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Moyo P, Corneau E, Cornell PY, Mochel AL, Magid KH, Levy C, Mor V. Antipsychotic initiation and new diagnoses excluded from quality-measure reporting among Veterans in community nursing homes contracted by the Veterans Health Administration in the United States. Int J Methods Psychiatr Res 2022; 31:e1898. [PMID: 34739736 PMCID: PMC8886286 DOI: 10.1002/mpr.1898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/13/2021] [Accepted: 10/21/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To assess whether prevailing antipsychotic use rates in community nursing homes (CNH) influence new initiation of antipsychotics and diagnosis with antipsychotic indications among Veterans. METHODS We used linked 2013-2016 Veterans Administration (VA) data, Medicare claims, Nursing Home Compare, and Minimum Data Set (MDS) assessments. The exposure was the proportion (in quintiles) of all CNH residents prescribed antipsychotics in the quarter preceding a Veteran's admission date. Using adjusted logistic regression, we analyzed two outcomes measured using MDS: antipsychotic initiation, and new diagnosis of an antipsychotic quality-measure exclusionary condition (i.e., schizophrenia, Tourette's syndrome, or Huntington's disease). RESULTS Among 8201 Veterans without an indication for antipsychotics at baseline, 21.1% initiated antipsychotics and 3.5% were newly diagnosed with any exclusionary diagnosis after CNH admission. Schizophrenia accounted for almost all (96.8%) the new diagnoses. Antipsychotic initiation increased with higher CNH antipsychotic use rates: OR = 2.55, 95% CI: 2.08--3.12, quintile 5 versus 1. CNHs with the highest prevalent use of antipsychotics were associated with increased odds of Veterans acquiring an exclusionary diagnosis (OR = 2.09, 95% CI: 1.32-3.32, quintile 5 vs. 1). CONCLUSIONS Incident antipsychotic use is common among Veterans admitted to CNHs. CNH antipsychotic prescribing practices are associated with Veterans being newly diagnosed with antipsychotic prescription indications, primarily schizophrenia.
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Affiliation(s)
- Patience Moyo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Emily Corneau
- Long Term Services and Supports Center of Innovation, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Portia Y Cornell
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Long Term Services and Supports Center of Innovation, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Amy L Mochel
- Long Term Services and Supports Center of Innovation, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Kate H Magid
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Cari Levy
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.,Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Vincent Mor
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Long Term Services and Supports Center of Innovation, Providence VA Medical Center, Providence, Rhode Island, USA
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Effectiveness of Interventions to Improve the Anticholinergic Prescribing Practice in Older Adults: A Systematic Review. J Clin Med 2022; 11:jcm11030714. [PMID: 35160166 PMCID: PMC8836376 DOI: 10.3390/jcm11030714] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pharmacotherapy in older adults is one of the most challenging aspects of patient care. Older people are prone to drug-related problems such as adverse effects, ineffectiveness, underdosage, overdosage, and drug interactions. Anticholinergic medications are associated with poor outcomes in older patients, and there is no specific intervention strategy for reducing drug burden from anticholinergic activity medications. Little is known about the effectiveness of current interventions that may likely improve the anticholinergic prescribing practice in older adults. AIMS This review seeks to document all types of interventions aiming to reduce anticholinergic prescribing among older adults and assess the current evidence and quality of existing single and combined interventions. METHODS We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO from January 1990 to August 2021. Only studies that examined the effect of interventions in older people focused on improving compliance with anticholinergic prescribing guidelines with quantifiable data were included. The primary outcome of interest was to find the effectiveness of interventions that enhance the anticholinergic prescribing practice in older adults. RESULTS We screened 3168 records and ended up in 23 studies that met the inclusion criteria. We found only single-component interventions to reduce anticholinergic prescribing errors in older people. Pharmacists implemented interventions without collaboration in nearly half of the studies (n = 11). Medication review (43%) and education provision (26%) to healthcare practitioners were the most common interventions. Sixteen studies (70%) reported significant reductions in anticholinergic prescribing errors, whereas seven studies (30%) showed no significant effect. CONCLUSION This systematic review suggests that healthcare practitioner-oriented interventions have the potential to reduce the occurrence of anticholinergic prescribing errors in older people. Interventions were primarily effective in reducing the burden of anticholinergic medications and assisting with deprescribing anticholinergic medications in older adults.
