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BMC Psychiatry
Published in: BMC Psychiatry 1/2017

Open Access 01-12-2017 | Research article

Trends in treatment with antipsychotic medication in relation to national directives, in people with dementia – a review of the Swedish context

Authors: Staffan Karlsson, Ingalill Rahm Hallberg, Patrik Midlöv, Cecilia Fagerström

Published in: BMC Psychiatry | Issue 1/2017

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Abstract

Background

The aim of this study was to explore trends in treatment with antipsychotic medication in Swedish dementia care in nursing homes as reported in the most recent empirical studies on the topic, and to relate these trends to directives from the national authorities.

Methods

The study included two scoping review studies based on searches of electronic databases as well as the Swedish directives in the field.

Results

During the past decade, directives have been developed for antipsychotic medication in Sweden. These directives were generic at first, but have become increasingly specific and restrictive with time. The scoping review showed that treatment with antipsychotic drugs varied between 6% and 38%, and was higher in younger older persons and in those with moderate cognitive impairment and living in nursing homes for people with dementia. A decreasing trend in antipsychotic use has been seen over the last 15 years.

Conclusions

Directives from the authorities in Sweden may have had an impact on treatment with antipsychotic medication for people with dementia. Treatment with antipsychotic medication has decreased, while treatment with combinations of psychotropic medications is common. National directives may possibly be even more effective, if applied in combination with systematic follow-ups.
Appendix
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Literature
1.
Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, Hasegawa K, Hendrie H, Huang Y, Jorm A, Mathers C, Menezes PR, Rimmer E, Scazufca M. Global prevalence of dementia: a Delphi consensus study. Lancet. 2005;366:2112–7.CrossRefPubMedPubMedCentral
2.
The National Board of Health and Welfare: Äldre och personer med funktionsnedsättning– regiform år 2014 Elderly and persons with impairments- management form, 2014. Some municipal services according to the Social Services Act. Stockholm: The National Board of Health and Welfare; 2015.
3.
The National Board of Health and Welfare: Nationell utvärdering – Vård och omsorg vid demenssjukdom 2014 – Indikatorer och underlag för bedömningar (National evaluation – Care in cases of dementia – Indicators and basis for assessment). Stockholm: The National Board of Health and Welfare; 2014.
4.
Fauth EB, Gibbons A. Which behavioural and psychological symptoms of dementia are the most problematic? Variability by prevalence, intensity, distress ratings, and associations with caregiver depressive symptoms. Int J Geriatr Psychiatry. 2014;29(3):263–71.CrossRefPubMed
5.
Linde RM, Stephan B, Matthews FE, Brayne C, Savva GM. The presence of behavioral and psychological symptoms and progression to dementia in the cognitively impaired older population. Int J Geriatr Psychiatry. 2013;28:700–9.CrossRefPubMed
6.
Sultzer DL. Psychosis and antipsychotic medications in Alzheimer's disease: clinical management and research perspectives. Dement Geriatr Cogn Disord. 2004;17:78–90.CrossRefPubMed
7.
Rochon PA, Stukel TA, Bronskill SE, Gomes T, Sykora K, Wodchis WP, Hillmer M, Kopp A, Gurwitz JH, Anderson GM. Variation in nursing home antipsychotic prescribing rates. Arch Intern Med. 2007;167:676–83.CrossRefPubMed
8.
