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Molleman PW, Zoomer-Hendriks MPD, Wetzels RB. [Canopy-enclosed bed: the state of the art]. Ned Tijdschr Geneeskd 2021; 165:D5605. [PMID: 34346596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Due to the persistence and complexity of problem behaviour in patients with dementia, doctors often prescribe psychotropic drugs for long periods of time. The need for psychosocial interventions in patients with dementia and psychological or psychiatric problems remains high and, according to the existing guidelines on problem behavior, they are the treatment of first choice. 5 years ago we described that the canopy-enclosed bed seemed to be able to meet this need. We observed that within a few weeks of patients getting a canopy-enclosed bed, psychotropic drugs could be reduced or even stopped. In this article, we would like to argue once again for more research into psychosocial interventions for problem behaviour.
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Kentin ZHA, Hopman T, Mulder A, Dauwerse L, Luijendijk HJ, Wetzels RB, Munster BCV. [Is the approach of delirium in Dutch nursing-homes in accordance with the national guideline?]. Tijdschr Gerontol Geriatr 2019; 50. [PMID: 32951372 DOI: 10.36613/tgg.1875-6832/2019.02.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Delirium is a common disorder, affecting many patients in nursing-homes, with large impact on patients. Implementation of good care and treatment can potentially prevent development of a delirium or may reduce the severity or duration. This research was conducted to get an impression of delirium care in Dutch nursing homes, and of the implementation of the recommendations of the national guideline. OBJECTIVES 1. How many Dutch nursing homes have a local protocol for delirium?2. To what extend do doctors, specialised in care for older people in nursing homes, screen, diagnose and treat delirium according to the Dutch guideline for delirium? METHODS Between June and December 2016, Dutch nursing homes were approached with an online questionnaire. Data were collected in Survey Monkey and descriptive analyses were performed. RESULTS 68 nursing homes were included. 32% of the nursing homes had a local delirium protocol. 48% of the doctors knew about the national guideline delirium, 60% used preventive measures, and screening instruments were used in 98%. 29% used diagnostic criteria. Non-medical interventions were applied by 96%. In 98%, haloperidol was the drug of first choice. Preventive antipsychotics were prescribed by 21%. CONCLUSIONS Only a third of the organisations developed a local delirium protocol. Standardising delirium care by a local delirium protocol, with special attention for prevention, diagnostics and aftercare of delirium, can be an important step in improving the quality of care in nursing homes.
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Affiliation(s)
| | | | | | | | - Hendrika J Luijendijk
- UMC Groningen, afdeling Huisartsgeneeskunde en Ouderengeneeskunde, Groningen, Netherlands
| | | | - Barbara C van Munster
- Universitair Medisch Centrum Groningen, Afdeling Interne Geneeskunde, Groningen, Netherlands, Groningen, Nederland
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Abstract
BACKGROUND During the course of dementia, most people develop some type of neuropsychiatric symptoms (NPS), which result in lower quality of life, high caregiver burden, psychotropic drug use and a major risk of institutionalization. Studies on NPS in people with dementia have been mainly conducted in clinical centres or psychiatric services. OBJECTIVES To investigate the course of NPS in people with dementia in primary care. METHODS Analysis of (cumulative) prevalence and incidence, persistence and resolution based on data collected during an assessment at home of a prospective naturalistic cohort study in primary care in a sample of 117 people with dementia and their informal caregivers. Subsyndromes of NPS were assessed with the Neuropsychiatric Inventory (NPI) and Cohen-Mansfield Agitation Inventory. Multivariate analyses were used to detect determinants for the course of NPS. RESULTS The mean age of the people with dementia was 78.6 years, and 52% were female. Mean Mini-Mental State Examination total score was 19.5, mean NPI total score 15.7. The most prevalent clinically relevant subsyndromes of the NPI were hyperactivity and mood/apathy, and the most prevalent individual NPS were aberrant motor behaviour (28%), agitation/aggression (24%) and apathy/indifference (22%). Of the people with dementia, 72.3% had one or more symptoms of the mood/apathy and 75.3% of the hyperactivity subsyndrome. CONCLUSIONS GPs should be aware of NPS in people with dementia and should actively identify them when they visit these patients or when informal caregivers consult them. Timely diagnosing facilitates adequate professional care.
