Objectives: Nursing home (NH) residents with dementia is exposed to high rates of psychotropic prescriptions. Our objectives were to: (1) pool the prevalence estimates of psychotropic polypharmacy from the existing literature and (2) examine potentially influential factors that are related to a higher or lower prevalence.
Design: Meta-analysis of data collected from randomized trials, quasi-experimental, prospective or retrospective cohort, and cross-sectional studies. English-language searches of PubMed and PsycINFO were completed by November 2020. Included studies reported prevalence estimates of psychotropic polypharmacy (i.e. defined as either two-or-more or three-or-more medications concurrently) in NH residents with dementia.
Setting And Participants: NH residents with dementia.
Measurements: Random-effects models were used to pool the prevalence of psychotropic polypharmacy in NH residents with dementia across studies. Estimates were provided for both two-or-more and three-or-more concurrent medications. Heterogeneity and publication bias were measured. Meta-regression examined the influence of the percentage of the sample who were male, mean age of the sample, geographic region (continent), sample size, and study year on the prevalence of psychotropic polypharmacy.
Results: Twenty-five unique articles were included comprising medications data from 92,370 NH residents with dementia in 12 countries. One-in-three (33%, [95% CI: 28%, 39%]) NH residents with dementia received two-or-more psychotropic medications concurrently. One-in-eight (13%, [95% CI: 10%, 17%]) received three-or-more psychotropic medications concurrently. Estimates were highly variable across both definitions of psychotropic polypharmacy (p < 0.001). Among study-level demographics, geographic region, sample size, or study year, only male sex was associated with greater use of two-or-more psychotropic medications (Unadjusted OR = 1.02, p = 0.006; Adjusted OR = 1.04, p = 0.07).
Conclusions: Psychotropic polypharmacy is common among NH residents with dementia. Identifying the causes of utilization and the effects on resident health and well-being should be prioritized by federal entities seeking to improve NH quality.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1017/S1041610220004032 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Clozapine treatment continues to be recognized as the gold standard for managing treatment-resistant schizophrenia. Combining clozapine with other antipsychotics (i.e.
View Article and Find Full Text PDFTherapeutic drug monitoring vs. pharmacogenetic testing in the context of elevated olanzapine concentrations and prior clozapine intolerability: a case study.
BMC Psychiatry
December 2024
University of California, Irvine, School of Medicine, 1001 Health Sciences Road, Irvine, CA, 92697, USA.
Article Synopsis
- Strong evidence supports therapeutic drug monitoring (TDM) for olanzapine and clozapine, but TDM for olanzapine is often underused despite its effectiveness.
- A case study of a 32-year-old male with schizoaffective disorder demonstrated that while olanzapine dosing revealed high levels indicating poor metabolism, pharmacogenetic tests did not provide useful information about his drug metabolism.
- The conclusion emphasizes the importance of TDM over pharmacogenomic testing for managing medications like olanzapine and clozapine, especially in patients suspected of having altered CYP1A2 metabolism.
Personality disorders and schizophrenia spectrum disorders in the Italian forensic psychiatric population: clinical features, pattern of violence and treatment.
Int Rev Psychiatry
November 2024
Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari "Aldo Moro", Bari, Italy.
Article Synopsis
- Since 2015, Residencies for Execution of Security Measures (REMS) in Italy have treated dangerous offenders acquitted for mental disorders, primarily those with schizophrenia spectrum disorders (SSD) and personality disorders (PD).
- The study analyzed data from 528 REMS patients, revealing that the PD group had more females and substance abuse issues, while the SSD group often involved serious offenses like homicide.
- Findings suggest that patients with PD show more violent behavior in REMS, while SSD patients are treated with higher doses and combinations of antipsychotics, highlighting the need for tailored treatment approaches.
Investigating pain-related medication use and contribution to polypharmacy in adults with intellectual disabilities: a systematic review.
BMC Med
December 2024
General Practice & Primary Care, School of Health & Wellbeing, University of Glasgow, Glasgow, G12 8TB, UK.
Background: Adults with intellectual disability experience more pain than adults without and, despite a higher number of medications being prescribed, may be less likely to receive medication for pain. We conducted a systematic review of existing literature on medication for pain and painful conditions in adults with intellectual disability to explore if there is any association with polypharmacy, multimorbidity or demographic characteristics.
Methods: This systematic review followed PRISMA guidelines.
Drug prescriptions in elderly hospitalized patients with cognitive impairment in the Italian Dementia Friendly Hospital project.
Front Pharmacol
November 2024
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
Objective: The aim of the study was to characterize drug prescription patterns in elderly patients hospitalized in acute wards as a function of cognitive status and staff training.
Methods: We recorded clinical parameters reflecting health status and drug prescriptions at admission, during hospital stay, and at discharge before and after a short staff training on the needs of aged cognitively impaired patients. Participants aged 65 and older had a Mini-Mental State Examination (MMSE) score ≥16.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!