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Changes between 1982 and 2000 in the prevalence of behavioral symptoms and psychotropic drug treatment among old people with cognitive impairment in geriatric care

Published online by Cambridge University Press:  09 July 2009

Hugo Lövheim ,
Per-Olof Sandman ,
Stig Karlsson  and
Yngve Gustafson
Hugo Lövheim*
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Per-Olof Sandman
Affiliation:
Department of Nursing, Umeå University, Umeå, Sweden
Stig Karlsson
Affiliation:
Department of Nursing, Umeå University, Umeå, Sweden
Yngve Gustafson
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
*
Correspondence should be addressed to: H. Lövheim, Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 85 Umeå, Sweden. Phone: +46 90 785 88 59; Fax: +46 90 13 06 23. Email: hugo.lovheim@germed.umu.se.
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Abstract

Background: People with a dementia disorder often live in institutional care facilities, particularly when the dementia disorder becomes severe or complicated by various behavioral disturbances. The aim of the present study was to analyze and compare the one-week prevalence of various behavioral symptoms and psychotropic drug treatment among people with cognitive impairment living in institutional care, in two large, comparable samples from 1982 and 2000.

Methods: A comparison was made between two cross-sectional samples, collected in 1982 and 2000 respectively, comprising 3404 participants with cognitive impairment living in geriatric care units in the county of Västerbotten, Sweden. Behavioral symptoms were measured using the Multi-Dimensional Dementia Assessment Scale (MDDAS) and cognition was measured using Gottfries’ cognitive scale.

Results: Eight out of 25 behavioral symptoms had become less common, and six more common, after controlling for demographic changes. Regressive behavior, resistance to care and passiveness became less common, while certain aberrant motor behaviors showed an increased prevalence. Antidepressant drug use increased from 6.8% to 43.2%, antipsychotic drug use decreased from 38.0% to 26.2% and anxiolytics, hypnotic and sedative drug use increased from 12.7% to 38.5%.

Conclusion: One-week prevalence of regressive symptoms and resistance to care had decreased and there were signs of a generally increased activity level among old people with cognitive impairment living in institutional geriatric care in 2000 compared to 1982. These changes may be an effect of the extensive changes in pharmacological treatments and in the organization of institutional geriatric care.

Keywords

dementianursing homeBPSDAlzheimer's diseaseaggressionSSRIantipsychotics
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 5 , October 2009 , pp. 941 - 948
Copyright
Copyright © International Psychogeriatric Association 2009