Ballard C, Lana MM, Theodoulou M, Douglas S, McShane R, Jacoby R, Kossakowski K, Yu LM. Juszczak E, on behalf of the Investigators DART AD: A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD trial). PLoS Med. 2008;5(4):e76.CrossRefPubMedPubMedCentral
9.
Mittal V, Kurup L, Williamson D, Muralee S, Tampi RR. Risk of cerebrovascular adverse events and death in elderly patients with dementia when treated with antipsychotic medications: a literature review of evidence. Am. J. Alzheimers Dis. Other Dement. 2011;26:10–28.CrossRef
10.
Oderda LH, Young JR, Asche CV, Pepper GA. Psychotropic-related hip fractures: meta-analysis of first-generation and second-generation antidepressant and antipsychotic drugs. Ann. Pharmacother. 2012;46:917–28.CrossRefPubMed
11.
de Mauleon A, Sourdet S, Renom-Guiteras A, Gillette-Guyonnet S, Leino-Kilpi H, Karlsson S, Bleijlevens M, Zabategui A, Saks K, Vellas B, Jolley D, Soto M. Associated factors with antipsychotic use in long-term institutional care in eight European countries: Results from the RightTimePlaceCare study. J Am Med Dir Assoc. 2014;15:812–8.CrossRefPubMed
12.
Mukamel DB, Weimer DL, Harrington C, Spector WD, Ladd H, Li Y. The effect of state regulatory stringency on nursing home quality. Health Serv Res. 2012;47(5):1791–813.CrossRefPubMedPubMedCentral
13.
Bowblis JR, Lucas JA. The impact of state regulations on nursing home care Practices. J Regul Econ. 2012;42:52–72.CrossRef
14.
Shorr RI, Fought RL, Ray WA. Changes in antipsychotic drug use in nursing homes during implementation of the OBRA-87 regulations. JAMA. 1994;271(5):358–62.CrossRefPubMed
15.
National Health Service (UK): National Dementia and Antipsychotic Prescribing Audit 2012. Leeds: National Health Service; 2012.
16.
Desai VC, Heaton PC, Kelton CM. Impact of the Food and Drug Administration's antipsychotic black box warning on psychotropic drug prescribing in elderly patients with dementia in outpatient and office-based settings. Alzheimer's & Dementia. 2012;8:453–7.CrossRef
17.
Gallini A, Andrieu S, Donohue JM, Oumouhou N, Lapeyre-Mestre M, Gardette V. Trends in use of antipsychotics in elderly patients with dementia: Impact of national safety warnings. European Neuropsychopharmacology. 2014;24:95–104.CrossRefPubMed
18.
The National Board of Health and Welfare: Kvaliteten på läkemedelsanvändningen hos äldre (The quality of medication utilization in older people). Stockholm: The National Board of Health and Welfare; 2000.
19.
Sink KM, Holden KF, Yaffe K. Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA. 2005;293:596–608.CrossRefPubMed
20.
Giron MS, Forsell Y, Bernsten C, Thorslund M, Winblad B, Fastbom J. Psychotropic drug use in elderly people with and without dementia. Int J Geriatr Psychiatry. 2001;16:900–6.CrossRefPubMed
21.
Wastesson JW, Ringbäck WG, Johnell K. Educational disparities in antipsychotic drug use among older people with and without dementia in Sweden. Acta Psychiatr Scand. 2015;132:20–8.CrossRefPubMed
22.
WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2015. Oslo: WHO Collaborating Centre for Drug Statistics Methodology; 2014.
23.
Arksey H, O’Malley L. Scoping Studies: Towards a Methodological Framework. Int. J. Social Research Methodology. 2005;8:19–32.CrossRef
24.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2009, 8:336–341.
25.
Lagergren M, Fratiglioni L, Hallberg IR, Berglund J, Elmståhl S, Hagberg B, Holst G, Rennemark M, Sjölund BM, Thorslund M, Wiberg I, Winblad B, Wimo A: A longitudinal study integrating population, care and social services data. The Swedish National Study on Aging and Care (SNAC). Aging Clin Exp Res 2004, 16:158–168.
26.
Verbeek H, Meyer G, Leino-Kilpi H, Zabalegui A, Hallberg IR, Saks K, Soto ME, Challis D, Sauerland D, Hamers JP. A European study investigating patterns of transition from home care towards institutional dementia care: the protocol of the RightTimePlaceCare study. BMC Public Health. 2012;12:68.CrossRefPubMedPubMedCentral
