the potential risks associated with psychotropic drug use and having PIM and DDI in people with mild dementia. Copyright © 2016 John Wiley & Sons, Ltd.
PubMed ID
26924491 View in PubMed
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A psychometric evaluation of a Swedish version of the Quality of Life in Late-Stage Dementia (QUALID) scale.

https://arctichealth.org/en/permalink/ahliterature94074
Source
Int Psychogeriatr. 2007 Dec;19(6):1040-50
Publication Type
Article
Date
Dec-2007
Author
Falk Hanna
Persson Lars-Olof
Wijk Helle
Author Affiliation
Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden. gusfalkh@student.gu.se
Source
Int Psychogeriatr. 2007 Dec;19(6):1040-50
Date
Dec-2007
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - psychology
Aged
Aged, 80 and over
Cross-Cultural Comparison
Dementia - drug therapy - psychology
Female
Health Status Indicators
Homes for the Aged
Humans
Language
Male
Mental Status Schedule - statistics & numerical data
Nursing Homes
Psychometrics - statistics & numerical data
Quality of Life - psychology
Questionnaires
Reproducibility of Results
Sweden
Abstract
BACKGROUND: The aim of the present study was to evaluate the validity, reliability and responsiveness of a Swedish translation of the Quality of Life in Late-Stage Dementia (QUALID) Scale. METHOD: A total of 169 elderly residents at 19 dementia special care units in eight long-term care facilities in the Gothenburg city region participated in the study. Assessments were made by 107 proxy informants. RESULTS: Results showed satisfactory levels of internal consistency reliability (Cronbach's alpha coefficients 0.74), acceptable inter-rater reliability between informants (0.69), and high test-retest reliability (0.86). As hypothesized, QUALID scores were also associated with those from other quality-of-life (QoL) indices (criterion validity), as well as with use of psychoactive drugs, and with tests of cognitive impairment (clinical validity). The responsiveness of the questionnaire was also acceptable. CONCLUSIONS: As important clinical decisions may derive from perceived QoL effects, it is vital that the QoL data be reliable, valid and sensitive to change. Our evaluations of the psychometric properties of the Swedish QUALID indicate that it satisfactorily meets the need for an instrument to assess QoL in late-stage dementia in Sweden, in a wide range of settings and applications.
PubMed ID
17697438 View in PubMed
Less detail

Psychotropic drug use among people with dementia--a six-month follow-up study.

https://arctichealth.org/en/permalink/ahliterature106308
Source
BMC Pharmacol Toxicol. 2013;14:56
Publication Type
Article
Date
2013
Author
Maria Gustafsson
Stig Karlsson
Yngve Gustafson
Hugo Lövheim
Author Affiliation
Department of Pharmacology and Clinical Neurosciences, Division of Clinical Pharmacology and Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden. maria.gustafsson@pharm.umu.se.
Source
BMC Pharmacol Toxicol. 2013;14:56
Date
2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Cognition - drug effects
Dementia - drug therapy - psychology
Drug Prescriptions - statistics & numerical data
Drug Utilization Review - statistics & numerical data
Follow-Up Studies
Health Services for the Aged
Homes for the Aged
Humans
Logistic Models
Psychotropic Drugs - administration & dosage - adverse effects - therapeutic use
Social Behavior
Sweden
Abstract
Psychotropic drugs are widely used among old people with dementia but few studies have described long-term treatment in this group of patients. The purpose of this study was to explore the long-term use of psychotropic drugs in old people with dementia.
Data on psychotropic drug use, functioning in the activities of daily living (ADL), cognitive function and behavioral and psychological symptoms were collected at baseline and six months later, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The data were collected in 2005-2006. Detailed data about the prescribing of psychotropic drugs were collected from prescription records. This study was conducted in 40 specialized care units in northern Sweden, with a study population of 278 people with dementia.
At the start of the study, 229 of the participants (82%) were prescribed at least one psychotropic drug; 150 (54%) used antidepressants, 43 (16%) used anxiolytics, 107 (38%) used hypnotics and sedatives, and 111 (40%) used antipsychotics. Among the baseline users of antidepressants, anxiolytics, hypnotics and sedatives and antipsychotics, 67%, 44%, 57% and 57% respectively, still used the same dose of the same psychotropic drug after six months. Associations were found between behavioral and psychological symptoms and different psychotropic drugs.
Psychotropic drug use was high among people with dementia living in specialized care units and in many cases the drugs were used for extended periods. It is very important to monitor the effects and adverse effects of the prescribed drug in this frail group of people.
Notes
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PubMed ID
24196341 View in PubMed
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Stopping antipsychotic drug therapy in demented nursing home patients: a randomized, placebo-controlled study--the Bergen District Nursing Home Study (BEDNURS).

