title: Nursing home structure and association with agitation and use of psychotropic drugs in nursing home residents in three countries: Norway, Austria and England.
abstract: BACKGROUND
  Understanding the underlying mechanisms and risk factors leading to agitation is crucial to reduce the severity of agitation and increase quality of life. International comparative studies offer special advantages in elucidating environmental risk factors by providing a wider diversity of environmental exposures such as nursing home structures, health care systems and genetic diversity.
  
  
  METHODS
  Baseline data for three different intervention studies in Austria (n = 38), England (n = 302) and Norway (n = 163) were combined posthoc. Patients were grouped according to their dementia severity using the global deterioration scale (GDS), functional assessment staging (FAST) and clinical dementia rating (CDR) scales. For the measurement of agitation, the Cohen-Mansfield Agitation Inventory (CMAI) was used. Data analysis was performed using one-way ANOVA, multivariate and linear regression analysis.
  
  
  RESULTS
  CMAI scores were available for 503 subjects with dementia. There were significant differences between the nursing home residents in the three countries regarding age, gender and dementia severity (all p values < 0.001). In the multivariate analyses, the level of agitation differed with higher mean scores in the Austrian (mean (SD) score 51.9(21.8)) compared to UK (43.3(16.1)) and Norwegian (41.6(13.2)) nursing homes (p = 0.002). Similarly, the use of psychotropic drugs differed significantly, with a higher proportion of neuroleptics in UK (48%, p < 0.001) and Austrian (52.6%; p = 0.001) compared to Norwegian (19%) nursing homes.
  
  
  CONCLUSIONS
  We found differences in agitation and antipsychotic drug use which are likely related to structural and cultural differences in nursing homes in three European countries. These findings suggest that structural changes can improve quality of care and quality of life for nursing home residents.
authors.affiliation: Psychiatric Clinic, Stavanger University Hospital, Stavanger, Norway. itestad@gmail.com
authors.forename: I
authors.initials: I
authors.lastname: Testad
authors.forename: S
authors.initials: S
authors.lastname: Auer
authors.forename: M
authors.initials: M
authors.lastname: Mittelman
authors.forename: C
authors.initials: C
authors.lastname: Ballard
authors.forename: J
authors.initials: J
authors.lastname: Fossey
authors.forename: Y
authors.initials: Y
authors.lastname: Donabauer
authors.forename: D
authors.initials: D
authors.lastname: Aarsland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001317:Austria / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment; D006707:Homes for the Aged / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D009664:Norway / Q000453:epidemiology; D009735:Nursing Homes / Q000458:organization & administration* / Q000706:statistics & numerical data; D010865:Pilot Projects; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D011788:Quality of Life; D012720:Severity of Illness Index
chemical_list: D011619:Psychotropic Drugs