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Affiliation(s)
- Petra Borsje
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Thebe, Region South-East, Goirle, The Netherlands
| | - Peter L B J Lucassen
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Bor
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roland B Wetzels
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne Margriet Pot
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands.,Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Joachim and Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
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van der Zon A, Wetzels RB, Bor H, Zuidema SU, Koopmans RTCM, Gerritsen DL. Two-Year Course of Quality of Life in Nursing Home Residents with Dementia. Am J Geriatr Psychiatry 2018; 26:754-764. [PMID: 29477831 DOI: 10.1016/j.jagp.2018.01.202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess the course of quality of life (QoL) in nursing home residents with dementia and to study its predictors. METHODS This longitudinal, multicenter, observational cohort study with a 2-year follow-up looked at 290 residents with dementia, who lived in 14 dementia special care units in nine nursing homes in the Netherlands. QoL was assessed with the Qualidem, providing a total score and QoL profile with nine subscales. Residents were assessed at five assessments: every 6 months during 2 years. A linear mixed model was used for data analysis. RESULTS No change was found in the Qualidem total score (range: 0-111) over 2 years. However, a significant increase of QoL over time was seen in the subscales "Care relationship," "Negative affect," "Restless tense behavior," "Positive self-image," "Social isolation," and "Feeling at home." A significant decrease of QoL was seen in the subscales "Positive affect," "Social relations," and "Having something to do." Most predictors of the course of Qol were found for the subscales "Positive self-image" (sex, Global Deterioration Scale, Severe Impairment Battery, Activities of Daily Living, and Neuropsychiatric Inventory) and "Having something to do" (Global Deterioration Scale, Severe Impairment Battery, and Activities of Daily Living). Sex and Neuropsychiatric Inventory at baseline were the predictors found most frequently. CONCLUSION The total QoL score was stable over a 2-year period. However, QoL subscales showed multidirectional changes. The largest QoL decline in the subscale "Having something to do" suggests that more attention should be given to useful activities in nursing home care.
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Affiliation(s)
- Anne van der Zon
- Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands; De Waalboog, Center for Specialized Geriatric Care "Joachim en Anna", Nijmegen, The Netherlands.
| | - Roland B Wetzels
- Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands; Pleyade, Elderly Care Organization, Arnhem, The Netherlands
| | - Hans Bor
- Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands; De Waalboog, Center for Specialized Geriatric Care "Joachim en Anna", Nijmegen, The Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
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van der Spek K, Koopmans RTCM, Smalbrugge M, Nelissen-Vrancken MHJMG, Wetzels RB, Smeets CHW, de Vries E, Teerenstra S, Zuidema SU, Gerritsen DL. The effect of biannual medication reviews on the appropriateness of psychotropic drug use for neuropsychiatric symptoms in patients with dementia: a randomised controlled trial. Age Ageing 2018; 47:430-437. [PMID: 29432518 DOI: 10.1093/ageing/afy001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Indexed: 12/31/2022] Open
Abstract
Objective We studied the efficacy of biannual structured medication reviews to improve the appropriateness of psychotropic drug (PD) prescriptions for neuropsychiatric symptoms (NPS) in nursing home patients with dementia. Study Design and Setting In this randomised controlled trial, the intervention encompassed a structured multidisciplinary medication review by physician, pharmacist and nurse. During this 18-month study, the patient's medical files were assessed every 6 months. The primary outcome was the appropriateness of PD prescriptions defined by the Appropriate Psychotropic drug use In Dementia (APID) index sum score, lower scores indicating more appropriate use. Results At baseline, 380 patients were included, of which 222 were randomised to the intervention group. Compared to the control group, the APID index sum score in the intervention group improved significantly for all PD prescriptions (-5.28, P = 0.005). Conclusion We advise the implementation of a structured, repeated medication review with the essential roles of pharmacist, physician and nurse, into daily practice. This work was supported and funded by the Netherlands Organisation for Health Research and Development (ZonMw). Netherlands Trial Register (NTR3569).