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Sanchez S, Chrusciel J, Ndiongue BM, Blochet C, Forget JF, Letty A, Hay PE, Novella JL. Risk Indicators Improve the Prescription Quality of Drugs with Anticholinergic Properties in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010423. [PMID: 35010682 PMCID: PMC8744764 DOI: 10.3390/ijerph19010423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022]
Abstract
AIM The objective of this study was to assess the impact of a collaborative therapeutic optimization program on the rate of potentially inappropriate prescription of drugs with anticholinergic properties in nursing homes. METHODS Quasi-experimental study in 37 nursing homes in France. The intervention included the use of quality indicators for prescriptions combined with educational sessions and dedicated materials for nursing home staff (unlimited access to study material for staff, including nurses, general practitioners, pharmacists). Indicators were calculated based on routine data collected from an electronic pill dispenser system. The primary outcome was the presence of at least one prescription containing ≥1 drug from a list of 12 drugs with anticholinergic properties. A difference-in-differences analysis was conducted at 18 months as well as propensity score weighting to minimize any potential indication bias. A generalized estimating equation model estimated the probability of being prescribed at least one target drug at any time during a 9-month period for each resident. RESULTS In total, 33 nursing homes (intervention group: n = 10; control group: n = 23) were included, totalling 8137 residents. There was a decrease in the use of drugs with anticholinergic properties over time in both groups, as well as a decline in the intervention group compared to the control group (Odds Ratio: 0.685, 95% CI: 0.533, 0.880; p < 0.01) that was attributable to the intervention. An estimated 49 anticholinergic properties drug prescriptions were avoided by the intervention. CONCLUSION This study found that an intervention based on indicators derived from routine prescription data was effective in reducing use of drugs with anticholinergic properties prescriptions in nursing homes.
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Affiliation(s)
- Stéphane Sanchez
- Pole Territorial Santé Publique et Performance, Hôpitaux Champagne Sud, 10003 Troyes, France;
- Fondation Korian Pour le Bien Vieillir, 75008 Paris, France; (B.M.N.); (A.L.); (P.E.H.)
- EA 3797, Santé Publique, Vieillissement, Qualité de vie et Réadaptation des Sujets Fragiles, Université Reims Champagne Ardennes, 51100 Reims, France;
- Correspondence: ; Tel.: +33-25-49-75-61
| | - Jan Chrusciel
- Pole Territorial Santé Publique et Performance, Hôpitaux Champagne Sud, 10003 Troyes, France;
| | - Biné Mariam Ndiongue
- Fondation Korian Pour le Bien Vieillir, 75008 Paris, France; (B.M.N.); (A.L.); (P.E.H.)
| | | | | | - Aude Letty
- Fondation Korian Pour le Bien Vieillir, 75008 Paris, France; (B.M.N.); (A.L.); (P.E.H.)
| | - Paul Emile Hay
- Fondation Korian Pour le Bien Vieillir, 75008 Paris, France; (B.M.N.); (A.L.); (P.E.H.)
| | - Jean Luc Novella
- EA 3797, Santé Publique, Vieillissement, Qualité de vie et Réadaptation des Sujets Fragiles, Université Reims Champagne Ardennes, 51100 Reims, France;
- Pole Autonomie Santé, Centre Hospitalier Universitaire de Reims, 92130 Issy les Moulineaux, France
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Mills J. Nurses Must Consider the Impact of Anticholinergic Medications in Schizophrenia Spectrum Disorders. Issues Ment Health Nurs 2021; 42:887-889. [PMID: 34415828 DOI: 10.1080/01612840.2021.1964828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jeremy Mills
- Peninsula, a Division of Parkwest Medical Center, Knoxville, Tennessee, USA
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Walsh KA, Byrne S, McSharry J, Browne J, Irving K, Hurley E, Rochford-Brennan H, Geoghegan C, Presseau J, Timmons S. Developing a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia. HRB Open Res 2021; 4:23. [PMID: 34136749 PMCID: PMC8185579 DOI: 10.12688/hrbopenres.13228.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Antipsychotics are commonly prescribed to people living with dementia in nursing home settings, despite strong guideline recommendations against their use except in limited circumstances. We aimed to transparently describe the development process for a complex intervention targeting appropriate requesting and prescribing of antipsychotics to nursing home residents with dementia in Ireland, by nurses and general practitioners (GPs) respectively. Methods: We report the development process for the ‘Rationalising Antipsychotic Prescribing in Dementia’ (RAPID) complex intervention, in accordance with the ‘Guidance for reporting intervention development studies in health research’ (GUIDED) checklist. The UK Medical Research Council framework for developing and evaluating complex interventions guided our overall approach, incorporating evidence and theory into the intervention development process. To unpack the intervention development process in greater detail, we followed the Behaviour Change Wheel approach. Guided by our stakeholders, we conducted three sequential studies (systematic review and qualitative evidence synthesis, primary qualitative study and expert consensus study), to inform the intervention development. Results: The RAPID complex intervention was developed in collaboration with a broad range of stakeholders, including people living with dementia and family carers, between 2015 and 2017. The finalised RAPID complex intervention was comprised of the following three components; 1) Education and training sessions with nursing home staff; 2) Academic detailing with GPs; 3) Introduction of an assessment tool to the nursing home. Conclusions: This paper describes the steps used by the researchers to develop a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia in Ireland, according to the GUIDED checklist. We found that the GUIDED checklist provided a useful way of reporting all elements in a cohesive manner and complemented the other tools and frameworks used. Transparency in the intervention development processes can help in the translation of evidence into practice.
