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


CONCLUSIONS
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.
Lövheim
Hugo
H
Department of Community Medicine and Rehabilitation, Umeå University, Sweden. hugo.lovheim@germed.umu.se
Sandman
Per-Olof
PO
Karlsson
Stig
S
Gustafson
Yngve
Y
D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000187:drug effects; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000453:epidemiology; D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006306:Health Surveys; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012112:Residential Facilities / Q000706:statistics & numerical data*; D013548:Sweden; D016896:Treatment Outcome
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D011619:Psychotropic Drugs