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Affiliation(s)
- Klaas van der Spek
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen Huispost 117 ELG, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen Huispost 117 ELG, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Joachim and Anna, Centre for Specialized Geriatric care, Nijmegen, Radboudumc Alzheimer Centrum, Nijmegen
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine/EMGO+ Institute for Health and Care Research, VU Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | | | - Roland B Wetzels
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen Huispost 117 ELG, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Claudia H W Smeets
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen Huispost 117 ELG, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Erica de Vries
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen Huispost 117 ELG, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Steven Teerenstra
- Department for Health Evidence, Group Biostatistics, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen Huispost 133 HEV, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, HPC FA21, PO Box 196, 9700 AD Groningen
| | - Debby L Gerritsen
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen Huispost 117 ELG, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Radboudumc Alzheimer Centrum, Nijmegen
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Borsje P, Lucassen PLBJ, Wetzels RB, Pot AM, Koopmans RTCM. Neuropsychiatric symptoms and psychotropic drug use in patients with dementia in general practices. Fam Pract 2018; 35:22-28. [PMID: 28985387 DOI: 10.1093/fampra/cmx061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) frequently occur in community-dwelling patients with dementia and they are also frequently prescribed psychotropic drugs. The prescription of psychotropic drugs has been found to be associated with the level of NPS. Data on NPS in patients with dementia in general practices are scarce. OBJECTIVES The aim of this study was to assess the prevalence rates of NPS and psychotropic drug use (PDU) in patients with dementia in general practices. METHODS We analyzed data from the baseline measurement of a prospective cohort study in a sample of (Dutch) patients in general practices. Prevalence rates of NPS and subsyndromes assessed with the Neuropsychiatric Inventory (NPI) and of PDU were calculated. Prevalence rates of individual NPS are presented both as clinically relevant symptoms (NPI symptom score ≥ 4) and as prevalence rates of symptoms with symptom score > 0. RESULTS Of the 117 patients, more than 90% had at least one symptom and more than 65% had at least one clinically relevant symptom. The most common NPS were agitation/aggression, dysphoria/depression and irritability/lability. The most common clinically relevant NPS were aberrant motor behaviour, agitation/aggression and apathy/indifference. Only 28.7% of the patients used at least one, 7.0% used at least two different and 1.7% used at least three different types of psychotropic drugs (excluding anti-dementia medication). CONCLUSIONS NPS are highly prevalent in patients with dementia in general practices, but PDU is rather low. The most common clinically relevant NPS were aberrant motor behaviour, agitation/aggression and apathy/indifference.
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Affiliation(s)
- Petra Borsje
- Department of Primary and Community Care, Alzheimer Centre, Radboud university medical center, Nijmegen, The Netherlands.,Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands.,Thebe, Region South-East, Goirle, The Netherlands
| | - Peter L B J Lucassen
- Department of Primary and Community Care, Alzheimer Centre, Radboud university medical center, Nijmegen, The Netherlands
| | - Roland B Wetzels
- Department of Primary and Community Care, Alzheimer Centre, Radboud university medical center, Nijmegen, The Netherlands
| | - Anne Margriet Pot
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands.,Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Alzheimer Centre, Radboud university medical center, Nijmegen, The Netherlands.,Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands.,Joachim end Anna, Centre for specialized geriatric care, Nijmegen, The Netherlands
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Arons AMM, Wetzels RB, Zwijsen S, Verbeek H, van de Ven G, Ettema TP, Koopmans RTCM, Gerritsen DL. Structural validity and internal consistency of the Qualidem in people with severe dementia. Int Psychogeriatr 2017; 30:1-11. [PMID: 28866990 DOI: 10.1017/s1041610217001405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Since its development, the Qualidem has had items that were considered unsuited for people with very severe dementia. This study attempted to investigate the applicability of all Qualidem items in people with all stages of dementia severity. METHODS Four data sets that contained Qualidem observations on people with dementia were combined. Dementia severity was categorized based on the Global Deterioration Scale (GDS), with a dichotomization of very severe dementia (GDS 7) and others (GDS 1-6). Unidimensional latent-trait models (Mokken scaling) were estimated to fit the Qualidem responses in the overall sample and the dichotomized groups. Scalability was assessed using coefficients of homogeneity (Loevinger's H), while reliability was assessed with Cronbach's α and ρ. RESULTS Combining the four databases resulted in 4,354 Qualidem measurements. The scalability of all scales was considered acceptable in the overall sample, as well is in the subgroups (all H > 0.3). Additionally, the reliability was good-excellent in the scales: "positive affect," "positive self-image," "care relationship," and "negative affect." Reliability was questionable-acceptable for "feeling at home," "social relations," "social isolation," and "restless tense behavior." Reliability was poor for "having something to do." CONCLUSIONS Statistical considerations allow using all Qualidem items in all dementia stages. Future research should determine balance of statistical- versus conceptual-based reasoning in this academic debate.
