title: Sedative load of medications prescribed for older people with dementia in care homes.
abstract: BACKGROUND
  The objective of this study was to determine the sedative load and use of sedative and psychotropic medications among older people with dementia living in (residential) care homes.
  
  
  METHODS
  Medication data were collected at baseline and at two further time-points for eligible residents of six care homes participating in the EVIDEM-End Of Life (EOL) study for whom medication administration records were available. Regular medications were classified using the Anatomical Therapeutic Chemical classification system and individual sedative loads were calculated using a previously published model.
  
  
  RESULTS
  At baseline, medication administration records were reviewed for 115 residents; medication records were reviewed for 112 and 105 residents at time-points 2 and 3 respectively. Approximately one-third of residents were not taking any medications with sedative properties at each time-point, while a significant proportion of residents had a low sedative load score of 1 or 2 (54.8%, 59.0% and 57.1% at baseline and time-points 2 and 3 respectively). More than 10% of residents had a high sedative load score (≥ 3) at baseline (12.2%), and this increased to 14.3% at time-points 2 and 3. Approximately two-thirds of residents (66.9%) regularly used one or more psychotropic medication(s). Antidepressants, predominantly selective serotonin re-uptake inhibitors (SSRIs), were most frequently used, while antipsychotics, hypnotics and anxiolytics were less routinely administered. The prevalence of antipsychotic use among residents was 19.0%, lower than has been previously reported for nursing home residents. Throughout the duration of the study, administration of medications recognised as having prominent sedative adverse effects and/or containing sedative components outweighed the regular use of primary sedatives.
  
  
  CONCLUSIONS
  Sedative load scores were similar throughout the study period for residents with dementia in each of the care homes. Scores were lower than previously reported in studies conducted in long-term care wards which have on-site clinical support. Nevertheless, strategies to optimise drug therapy for care home residents with dementia which rely on clinicians external to the care home for support and medication review are required.
authors.affiliation: School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK. c.parsons@qub.ac.uk
authors.forename: Carole
authors.initials: C
authors.lastname: Parsons
authors.forename: Jane
authors.initials: J
authors.lastname: Haydock
authors.forename: Elspeth
authors.initials: E
authors.lastname: Mathie
authors.forename: Natasha
authors.initials: N
authors.lastname: Baron
authors.forename: Ina
authors.initials: I
authors.lastname: Machen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stevenson
authors.forename: Sarah
authors.initials: S
authors.lastname: Amador
authors.forename: Claire
authors.initials: C
authors.lastname: Goodman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006707:Homes for the Aged / Q000639:trends; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D009735:Nursing Homes / Q000639:trends; D019338:Polypharmacy; D055553:Prescription Drugs / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D055553:Prescription Drugs