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Affiliation(s)
- Kieran A Walsh
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, T12XH60, Ireland.,Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, T12YN60, Ireland.,School of Public Health, University College Cork, Cork, T12K8AF, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, T12YN60, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91TK33, Ireland
| | - John Browne
- School of Public Health, University College Cork, Cork, T12K8AF, Ireland
| | - Kate Irving
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Eimir Hurley
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Helen Rochford-Brennan
- Expert by Experience, N/A, N/A, Ireland.,Irish Dementia Working Group, The Alzheimer Society of Ireland, Dublin, Ireland
| | | | - Justin Presseau
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, K1G 5Z3, Canada
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, T12XH60, Ireland
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Kijowska V, Barańska I, Szczerbińska K. Relationship between administrative characteristics of long-term care institutions and use of antipsychotics and anxiolytics in residents with cognitive impairment. Int J Geriatr Psychiatry 2021; 36:349-359. [PMID: 32909329 DOI: 10.1002/gps.5432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/31/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To identify the facility characteristics that are associated with prescribing practices of typical and atypical antipsychotics, and anxiolytics in residents with cognitive impairment in long-term care (LTC) institutions. METHODS A cross-sectional analysis of a country-representative sample of 23 LTC institutions in Poland was conducted in 2015-2016. Trained staff from each facility used the InterRAI-LTCF tool and drug dispensary cards on the day of resident's assessment to collect data on medication use from 455 residents with cognitive impairment. We used the anatomical therapeutic chemical classification and a multiple correspondence analysis. RESULTS We identified facility characteristics associated with higher rate of prescribing of: typical antipsychotics (nursing home, private ownership status, higher staff/bed ratio of physicians and nurses, and lower as refers to care assistants); atypical antipsychotics (residential home, public ownership status, higher staff/bed ratio of care assistants, and lower as refers to physicians); and anxiolytics (residential home, facilities of small size, public ownership status, higher staff/bed ratio of care assistants, lower of nurses and physicians). In the facilities where less residents received typical antipsychotics, anxiolytics were prescribed more often, and vice versa (rho = -0.442; p = 0.035). CONCLUSION This study showed a considerable variation in the use of typical and atypical antipsychotics, and anxiolytics between nursing and residential homes, which was associated with their organization (type, size, ownership status, and employment rate). We found a negative correlation between prescribing typical antipsychotics and anxiolytics, which made us aware that these medications may be used interchangeably in LTC facilities, despite the fact that both should be avoided.