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Affiliation(s)
| | - Roland B Wetzels
- Department of Primary and Community Care,Centre for Family Medicine,Geriatric Care and Public Health,Radboud University Medical Center,Nijmegen,the Netherlands
| | - Sandra Zwijsen
- Department of General Practice and Elderly Care Medicine,VU University Medical Center,Amsterdam,the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research CAPHRI School for Public Health and Primary Care,Maastricht University,Maastricht,the Netherlands
| | | | | | - Raymond T C M Koopmans
- Department of Primary and Community Care,Centre for Family Medicine,Geriatric Care and Public Health,Radboud University Medical Center,Nijmegen,the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care,Centre for Family Medicine,Geriatric Care and Public Health,Radboud University Medical Center,Nijmegen,the Netherlands
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van der Spek K, Gerritsen DL, Smalbrugge M, Nelissen-Vrancken MH, Wetzels RB, Smeets CH, Zuidema SU, Koopmans RT. A reliable and valid index was developed to measure appropriate psychotropic drug use in dementia. J Clin Epidemiol 2015; 68:903-12. [DOI: 10.1016/j.jclinepi.2015.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 02/03/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
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Molleman PW, van Kesteren JBMH, Ubink-Bontekoe CJM, Zoomer-Hendriks MPD, Wetzels RB. [Canopy-enclosed bed for dementia patients with behavioural problems]. Ned Tijdschr Geneeskd 2015; 159:A9617. [PMID: 26577384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Patients with dementia almost all have one or more symptoms of problem behaviour. This problem behaviour includes a wide range of symptoms including depression, anxiety and apathy, and behavioural problems such as aggression, general restlessness, compulsion to walk, disinhibition and calling, and psychotic disorders such as delusions and hallucinations. Due to the persistence and complexity of problem behaviour in patients with dementia, doctors often prescribe psychotropic drugs for long periods of time. In nursing homes there is a great need for non-pharmacological treatments for patients with psychological or psychiatric problems. The canopy-enclosed bed seems to meet this need and has positive effects. We observed that within a few weeks of patients getting a canopy-enclosed bed, psychotropic drugs could be reduced or even stopped. Using a canopy-enclosed bed is a measure of restraint. Therefore it remains important to carefully trade off its deployment with the intended goal.
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van der Putten MJG, Wetzels RB, Bor H, Zuidema SU, Koopmans RTCM. Antipsychotic drug prescription rates among Dutch nursing homes: the influence of patient characteristics and the dementia special care unit. Aging Ment Health 2014; 18:828-32. [PMID: 24506695 DOI: 10.1080/13607863.2014.884537] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the differences in antipsychotic drug prescription rates in residents with dementia in dementia special care units (SCUs) of Dutch nursing homes, considering the differences in patient characteristics. METHOD As part of the Waalbed-II study, the data on antipsychotic drug use in 290 patients were collected and the Global Deterioration Scale (GDS) stage, type of dementia and behaviour (Cohen-Mansfield Agitation Inventory (CMAI)) were measured in 14 SCUs in nine nursing homes. A multilevel logistic regression model was used to assess the difference in antipsychotic drug prescription rates between dementia SCUs adjusted for age, gender, GDS stage, type of dementia and CMAI factor scores. RESULTS Two hundred and ninety residents met the inclusion criteria. Thirty-two per cent were prescribed an antipsychotic drug. Antipsychotic drugs were more often prescribed in patients with physically aggressive and non-aggressive behaviour and in patients with mixed dementia (vascular/Alzheimer's) than in patients with other types of dementia. Antipsychotic drug prescriptions significantly differed among the dementia SCUs. The odds of antipsychotic drug use for patients in the SCU with the highest prevalence of drug use were 2.76 (95% confidence interval (CI) 1.14-6.69) times as high as for the SCU with the lowest prevalence of drug use, taking the patient characteristics into account. CONCLUSION Antipsychotic drug use in nursing home residents with dementia is not only predicted by the type of dementia and patient behaviour, but it is independently associated with the dementia SCU at which the patient resides. This result indicates that antipsychotic drugs are not only prescribed for their clinical indications (agitation/aggression) but are associated with environmental factors that may reflect a specific nursing home prescribing culture.