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References

Adolfsson, R., Gottfries, C. G., Nyström, L. and Winblad, B. (1981). Prevalence of dementia disorders in institutionalized Swedish old people: the work load imposed by caring for these patients. Acta Psychiatrica Scandinavica, 63, 225–244.CrossRefGoogle ScholarPubMed
Ballard, C. et al. (2009). The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurology, 8, 151–157. doi: 10.1016/S1474-4422(08)70295-3.CrossRefGoogle ScholarPubMed
Black, W. and Almeida, O. P. (2004). A systematic review of the association between the Behavioral and Psychological Symptoms of Dementia and burden of care. International Psychogeriatrics, 16, 295–315. doi: 10.1017/S1041610204000468.CrossRefGoogle ScholarPubMed
Burns, A. and Rabins, P. (2000). Carer burden in dementia. International Journal of Geriatric Psychiatry, 15, S9–S13.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Burns, A., O'Brien, J. and Ames, D. (2005). Dementia. 3rd edn. London: Hodder Arnold.Google Scholar
Coehlo, D. P., Hooker, K. and Bowman, S. (2007). Institutional placement of persons with dementia: what predicts occurrence and timing? Journal of Family Nursing, 13, 253–277. doi: 10.1177/1074840707300947.CrossRefGoogle ScholarPubMed
Douglas, I. J. and Smeeth, L. (2008). Exposure to antipsychotics and risk of stroke: self controlled case series study. BMJ, 337, a1227. doi: 10.1136/bmj.a1227.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Kallin, K., Gustafson, Y., Sandman, P. O. and Karlsson, S. (2004). Drugs and falls in older people in geriatric care settings. Aging Clinical and Experimental Research, 16, 270–276.CrossRefGoogle ScholarPubMed
Lebowitz, B. D. et al. (1997). Diagnosis and treatment of depression in late life: consensus statement update. JAMA, 278, 1186–1190.CrossRefGoogle ScholarPubMed
Lopez, O. L. et al. (2003). Patterns of change in the treatment of psychiatric symptoms in patients with probable Alzheimer's disease from 1983 to 2000. Journal of Neuropsychiatry and Clinical Neurosciences, 15, 67–73.CrossRefGoogle ScholarPubMed
Lövheim, H., Sandman, P. O., Kallin, K., Karlsson, S. and Gustafson, Y. (2006). Relationship between antipsychotic drug use and behavioral and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care. International Psychogeriatrics, 18, 713–726. doi: 10.1017/S1041610206003930.CrossRefGoogle ScholarPubMed
Lövheim, H., Sandman, P.O., Kallin, K., Karlsson, S. and Gustafson, Y. (2008a). Symptoms of mental health and psychotropic drug use among old people living in geriatric care: changes between 1982 and 2000. International Journal of Geriatric Psychiatry, 23, 289–294. doi: 10.1002/gps.1876.CrossRefGoogle ScholarPubMed
Lövheim, H., Sandman, P. O., Karlsson, S. and Gustafson, Y. (2008b). Behavioral and psychological symptoms of dementia in relation to level of cognitive impairment. International Psychogeriatrics, 20, 777–789. doi: 10.1017/S1041610208006777.CrossRefGoogle ScholarPubMed
Montagnier, D. et al. (2006). Evolution of prevalence of depressive symptoms and antidepressant use between 1988 and 1999 in a large sample of older French people: results from the Personnes Agées Quid Study. Journal of the American Geriatrics Society, 54, 1839–1845. doi: 10.1111/j.1532-5415.2006.00969.x.CrossRefGoogle Scholar
Morgan, K. (2003). Sleep, aging, and late-life insomnia. In Tallis, R. and Fillit, H. (eds.), Brocklehurst's Textbook of Geriatric Medicine and Gerontology (pp. 1367–1380). London: Churchill Livingstone.Google Scholar
Nygaard, H. A., Ruths, S., Straand, J. and Naik, M. (2004). Not less but different: psychotropic drug utilization trends in Norwegian nursing homes during a 12-year period: the Bergen District Nursing Home (BEDNURS) Study. Aging: Clinical and Experimental Research, 16, 277–282.Google ScholarPubMed
O'Connor, D. W., Ames, D., Gardner, B. and King, M. (2009). Psychosocial treatments of psychological symptoms in dementia: a systematic review of reports meeting quality standards. International Psychogeriatrics, 21, 241–251.CrossRefGoogle ScholarPubMed
Ramasubbu, R. (2004). Antidepressant treatment-associated behavioural expression of hypomania: a case series. Progress in Neuro-psychopharmacology and Biological Psychiatry, 28, 1201–1207. doi: 10.1016/j.pnpbp.2004.06.015.CrossRefGoogle ScholarPubMed
Robert, P. H. et al. (2005). Grouping for behavioral and psychological symptoms in dementia: clinical and biological aspects. Consensus paper of the European Alzheimer disease consortium. European Psychiatry, 20, 490–496, doi: 10.1016/j.eurpsy.2004.09.031.CrossRefGoogle ScholarPubMed
Rochon, P. A. et al. (2008). Antipsychotic therapy and short-term serious events in older adults with dementia. Archives of Internal Medicine, 168, 1090–1096.CrossRefGoogle ScholarPubMed
Sandberg, O., Gustafson, Y., Brännström, B. and Bucht, G. (1998). Prevalence of dementia, delirium and psychiatric symptoms in various care settings for the elderly. Scandinavian Journal of Social Medicine, 26, 56–62.CrossRefGoogle ScholarPubMed
Sandman, P. O., Adolfsson, R., Norberg, A., Nyström, L. and Winblad, B. (1988). Long-term care of the elderly: a descriptive study of 3600 institutionalized patients in the county of Västerbotten, Sweden. Comprehensive Gerontology A, 2, 120–132.Google ScholarPubMed
Schneider, L. S., Dagerman, K. S. and Insel, P. (2005). Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA, 294, 1934–1943.CrossRefGoogle ScholarPubMed
Shin, I. S., Carter, M., Masterman, D., Fairbanks, L. and Cummings, J. L. (2005). Neuropsychiatric symptoms and quality of life in Alzheimer disease. American Journal of Geriatric Psychiatry, 13, 469–474.CrossRefGoogle ScholarPubMed
Sink, K. M., Holden, K. F. and Yaffe, K. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA, 293, 596–608.CrossRefGoogle ScholarPubMed
Spigset, O. (1999). Adverse reactions of selective serotonin reuptake inhibitors: reports from a spontaneous reporting system. Drug Safety, 20, 277–287.CrossRefGoogle ScholarPubMed
Statistics Sweden (2007). Population Statistics. Population by Region, Marital Status, Age and Sex. Years 1968–2006. Örebro: Statistics Sweden.Google Scholar
Tangwongchai, S. et al. (2008). Galantamine for the treatment of BPSD in Thai patients with possible Alzheimer's disease with or without cerebrovascular disease. American Journal of Alzheimer's Disease and Other Dementias, 23, 593–601. doi: 10.1177/1533317508320603.CrossRefGoogle ScholarPubMed
Testad, I., Aasland, A. M. and Aarsland, D. (2007). Prevalence and correlates of disruptive behavior in patients in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 22, 916–921. doi: 10.1002/gps.1766.CrossRefGoogle ScholarPubMed