Association between changes in the use of psychotropic drugs and behavioural and psychological symptoms of dementia over 1 year among long‐term care facility residents

Abstract

Aim: Pharmacological treatments are often used in treating the behavioural and psychological symptoms of dementia (BPSD) in nursing homes, despite the fact that non-pharmacological treatments are recommended as a firstline treatment and can provide a suitable alternative. Because the course of BPSD is known to fluctuate depending on individual symptoms over time, the frequencies of drug use and BPSD, as well as their association, should be observed over a longer period. We investigated the association between the changes in psychotropic drug (PD) use and BPSD, focusing on the number of symptoms, severity, and care burden over 1 year among longterm care facility residents. Methods: A 1-year follow-up study was conducted among older residents with dementia or similar symptoms (n = 312 at baseline; n = 237 at followup) by using a care staff questionnaire in 10 long-term care facilities in Hokkaido, Japan. Medication use was determined based on prescription information. The brief questionnaire form of the Neuropsychiatric Inventory was used to assess BPSD. Results: Among residents followed up for 1 year, new users of PDparticularly anxiolytics and hypnotics-had a significantly increased number and severity of BPSD, compared with non-PD users. Continuing PDs was also related to increased severity over the year. Among residents with any persistent BPSD for 1 year, new use of PDs-particularly anxiolytics and hypnotics-was significantly associated with an increased care burden of BPSD, compared with the non-use of PDs. The discontinuation of PDs was significantly associated with a decreased care burden, compared with the non-use of PDs. Conclusions: Our study suggests that PDs, particularly anxiolytics and hypnotics, may be prescribed carefully in response to exacerbation of BPSD in terms of the number of symptoms, severity, and care burden in long-term care facilities. Continuous monitoring of PDs use and BPSD is important to effectively address BPSD. The ratio of psychotropic drug users either at baseline or follow-up to total participants. ‡ The ratio of psychotropic drug users at follow-up to non-users at baseline. § The ratio of psychotropic drug users at follow-up to users at baseline. ¶ The ratio of psychotropic drug non-users at follow-up to users at baseline.Psychotropic drug use in a care facility

Use of psychotropic drugs and drugs with anticholinergic properties among residents with dementia in intermediate care facilities for older adults in Japan: a cohort study

“…The decrease may result from adjustment of the use of hypnotics and anxiolytics in response to symptom changes. 18 In contrast, there were no changes in the prescription of PD in residents with severe dementia found in our study. Therefore, our results suggest that challenges concerning the management of BPSD in residents with severe dementia still remain.…”

“…25 Compared with a study conducted in some different types of NH/LTCFs in Japan, the prevalence of antipsychotics was slightly lower in our study sample, whereas the prevalence of antidepressants and hypnotics/anxiolytics was comparable. 18 We observed a decreased use of hypnotics and anxiolytics in residents with mild-tomoderate dementia, which led to a decrease in regularly prescribed PD after admission to Roken. The decrease may result from adjustment of the use of hypnotics and anxiolytics in response to symptom changes.…”

“…Although non-pharmacological approaches should first be considered for the management of BPSD, 10 pharmacological treatments, such as antipsychotics, benzodiazepines and antidepressants, have been commonly administered to NH/LTCF residents despite safety concerns and limited effectiveness. [11][12][13][14][15][16][17][18][19] Furthermore, wide variations in the use of these types of drugs have been reported among different countries. 20 In terms of safety concerns related to medication for BPSD management, the following issues have been reported.…”

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“…Dementia is one of the most severe manifestations of cognitive impairment associated with elderly people and affects ~50 million patients worldwide. 1 The neurodegeneration caused by Alzheimer disease (AD) is the most common cause of dementia, 2,3 and AD is usually considered to be one of the most serious progressive lifelong neurodegenerative brain diseases, which is characterized by memory insufficiency, confusion, and other behavioral deficits. 4,5 The number of people diagnosed with AD is predicted to increase from 36 million to ~100 million in 40 years.…”

Behavioral and Psychological Symptoms and Associated Factors in Community-Dwelling Persons at the First Time of Dementia Diagnosis

“…BPSD was lowest among participants taking one medication (11.88 ± 11.88) and highest when they were taking three or more medications (18.16 ± 15.77), followed by two medications (17.62 ± 14.33). In a study that analyzed one-year changes in symptoms, anti-anxiety agents and sleeping pills were used most often, and increased medication use was associated with increased BPSD-a result that remained identical after one year [30]. Therefore, it is necessary to recognize that caution is warranted when prescribing and taking two or more medications.…”