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Affiliation(s)
- M J G van der Putten
- a Department of Primary and Community Care, Centre for Family Medicine, Elderly Care Medicine and Public Health , Medical Centre, Radboud University Nijmegen , Nijmegen , The Netherlands
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11
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Borsje P, Wetzels RB, Lucassen PLBJ, Pot AM, Koopmans RTCM. Neuropsychiatric symptoms in patients with dementia in primary care: a study protocol. BMC Geriatr 2014; 14:32. [PMID: 24628730 PMCID: PMC3995579 DOI: 10.1186/1471-2318-14-32] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 03/11/2014] [Indexed: 12/05/2022] Open
Abstract
Background Neuropsychiatric symptoms (NPS) frequently occur in patients with dementia. To date, prospective studies on the course of NPS have been conducted in patients with dementia in clinical centers or psychiatric services. The primary goal of this study is to investigate the course of NPS in patients with dementia and caregiver distress in primary care. We also aim to detect determinants of both the course of NPS in patients with dementia and informal caregiver distress in primary care. Methods/design This is a prospective observational study on the course of NPS in patients with dementia in primary care. Thirty-seven general practitioners (GPs) in 18 general practices were selected based on their interest in participating in this study. We will retrieve electronic medical files of patients with dementia from these general practices. Patients and caregivers will be followed for 18 months during the period January 2012 to December 2013. Patient characteristics will be collected at baseline. Time to death or institutionalization will be measured. Co-morbidity will be assessed using the Charlson index. Psychotropic drug use and primary and secondary outcome measures will be measured at 3 assessments, baseline, 9 and 18 months. The primary outcome measures are the Neuropsychiatric Inventory score for patients with dementia and the Sense of Competence score for informal caregivers. In addition to descriptive analyses frequency parameters will be computed. Univariate analysis will be performed to identify determinants of the course of NPS and informal caregiver distress. All determinants will then be tested in a multivariate regression analysis to determine their unique contribution to the course of NPS and caregiver distress. Discussion The results of this study will provide data on the course of NPS, which is clinically important for prognosis. The data will help GPs and other professionals in planning follow-up visits and in the timing for offering psycho-education, psychosocial interventions and the provision of care. In addition, these data will enlarge health professionals’ awareness of NPS in their patients with dementia.