27.
The Swedish Council on Health Technology Assessment (SBU): Demenssjukdomar, En systematisk litteraturöversikt (Dementia diseases. A systematic literature review). Stockholm: SBU; 2006.
28.
The National Board of Health and Welfare (NBHW) a: Indikatorer för god läkemedelsterapi hos äldre (Indicators for good medication among older people). Stockholm: NBHW; 2010.
29.
The National Board of Health and Welfare (NBHW): Psykisk sjukdom bland äldre och behandling inom vården (Mental illness among elderly and treatment within health care). Stockholm: NBHW; 2013.
30.
The National Board of Health and Welfare (NBHW): Uppföljning av äldres läkemedels-användning (Follow up of older peoples utilization of medication). Stockholm: NBHW; 2004.
31.
Medical Products Agency (MPA): Läkemedels-behandling och bemötande vid beteendemässiga och psykiska symtom vid demenssjukdom-BPSD (Medication treatment and encountering behaviour and psychological symptoms in dementia disease-BPSD). Stockholm: MPA; 2008.
32.
The National Board of Health and Welfare (NBHW) b: Nationella riktlinjer för vård och omsorg vid demenssjukdom 2010. (National guidelines for care and service in dementia disease). Stockholm: NBHW; 2010.
33.
The National Board of Health and Welfare (NBHW) c: Indikatorer. Nationella riktlinjer för vård och omsorg vid demenssjukdom 2010. Indikator 3. Bilaga 3 (Indicators. National guidelines for care and service in dementia disease 2010. Indicator 3. Appendix 3). Stockholm: NBHW; 2010.
34.
The National Board of Health and Welfare (NBHW) d: Indikatorer. Nationella riktlinjer för vård och omsorg vid demenssjukdom 2010. Indikator 2. Bilaga 3 (Indicators. National guidelines for care and service in dementia disease 2010. Indicator 2. Appendix 3). Stockholm: NBHW; 2010.
35.
The National Board of Health and Welfare (NBHW): Öppna jämförelser 2014 – Läkemedels-behandlingar – Jämförelser mellan landsting. (Open comparisons 2014. Medication treatment. Comparisons between county councils). Stockholm: NBHW; 2014.
36.
Johnell K, Religa D, Eriksdotter M. Differences in drug therapy between dementia disorders in the Swedish dementia registry: A nationwide study of over 7,000 patients. See comment in PubMed Commons belowDement Geriatr Cogn Disord. 2013;35(5–6):239–48.
37.
Gustavsson M, Karlsson S, Lovheim H. Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units. BMC Pharmacol Toxicol. 2013;14:10.CrossRef
38.
Gustavsson M, Karlsson S, Gustavsson Y, Lovheim H. Psychotropic drug use among people with dementia – a six-month follow-up study. BMC Pharmacol Toxicol. 2013;14:56.CrossRef
39.
Lovheim H, Sandman P-O, Kallin K, Karlsson S, Gustafson Y. Symptoms of mental health and psychotropic drug use among old people in geriatric care, changes between 1982 and 2000. Int J Geriatr Psychiatry. 2008;23(3):289–94.CrossRefPubMed
40.
Lövheim H, Sandman PO, Karlsson S, Gustafson Y. Changes between 1982 and 2000 in the prevalence of behavioral symptoms and psychotropic drug treatment among old people with cognitive impairment in geriatric care. Int Psychogeriatr. 2009;21(5):941–8.CrossRefPubMed
41.
Lovheim H, Sandman P-O, Kallin K, Karlsson S, Gustavsson Y. Relationship between antipsychotic drug use and behavioural and psychological symptoms of dementia in old people with cognitive impairment living in geriatric care. Int Psychogeriatr. 2006;18(4):713–26.CrossRefPubMed
42.
Lövheim H, Bergdahl E, Sandman PO, Karlsson S, Gustafson Y. One-week prevalence of depressive symptoms and psychotropic drug treatments among old people with different levels of cognitive impairment living in institutional care: changes between 1982 and 2000. Int Psychogeriatr. 2010;22(7):1154–60.CrossRefPubMed
