Fifteen year comparison of antipsychotic use in people with dementia within hospital and nursing home settings: sequential cross-sectional study.
OBJECTIVE
The use of antipsychotics to treat people with behavioural and psychological symptoms associated with dementia is controversial, especially in long-stay settings. We assessed the relationship between behaviour, function and antipsychotic use in people with dementia in a long-stay psychiatric unit and designated elderly mentally ill (EMI) nursing homes over a 15-year period.


METHODS
Sequential cross-sectional studies assessing twelve behaviours and seven measures of function for each patient. Antipsychotic and antidepressant use was obtained from current prescription records.


RESULTS
Regular antipsychotic use in hospital fell between 1990 and 1998. In 1998 use in nursing homes was significantly greater than in hospital, and increased between 1998 and 2005. Noisiness/verbal aggression (NVA) was the only behaviour more commonly associated with regular antipsychotic use over that timescale. Those with low levels of core symptoms (p = 0.021) and high dependency patients (p = 0.001) were more likely to be receiving regular antipsychotics in nursing homes than in hospital. Depression was not treated well even when identified.


CONCLUSIONS
Compared to a long-stay hospital setting, antipsychotic drug use for people with dementia in nursing homes has risen and become less systematic. This cannot be explained by increasing core behaviour symptoms or differences in physical dependency.
Connelly
Peter J
PJ
Department of Old Age Psychiatry, Murray Royal Hospital, Muirhall Road, Perth PH2 7BH, Scotland, UK. pjc@dementiaresearch.freeserve.co.uk
Law
Emma
E
Angus
Susan
S
Prentice
Neil
N
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D003866:Depressive Disorder / Q000188:drug therapy; D005260:Female; D006707:Homes for the Aged; D006761:Hospitals; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy; D009735:Nursing Homes; D012606:Scotland; D012720:Severity of Illness Index
D000928:Antidepressive Agents; D014150:Antipsychotic Agents