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Affiliation(s)
- Petra Borsje
- Department of Primary and Community Care, Radboud university medical centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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12
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van der Spek K, Gerritsen DL, Smalbrugge M, Nelissen-Vrancken MHJMG, Wetzels RB, Smeets CHW, Zuidema SU, Koopmans RTCM. PROPER I: frequency and appropriateness of psychotropic drugs use in nursing home patients and its associations: a study protocol. BMC Psychiatry 2013; 13:307. [PMID: 24238392 PMCID: PMC3840691 DOI: 10.1186/1471-244x-13-307] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 11/13/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Nursing home patients with dementia use psychotropic drugs longer and more frequently than recommended by guidelines implying psychotropic drugs are not always prescribed appropriately. These drugs can have many side effects and effectiveness is limited. Psychotropic drug use between nursing home units varies and is not solely related to the severity of neuropsychiatric symptoms. There is growing evidence indicating that psychotropic drug use is associated with environmental factors, suggesting that the prescription of psychotropic drugs is not only related to (objective) patient factors. However, other factors related to the patient, elderly care physician, nurse and the physical environment are only partially identified. Using a mixed method of qualitative and quantitative research, this study aims to understand the nature of psychotropic drug use and its underlying factors by identifying: 1) frequency and appropriateness of psychotropic drug use for neuropsychiatric symptoms in nursing home patients with dementia, 2) factors associated with (appropriateness of) psychotropic drug use. METHODS A cross-sectional mixed methods study. For the quantitative study, patients with dementia (n = 540), nursing staff and elderly care physicians of 36 Dementia Special Care Units of 12 nursing homes throughout the Netherlands will be recruited. Six nursing homes with high average rates and six with low average rates of psychotropic drug use, based on a national survey about frequency of psychotropic drug use on units, will be included. Psychotropic drugs include antipsychotics, anxiolytics, hypnotics, antidepressants, anticonvulsants and anti-dementia drugs. Appropriateness will be measured by an instrument based on the Medication Appropriateness Index and current guidelines for treatment of neuropsychiatric symptoms. Factors associated to psychotropic drug use, related to the patient, elderly care physician, nurse and physical environment, will be explored using multilevel regression analyses. For the qualitative study, in depth interviews with staff will be held and analyzed to identify and explore other unknown factors. DISCUSSION This study will provide insight into factors that are associated with the frequency and appropriateness of psychotropic drug use for neuropsychiatric symptoms. Understanding psychotropic drug use and its associations may contribute to better dementia care.
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Affiliation(s)
- Klaas van der Spek
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, VU Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | | | - Roland B Wetzels
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Claudia HW Smeets
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice, University of Groningen, University Medical Center Groningen, HPC FA21, PO Box 196, 9700 AD Groningen, The Netherlands
| | - Raymond TCM Koopmans
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Smeets CHW, Smalbrugge M, Gerritsen DL, Nelissen-Vrancken MHJMG, Wetzels RB, van der Spek K, Zuidema SU, Koopmans RTCM. Improving psychotropic drug prescription in nursing home patients with dementia: design of a cluster randomized controlled trial. BMC Psychiatry 2013; 13:280. [PMID: 24180295 PMCID: PMC3840636 DOI: 10.1186/1471-244x-13-280] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 10/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuropsychiatric symptoms are highly prevalent in nursing home patients with dementia. Despite modest effectiveness and considerable side effects, psychotropic drugs are frequently prescribed for these neuropsychiatric symptoms. This raises questions whether psychotropic drugs are appropriately prescribed. The aim of the PROPER (PRescription Optimization of Psychotropic drugs in Elderly nuRsing home patients with dementia) II study is to investigate the efficacy of an intervention for improving the appropriateness of psychotropic drug prescription in nursing home patients with dementia. METHODS/DESIGN The PROPER II study is a multi-center cluster randomized controlled, pragmatic trial using parallel groups. It has a duration of eighteen months and four six-monthly assessments. Six nursing homes will participate in the intervention and six will continue care as usual. The nursing homes will be located throughout the Netherlands, each participating with two dementia special care units with an average of fifteen patients per unit, resulting in 360 patients. The intervention consists of a structured and repeated multidisciplinary medication review supported by education and continuous evaluation. It is conducted by pharmacists, physicians, and nurses and consists of three components: 1) preparation and education, 2) conduct, and 3) evaluation/guidance. The primary outcome is the proportion of patients with appropriate psychotropic drug use. Secondary outcomes are the overall frequency of psychotropic drug use, neuropsychiatric symptoms, quality of life, activities of daily living, psychotropic drug side effects and adverse events (including cognition, comorbidity, and mortality). Besides, a process analysis on the intervention will be carried out. DISCUSSION This study is expected to improve the appropriateness of psychotropic drug prescription for neuropsychiatric symptoms in nursing home patients with dementia by introducing a structured and repeated multidisciplinary medication review supported by education and continuous evaluation. TRIAL REGISTRATION Netherlands Trial Registry (NTR): NTR3569.
