title: Antipsychotic prescription amongst hospitalized patients with dementia.
abstract: BACKGROUND
  Antipsychotic drugs are used to treat behavioural and psychological symptoms of dementia, despite significant safety concerns regarding increased risk of stroke and mortality. The numbers of patients with dementia and related behavioural symptoms being treated in acute hospitals is increasing.
  
  
  OBJECTIVE
  (i) to determine pre-admission and in-hospital prevalence of antipsychotic use in a national sample of patients with dementia and acute illness; (ii) identify reasons for antipsychotic use; (iii) assess features of the ward environment which impact on patients with dementia; (iv) determine availability of dementia-specific policies, training, appraisal and mentorship programs which influence service delivery.
  
  
  METHODS
  Four-part standardized audit in 35 public acute hospitals comprising (i) retrospective healthcare record review (n = 660); (ii) prospective assessment of ward environment (n = 77); (iii) ward organization interview with clinical managers (n = 77); (iv) hospital organisation interview with senior managers (n = 35).
  
  
  RESULTS
  Antipsychotic drugs were prescribed to 29% of patients with dementia before hospitalization and to 41% during hospitalization; one quarter received new or additional prescriptions. Assessments for delirium (45%), dementia symptoms (39%), mood (26%), mental state (64%) and distress-provoking factors (3%) were suboptimal. Drug indications were documented in 78%. Non-pharmacological interventions were not documented. Most wards lacked environmental cues to promote orientation. Dementia-specific care pathways existed in 2 of 35 hospitals. Staff support and training programmes were suboptimal. 12% of patients were discharged with new antipsychotic prescriptions.
  
  
  CONCLUSIONS
  Antipsychotic medications are commonly prescribed for hospitalized patients with dementia in Ireland. Ward environments and dementia-related governance structures are suboptimal.
authors.affiliation: Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Gallagher
authors.affiliation: Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Curtin
authors.affiliation: Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: de Siún
authors.affiliation: Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: O'Shea
authors.affiliation: Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Kennelly
authors.affiliation: Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: O'Neill
authors.affiliation: Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Timmons
mesh_terms: D000208:Acute Disease / Q000453:epidemiology / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003693:Delirium / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D004777:Environment; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D010362:Patients' Rooms; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D000066553:Problem Behavior; D011569:Psychiatric Status Rating Scales
chemical_list: D014150:Antipsychotic Agents