https://arctichealth.org/en/permalink/ahliterature93546
Source
Int J Geriatr Psychiatry. 2008 Sep;23(9):889-95
Publication Type
Article
Date
Sep-2008
Author
Ruths Sabine
Straand Jørund
Nygaard Harald A
Aarsland Dag
Author Affiliation
Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway. sabine.ruths@isf.uib.no
Source
Int J Geriatr Psychiatry. 2008 Sep;23(9):889-95
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antipsychotic Agents - therapeutic use
Benzodiazepines - therapeutic use
Dementia - drug therapy - psychology
Double-Blind Method
Female
Haloperidol - therapeutic use
Humans
Long-Term Care
Male
Neuropsychological Tests
Norway
Nursing Homes
Risperidone - therapeutic use
Withholding Treatment
Abstract
BACKGROUND: Despite modest efficacy, unpredictable individual utility, and a high rate of adverse effects, behavioural and psychological symptoms of dementia (BPSD) are common determinants for antipsychotic drug therapy in nursing home patients. AIMS: To explore the impact on BPSD of stopping long-term antipsychotic treatment in nursing home patients with dementia. METHODS: Fifty-five patients (43 women; mean age 84.1) taking haloperidol, risperidone, or olanzapine for BPSD were randomly assigned to cessation (intervention group, n=27) or continued treatment with antipsychotic drugs (reference group, n=28) for 4 consecutive weeks. The Neuropsychiatric Inventory (NPI) Questionnaire was used to examine changes in behavioural and psychological symptoms. RESULTS: By study completion, 23 of the 27 intervention group patients were still off antipsychotics. Symptom scores (NPI) remained stable or even improved in 42 patients (intervention group, 18 out of 27; reference group, 24 out of 28; p=0.18). As compared to patients with stable or improved symptom scores, patients with behavioural deterioration after antipsychotic cessation used higher daily drug doses at baseline (p=0.42). CONCLUSION: A large share of elderly nursing home patients on long-term treatment with antipsychotics for BPSD, do well without this treatment. Standardized symptom evaluations and drug cessation attempts should therefore be undertaken at regular intervals.
Notes
Comment In: Curr Psychiatry Rep. 2009 Feb;11(1):419187700
PubMed ID
18306150 View in PubMed
Less detail

Treatment of depression in elderly patients with and without dementia disorders.

https://arctichealth.org/en/permalink/ahliterature46613
Source
Int Clin Psychopharmacol. 1992 Jun;6 Suppl 5:55-64
Publication Type
Article
Date
Jun-1992
Author
C G Gottfries
I. Karlsson
A L Nyth
Author Affiliation
Department of Psychiatry and Neurochemistry, University of Gothenborg, Mölndals Hospital, Sweden.
Source
Int Clin Psychopharmacol. 1992 Jun;6 Suppl 5:55-64
Date
Jun-1992
Language
English
Publication Type
Article
Keywords
Aged
Alzheimer Disease - drug therapy - psychology
Citalopram - adverse effects - therapeutic use
Dementia - drug therapy - psychology
Dementia, Vascular - drug therapy - psychology
Depressive Disorder - drug therapy - psychology
Humans
Neuropsychological Tests
Abstract
In two inter-Nordic multicenter controlled studies the effect of Citalopram on elderly patients with depression and emotional disturbances has been studied. One investigation included 98 patients in whom Alzheimer type dementia (AD/SDAT) and vascular dementia (VD) had been diagnosed, many of whom also had emotional disturbances. After four weeks treatment with Citalopram (10-30 mg/daily) there was significant improvement in confusion, irritability, anxiety, depressed mood and restlessness. No effect was seen on the intellectual capacity or motor performance measured. In the other study, which was a six weeks trial comparing Citalopram and placebo, elderly patients with a treatment-requiring depression were treated. Demented as well as non-demented patients were included. The Hamilton Depression Scale, the Montgomery-Asberg Depression Rating Scale and The Clinical Global Impressions all recorded an effect of Citalopram superior to that of placebo. In both studies depressive symptoms as well as symptoms of agitation, anxiety, restlessness and irritability improved. Citalopram is therefore considered not only an antidepressive drug but also an emotional stabilizer. The drug was well tolerated by elderly often somatically ill patients. Side effects were few.
PubMed ID
1431023 View in PubMed
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11 records – page 1 of 2.