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Affiliation(s)
- Claudia HW Smeets
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, VU Medical Center, P.O Box 7057, 1007, MB Amsterdam, The Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
| | | | - Roland B Wetzels
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Klaas van der Spek
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice, University of Groningen, University Medical Center Groningen, HPC FA21, P.O. Box 196, 9700, AD Groningen, the Netherlands
| | - Raymond TCM Koopmans
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands
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van de Ven-Vakhteeva J, Bor H, Wetzels RB, Koopmans RTCM, Zuidema SU. The impact of antipsychotics and neuropsychiatric symptoms on the quality of life of people with dementia living in nursing homes. Int J Geriatr Psychiatry 2013; 28:530-8. [PMID: 22886912 DOI: 10.1002/gps.3858] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/25/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to establish whether antipsychotic (AP) use in patients with dementia negatively affects quality of life (QoL) independent of neuropsychiatric symptoms (NPS). METHOD We tested 290 patients with dementia living in nine nursing homes throughout the Netherlands in a longitudinal study. The measurements were repeated every 6 months over 2 years. We studied the change in NPS and AP use and their effect on QoL over time in two separate generalized estimating equations. We assessed QoL and NPS using the Qualidem questionnaire and the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH), respectively. RESULTS Antipsychotic prescriptions did not significantly change participant QoL, whereas NPI-NH total score changes consistently predicted changes in QoL. According to the Qualidem, the development of QoL in patients who chronically used APs did not differ from AP-free patients, except on the restless tense behavior subscale. AP-free patients' "restless tense behavior" improved compared with patients who chronically used APs, who showed a slight deterioration in these symptoms; however, this effect did not significantly influence total QoL. CONCLUSION Antipsychotic use does not necessarily have detrimental effects on the QoL of patients with dementia; rather, NPS consistently and negatively affects QoL. The use of APs to treat NPS is justified when used carefully (i.e., their benefits and side effects should be monitored).
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Affiliation(s)
- Julia van de Ven-Vakhteeva
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Alzheimer Center Nijmegen, Radboud University Nijmegen, Medical Center, Nijmegen, The Netherlands.
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15
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Bouman AIE, Ettema TP, Wetzels RB, van Beek APA, de Lange J, Dröes RM. Evaluation of Qualidem: a dementia-specific quality of life instrument for persons with dementia in residential settings; scalability and reliability of subscales in four Dutch field surveys. Int J Geriatr Psychiatry 2011; 26:711-22. [PMID: 20845397 DOI: 10.1002/gps.2585] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Accepted: 06/03/2010] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the scalability and reliability of Qualidem, a quality of life observation instrument rated by professional caregivers of persons with mild to very severe dementia living in residential settings. METHOD Data from four field surveys in the Netherlands were used. The instrument consists of nine subscales for mild to severe dementia; of which six can be applied in very severe dementia. The Mokken scaling model was used to compute scalability and reliability coefficients for each subscale and dementia group. RESULTS Seven hundred fifty nine persons with mild to severe dementia and 214 persons with very severe dementia residing in 36 nursing homes and 4 homes for the elderly were included. In general, the subscales for the mild to severely demented group were scalable and (moderate) sufficiently reliable; the results confirmed the results of previous research to develop Qualidem. For the very severe demented group, four out of six subscales were scalable (Care relationship, H = 0.56; Positive affect, H = 0.55; Restless tense behavior, H = 0.42; and Social isolation, H = 0.34); they were also sufficiently reliable to measure quality of life (0.57 ≤ ρ ≤ 0.82). From the other two measured subscales, Social relations was considered not scalable (H = 0.26) and Negative affect was scalable (H = 0.36), but insufficiently reliable (ρ = 0.40). CONCLUSION Qualidem is an easy to administer and overall moderately sufficient reliable rating scale that provides a quality of life profile of persons with mild to even very severe dementia living in residential settings.
