Behavioral symptoms and the administration of psychotropic drugs to aged patients with dementia in nursing homes and in acute geriatric wards.
OBJECTIVE
To describe the prevalence of various psychiatric and behavioral symptoms among patients with dementia in nursing homes and acute geriatric wards and to investigate the administration of psychotropic medications to these patients.


METHODS
425 consecutive patients (>70 years) in six acute geriatric wards in two city hospitals and seven nursing homes in Helsinki, Finland, were assessed with an extensive interview, cognitive tests, and attention tests. Of these, 255 were judged to have dementia according to the following information: previous dementia diagnoses and their adequacy, results of CT scans, Mini-mental State Examination (MMSE) tests, Clinical Dementia Scale (CDR) tests, and DSM-IV criteria. Psychiatric and behavioral symptoms were recorded over two weeks for each patient.


RESULTS
Psychiatric and behavioral symptoms were very common among patients with dementia in both settings. In all, 48% presented with psychotic symptoms (delusions, visual or auditory hallucinations, misidentifications or paranoid symptoms), 43% with depression, 26% agitation, and 26% apathy. Use of psychotropic drugs was also common: 87% were on at least one psychotropic drug, 66% took at least two, 36% at least three, and 11% four or more psychotropic drugs. Of the patients with dementia, 42% were on conventional antipsychotics, and 34% on anxiolytics despite their known side-effects. Only 13% were on atypical antipsychotics and 3% on cholinesterase inhibitors. The use of selective serotonin reuptake inhibitors (SSRIs) was common (31%) among the patients. A surprising finding was that drugs with anticholinergic effects were also frequently (20%) used.


CONCLUSIONS
Both behavioural symptoms and use of psychotropic drugs are very common among dementia patients in institutional settings. The frequent use of potentially harmful drugs implies a need for education among physicians taking care of these patients.
Pitkala
K H
KH
Department of Medicine, Geriatric Clinic, Helsinki University Hospital, Finland. kaisu.pitkala@hus.fi
Laurila
J V
JV
Strandberg
T E
TE
Tilvis
R S
RS
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D004569:Electroencephalography; D005387:Finland / Q000453:epidemiology; D006299:Health Services for the Aged; D006760:Hospitalization; D006786:Hospitals, Urban; D006801:Humans; D008279:Magnetic Resonance Imaging; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D009483:Neuropsychological Tests; D009735:Nursing Homes; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed
D011619:Psychotropic Drugs