43.
Olsson J, Bergman A, Carlsten A, Oké T, Bernsten C, Schmidt IK, Fastbom J. Quality of drug prescribing in elderly people in nursing homes and special care units for dementia: a cross-sectional computerized pharmacy register analysis. Clin Drug Investig. 2010;30(5):289–300.CrossRefPubMed
44.
Jelic V, Haglund A, Kowalski J, Langworth S, Winblad B. Donepezil treatment of severe Alzheimer's disease in nursing home settings. A responder analysis. Dement Geriatr Cogn Disord. 2008;26(5):458–66.CrossRefPubMed
45.
Lövheim H, Gustafson Y, Karlsson S, Sandman PO. Comparison of behavioral and psychological symptoms of dementia and psychotropic drug treatments among old people in geriatric care in 2000 and 2007. Int Psychogeriatr. 2011;23(10):1616–22.CrossRefPubMed
46.
Gustafsson M, Sandman PO, Karlsson S, Gustafson Y, Lövheim H. Association between behavioral and psychological symptoms and psychotropic drug use among old people with cognitive impairment living in geriatric care settings. Int Psychogeriatr. 2013;25(9):1415–23.CrossRefPubMed
47.
Gustavsson M, Isaksson U, Karlsson S, Sandman PO, Lövheim H. Behavioral and psychological symptoms and psychotropic drugs among people with cognitive impairment in nursing homes in 2007 and 2013. Eur J Clin Pharmacol. 2016, Apr;13 [Epub ahead of print]
48.
Bowblis JR, Crystal S, Intrator O. Lucas, JA: Response to regulatory stringency: The case of antipsychotic medication use in nursing homes. Health Econ. 2012;21:977–93.CrossRefPubMed
49.
Kales HC, Zivin K, Kim HM, Valenstein M, Chiang C, Ignacio RV, Ganoczy D, Cunningham F, Schneider LS, Blow FC. Trends in antipsychotic use in dementia 1999–2007. Arch Gen Psychiatry. 2011;68(2):190–7.CrossRefPubMed
50.
Olsson J, Bergman A, Carlsten A. Oke´ T, Bernsten C, Schmidt IK, Fastbom J: Quality of Drug Prescribing in Elderly People in Nursing Homes and Special Care Units for Dementia. A Cross-Sectional Computerized Pharmacy Register Analysis. Clin Drug Investig. 2010;30(5):289–300.CrossRefPubMed
51.
Dhalla IA, Anderson GM, Mamdani MM, Bronskill SE, Sykora K, Rochon PA. Inappropriate prescribing before and after nursing home admission. J Am Geriatr Soc. 2002;50:995–1000.CrossRefPubMed
52.
Grabowski DC, Town RJ: Does information matter? Competition, quality, and the impact of nursing home report cards. Health Serv Res 2011, 46(6pt1):1698–1719.
53.
54.
Livingston G, Kelly L, Lewis-Holmes E, Baio G, Morris S, Patel N, Omar RZ, Katona C, Cooper C. A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioral interventions for managing agitation in older adults with dementia. Health Technol Assess. 2014;18(39):1–226. v-viCrossRef
55.
Deudon A, Maubourguet N, Gervais X, Leone E, Brocker P, Carcaillon L, Riff S, Lavallart B, Robert PH. Non-pharmacological management of behavioral symptoms in nursing homes. Int J Geriatr Psychiatry. 2009;24(12):1386–95.CrossRefPubMed
56.
Stephenson CP, Karanges E, McGregor IS. Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011. Aust N Z J Psychiatry. 2013;47(1):74–87.CrossRefPubMed
57.
Vasudev A, Shariff SZ, Liu K, Burhan AM, Herrmann N, Leonard S, Mamdani M. Trends in Psychotropic Dispensing Among Older Adults with Dementia Living in Long-Term Care Facilities: 2004–2013. Am J Geriatr Psychiatry. 2015;23(12):1259–69.CrossRefPubMed
Metadata
Title
Trends in treatment with antipsychotic medication in relation to national directives, in people with dementia – a review of the Swedish context
Authors
Staffan Karlsson
Ingalill Rahm Hallberg
Patrik Midlöv
Cecilia Fagerström
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2017
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-017-1409-9

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