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Affiliation(s)
- A I E Bouman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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Wetzels RB, Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM. Determinants of quality of life in nursing home residents with dementia. Dement Geriatr Cogn Disord 2010; 29:189-97. [PMID: 20215750 DOI: 10.1159/000280437] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2010] [Indexed: 11/19/2022] Open
Abstract
AIMS The goal of this study is to assess the relationship between quality of life (QoL), neuropsychiatric symptoms (NPS), psychotropic drug use (PDU) and patient characteristics in a large group of nursing home residents with dementia. METHODS This cross-sectional observational study included 288 individuals with dementia who reside in 14 special care units in 9 nursing homes. The following measures were used: the Qualidem scale to assess QoL, the Neuropsychiatric Inventory-Nursing Home version, the Global Deterioration Scale (GDS), the Severe Impairment Battery-short version, an Activities of Daily Living scale and PDU. Associations between QoL and NPS were examined using multivariate linear regression models with corrections for potential covariates. RESULTS The average age of the residents was 84 years (SD = +/-7). Agitation, depression, psychosis, psychomotor agitation and psychotropic drugs were independently associated with poor QoL. In patients with mild to moderately severe dementia (GDS 4-6), NPS, PDU and cognitive impairment explained almost half of the variance in QoL scores. Agitation and depression were particularly strong predictors of poor QoL. In patients with severe dementia (GDS 7), agitation, depression, psychosis and cognitive impairment were associated with poor QoL. CONCLUSIONS NPS, cognition and PDU independently impair QoL for patients in both the moderate and advanced stages of dementia. These results challenge existing pharmacological intervention strategies and highlight the need for psychosocial interventions in the treatment of NPS.
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Affiliation(s)
- R B Wetzels
- Department of Primary and Community Care, Center for Family Medicine, Radboud University Nijmegen, The Netherlands.
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Thissen AJC, Ekkerink JLP, Mahler MM, Kuin Y, Wetzels RB, Gerritsen DL. [Premorbid personality and aggressive behavior: a study with residents of psychogeriatric nursing homes]. Tijdschr Gerontol Geriatr 2010; 41:116-125. [PMID: 20593739 DOI: 10.1007/bf03096193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
From experimental research it appears that personality plays a role in causes and onset of aggressive behavior in adults. However, studies about the influence of premorbid personality on aggressive behavior of older persons with dementia show contradictory results. In this study we gathered data on personality and behavior of 166 residents of psychogeriatric nursing homes. Nursing staff filled out the Cohen-Mansfield Agitation Inventory (Dutch version, CMAI-D). Proxy family members completed the Hetero Anamnestic Personality questionnaire (HAP). Results showed that on the CMAI-D aggression could be distinguished from other forms of agitation. Four subscales of the HAP showed significant positive correlations with aggression as measured with the CMAI-D. These subscales were: Antagonism, Whimsical and impulsive behavior, Rigid behavior, and Being vulnerable in social interactions. Although the influence of personality decreased with increasing cognitive impairment, it was still present in stage 6 of the Reisberg Global Deterioration Scale. In depth analysis items of the HAP revealed a first profile of the aggression prone personality.
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Affiliation(s)
- A J C Thissen
- Barendse & Thissen, psychologenpraktijk te Schijndel.
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Abstract
BACKGROUND Efficient neuropsychological tests are needed to measure cognitive impairment in moderate to severe dementia. OBJECTIVE To examine construct validity of the Severe Impairment Battery Short Version (SIB-S) in nursing home patients with moderate to severe dementia, and to examine potential floor effects for the SIB-S. METHODS Cross-sectional comparison of cognitive measures, dementia severity and functional dependency. RESULTS A total of 290 patients were included 264 of whom had complete SIB-S protocols. Internal consistency of the SIB-S was very high (Cronbach alpha = 0.97). Principal-component analysis produced three factors, the first of which explained more than 50% of common score variance. Semantic memory items loaded highly on the first factor. Total SIB-S scores were associated with cognitive impairment (SIB-S--Mini Mental State Examination (MMSE) rho = 0.91, p<0.001), and with functional dependency (SIB-S--ADL scale rho = -0.61, p<0.001). SIB-S total scores differentiated between dementia stages as measured with the Global Deterioration Scale (F = 164.6; df 3,260, p<0.001). Comparisons of SIB-S total score variance across patients with moderate to severe dementia and patients with below or above average Mini Mental State Exam scores indicate an absence of large floor effects. CONCLUSION In this first study examining an independently administered SIB-S, the scale proved to be a homogeneous and valid measure of cognitive impairment. The SIB short version can be used to assess moderately to severely demented patients, who may find it difficult to complete traditional, lengthier neuropsychological tests.
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Affiliation(s)
- J F M de Jonghe
- Geriatric Medicine, Medical Center Alkmaar 046, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
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