Psychotropic and cognitive-enhancing medication use and its documentation in contemporary long-term care practice.
BACKGROUND
In long-term care (LTC) settings, use of psychotropic medications to manage behavioral and psychological symptoms of dementia and use of cognitive enhancers are commonplace. It is important that these medications are properly used to ensure resident well-being, and thus, it is paramount to understand use of these medications in contemporary practice to develop appropriate quality improvement initiatives.


OBJECTIVE
To characterize psychotropic and cognition-enhancing medication use LTC residents and current trends in documentation.


METHODS
Cross-sectional chart review of residents aged >65 years with dementia receiving psychotropic medications and/or cognitive enhancers.


RESULTS
From 180 residents, 84 (82% female) met inclusion criteria (average age 86 years). The prevalence of psychotropic medication use was as follows: cognitive enhancers, 71%; antidepressants, 98%; antipsychotics, 61%; sedative hypnotics, 23%. Quetiapine was the most commonly used antipsychotic (48%), followed by risperidone (28%) and olanzapine (15%), all of which were dosed within accepted guidelines. The duration of therapy ranged from 2 to 5 years for antipsychotic medications and 1¼ to 3 years for antidepressants. Documentation documentation rates were hightest for psychotropics versus cognitive enhancers. There was no documentation of attempts to lower doses or discontinue psychotropic medications or cognitive enhancers.


CONCLUSIONS
Many, but not all psychotropics used were acceptable choices. The duration of therapy appears to be excessive for antipsychotic medications. Documentation of ongoing need for medications varied and could be improved on to better assess residents' medication regimens. Further research will inform efforts to enhance the care of these residents.
University of Waterloo School of Pharmacy, Kitchener, ON, Canada.
Carlos
C
Rojas-Fernandez
Mina
M
Mikhail
Susan G
SG
Brown
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 / Q000188:drug therapy*; D004282:Documentation; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D018697:Nootropic Agents / Q000627:therapeutic use*; D009735:Nursing Homes; D011619:Psychotropic Drugs / Q000627:therapeutic use*
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D018697:Nootropic Agents; D011619:Psychotropic Drugs
cognitive enhancers; documentation; long-term care; psychotropics