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Affiliation(s)
- Violetta Kijowska
- Laboratory for Research on Aging Society, Department of Sociology of Medicine, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Ilona Barańska
- Laboratory for Research on Aging Society, Department of Sociology of Medicine, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Szczerbińska
- Laboratory for Research on Aging Society, Department of Sociology of Medicine, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Grill P, Marwick C, De Souza N, Burton JK, Hughes C, Guthrie B. The burden of psychotropic and anticholinergic medicines use in care homes: population-based analysis in 147 care homes. Age Ageing 2021; 50:183-189. [PMID: 32706851 DOI: 10.1093/ageing/afaa122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND older people living in care-homes are particularly vulnerable to adverse effects of psychotropic and anticholinergic drugs. METHODS anonymised dispensed prescription data from all 4,478 residents aged ≥ 60 years in 147 care-homes in two Scottish health boards were analysed. Psychotropic medicines examined were antipsychotics, antidepressants, hypnotic/anxiolytics, opioids and gabapentinoids. Anticholinergic burden was measured using the modified anticholinergic risk scale (mARS). Variation between care-homes and associations with individual and care-home characteristics were examined using multilevel logistic regression. RESULTS 63.5% of residents were prescribed at least one psychotropic drug, and 27.0% two or more, most commonly antidepressants (41.6%), opioids (20.3%), hypnotic/anxiolytics (16.9%) and antipsychotics (16.7%). 48.1% were prescribed an anticholinergic drug, and 12.1% had high anticholinergic burden (mARS ≥ 3). Variation between care-homes was high for antipsychotics (intra-cluster correlation coefficient [ICC] 8.2%) and hypnotics/anxiolytics (ICC = 7.3%), and moderate for antidepressants (ICC = 4.7%) and anticholinergics (ICC = 2.8%). Prescribing of all drugs was lower in the oldest old. People with dementia were more likely to be prescribed antipsychotics (adjusted OR = 1.45, 95%CI 1.23-1.71) but less likely to be prescribed anticholinergics (aOR = 0.61, 95%CI 0.51-0.74). Prescribing of antipsychotics was higher in Tayside (aOR = 1.52, 95%CI 1.20-1.92), whereas prescribing of antidepressants (particularly tricyclic-related) was lower (aOR = 0.66, 95%CI 0.56-0.79). There was no association with care-home regulator quality scores. CONCLUSION care-home residents have high psychotropic and anticholinergic burden, with considerable variation between care-homes that is not related to existing measures of quality of care. Research to better understand variation between care-homes and the interaction with local prescribing cultures is needed.
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Affiliation(s)
- Paula Grill
- Undergraduate Medical Student, School of Medicine, University of Dundee, Dundee, UK
| | - Charis Marwick
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Nicosha De Souza
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Jennifer Kirsty Burton
- Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Carmel Hughes
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - Bruce Guthrie
- Usher Institute, School of Medicine, University of Edinburgh, Edinburgh, UK
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El Haddad K, de Souto Barreto P, de Mazieres CL, Rolland Y. Effect of a geriatric intervention aiming to improve polypharmacy in nursing homes. Eur Geriatr Med 2020; 11:863-868. [PMID: 32462509 DOI: 10.1007/s41999-019-00279-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/05/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To examine the effect of an intervention comprising professional support by a geriatrician engaged in a quality care indicators' audit for nursing home (NH) staff on reducing polypharmacy. METHODS Of a total of 3709 NH residents, 90 NHs (2026 residents) were allocated to a light intervention and 85 NHs (1683 residents) to a strong intervention group. RESULTS Mixed-effect linear model found no significant variation in the total number of medications over time (β-coefficient for interaction 0.007, 95% CI - 0.15, 0.16). Within-group-adjusted mean differences showed a statistical decline in the psychotropic medication class (- 0.04 SE 0.02 p 0.03 for the strong intervention group and - 0.06 SE 0.02 p 0.001 for the light intervention group) and a statistically significant increase in the analgesics use. CONCLUSION The possibility that a simple audit intervention might reduce psychotropic prescriptions deserves further investigation.
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Affiliation(s)
- Kamal El Haddad
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, 31059, Toulouse, France.
- Institut du Vieillissement, Gérontopôle, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000, Toulouse, France.
| | - Philipe de Souto Barreto
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, 31059, Toulouse, France
- INSERM U1027, University of Toulouse III, Toulouse, France
| | - Clarisse Laffon de Mazieres
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, 31059, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, 31059, Toulouse, France
- INSERM U1027, University of Toulouse III, Toulouse, France
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Liu YP, Chien WC, Chung CH, Chang HA, Kao YC, Tzeng NS. Are Anticholinergic Medications Associated With Increased Risk of Dementia and Behavioral and Psychological Symptoms of Dementia? A Nationwide 15-Year Follow-Up Cohort Study in Taiwan. Front Pharmacol 2020; 11:30. [PMID: 32116707 PMCID: PMC7033580 DOI: 10.3389/fphar.2020.00030] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/13/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/OBJECTIVE In previous reports, the usage of anticholinergic medications has been associated with an increased risk of dementia with prolonged usage or with a high Anticholinergic Cognitive Burden (ACB). This study aimed to investigate the association between anticholinergic medications and the risk of dementia using data from Taiwan's National Health Research Database (NHIRD). METHODS A total of 790,240 patients, with 197,560 patients receiving anticholinergic medications and 592,680 control patients (1:3) matched for sex, age, and index-year, were enrolled from the two million Longitudinal Health Insurance Dataset, a subdataset of the NHIRD, between 2000 and 2015. The time-dependent Cox regression analysis was used to explore the hazard ratio (HR) with a 95% confidence interval for the association between anticholinergics and the risk of dementia during the 15-year follow-up. The behavioral and psychological symptoms of dementia (BPSD) were recognized by the usage of psychotropics. The ACB ranged from zero to three, divided as score <1, 1-1.9, 2-2.9, 3-4.9,and ≧5. The sensitivity analysis was done by excluding the diagnoses of dementia in the first 2 or 4 years after anticholinergic usage. RESULTS In the anticholinergic usage cohort, the HR was 1.043 (95% CI = 0.958-1.212, p = 0.139) without a significant difference. The sensitivity analysis revealed no association between the usage of anticholinergics and the risk of dementia. Anticholinergic usage was not associated with BPSD. Male sex, patients of ages of 60-64 and ≧80, usage of antiparkinsonian medications, a history of Parkinson's disease, epilepsy, urinary incontinence, depression, bipolar disorder, and psychotic disorder were independent risk factors of dementia. Increased HRs for dementia were associated with an ACB ≥ 5 and an anticholinergic usage period ≥ 1,460 days. CONCLUSION In this study, the usage of anticholinergics was not associated with the risk of dementia or BPSD in a 15-year follow-up study. However, patients with the male sex, patients with ages of 65-79 and ≧80, patients with some comorbidities, high ACB scores, and long anticholinergic treatment duration were associated with the risk of dementia.
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Affiliation(s)
- Yia-Ping Liu
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Laboratory of Cognitive Neuroscience, Departments of Physiology and Biophysics, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Graduate of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
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10
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Laffon de Mazières C, Lapeyre-Mestre M, Vellas B, de Souto Barreto P, Rolland Y. Impact of a geriatric intervention conducted in nursing homes on inappropriate prescriptions of antipsychotics. Eur Geriatr Med 2019; 10:285-293. [PMID: 34652759 DOI: 10.1007/s41999-018-00155-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To study the effect of a quality assurance approach in a nursing home, with or without the intervention of a geriatrician, on the potentially inappropriate prescription of antipsychotics (PIPA) at 18 months; and to identify the factors associated with PIPA after 18 months of intervention (T18). METHODS We used data from a multicentre individually tailored controlled trial (IQUARE study). The study population comprised residents included in the IQUARE study with at least one potentially inappropriate prescription of antipsychotics at baseline (T0) who were still in nursing home at T18 (n = 636; nursing homes = 175). The control group received individual feedback from the quality assurance audit performed at baseline. The intervention group also had at least 5 collaborative work meetings with a geriatrician over an 18-month period. We used a multilevel logistic regression model. RESULTS The rates of inappropriate antipsychotic drug prescribing were 66.5% and 45.2% at T0 and T18, respectively. This decrease in the rate of PIPA is significant (p < 0.001). A significant decrease was found within each group: in the intervention arm (68.1% at T0 vs. 44.6% at T18; p < 0.001) and in the control arm (65.2% at T0 vs. 45.6% at T18; p < 0.001). Multivariate analysis did not highlight any statistically significant association between living in a nursing home having received an intervention and PIPA at T18. CONCLUSIONS Collaborative work meetings with a geriatrician does not provide significant added value to a global quality assurance approach towards PIPA. Individual feedback to each nursing home appears to have a substantial impact on decreasing PIPA.
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Affiliation(s)
- Clarisse Laffon de Mazières
- Department of Geriatric Medicine, Toulouse University Hospital (CHU de Toulouse), Gérontopôle, Toulouse, France. .,Inserm UMR 1027, 37 Allées Jules Guesde, Toulouse, France.
| | - Maryse Lapeyre-Mestre
- Inserm UMR 1027, 37 Allées Jules Guesde, Toulouse, France.,Department of Medical and Clinical Pharmacology, CIc 1436, CHU de Toulouse, 37 Allées Jules Guesde, Toulouse, France
| | - Bruno Vellas
- Department of Geriatric Medicine, Toulouse University Hospital (CHU de Toulouse), Gérontopôle, Toulouse, France.,Inserm UMR 1027, 37 Allées Jules Guesde, Toulouse, France
| | - Philipe de Souto Barreto
- Department of Geriatric Medicine, Toulouse University Hospital (CHU de Toulouse), Gérontopôle, Toulouse, France.,Inserm UMR 1027, 37 Allées Jules Guesde, Toulouse, France
| | - Yves Rolland
- Department of Geriatric Medicine, Toulouse University Hospital (CHU de Toulouse), Gérontopôle, Toulouse, France.,Inserm UMR 1027, 37 Allées Jules Guesde, Toulouse, France
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