Rest homes have become a major component of the health care system for frail elderly persons and deinstitutionalized psychiatric patients. Although psychoactive medications are frequently used in rest homes, there is little detailed information about the extent of such use, its supervision, or its effects. In a survey of a random sample of 55 rest homes in Massachusetts, we found that 55 percent of the residents were taking at least one psychoactive medication. Antipsychotic medications were being administered to 39 percent; of these, 18 percent were receiving two or more such drugs. In a follow-up investigation, we studied 837 residents in 44 rest homes with particularly high levels of antipsychotic-drug use. About half the residents had no evidence of participation by a physician in decisions about their mental health during the year of the study. A third of the residents had performance deficits on mental-status testing that indicated serious cognitive impairment, although the causal relation of such impairment to medication use could not be determined. Six percent had evidence of moderate or severe tardive dyskinesia, probably as a side effect of medication. An assessment of staff competence revealed a low level of comprehension of the purpose and side effects of commonly used psychoactive drugs. We conclude that psychoactive drugs are widely used in rest homes, with little medical supervision or understanding by staff members of their possible side effects.
Source Information
Program for the Analysis of Clinical Strategies, Harvard Medical School, Boston, MA 02115.
This article has been cited by other articles:
Rochon, P. A., Stukel, T. A., Bronskill, S. E., Gomes, T., Sykora, K., Wodchis, W. P., Hillmer, M., Kopp, A., Gurwitz, J. H., Anderson, G. M.
(2007). Variation in Nursing Home Antipsychotic Prescribing Rates. Arch Intern Med
167: 676-683
[Abstract][Full Text]
Herrmann, N., Lanctot, K. L., Khan, L. R.
(2004). The Role of Norepinephrine in the Behavioral and Psychological Symptoms of Dementia. J. Neuropsychiatry Clin. Neurosi.
16: 261-276
[Abstract][Full Text]
Lee, P. E, Gill, S. S, Freedman, M., Bronskill, S. E, Hillmer, M. P, Rochon, P. A
(2004). Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review. BMJ
329: 75-
[Abstract][Full Text]
Hermann, R. C., Yang, D., Ettner, S. L., Marcus, S. C., Yoon, C., Abraham, M.
(2002). Prescription of Antipsychotic Drugs by Office-Based Physicians in the United States, 1989-1997. Psychiatr. Serv.
53: 425-430
[Abstract][Full Text]
Talerico, K. A., Evans, L. K., Strumpf, N. E.
(2002). Mental Health Correlates of Aggression in Nursing Home Residents With Dementia. Gerontologist
42: 169-177
[Abstract][Full Text]
Wood, S., Cummings, J. L., Schnelle, B., Stephens, M.
(2002). A Videotape-Based Training Method for Improving the Detection of Depression in Residents of Long-Term Care Facilities. Gerontologist
42: 114-121
[Abstract][Full Text]
Madhusoodanan, S.
(2001). Introduction: Antipsychotic Treatment of Behavioral and Psychological Symptoms of Dementia in Geropsychiatric Patients. AJGP
9: 283-288
[Full Text]
Hughes, C. M, Lapane, K. L, Mor, V., Turrell, A, Castleden, C M
(1999). Impact of legislation on nursing home care in the United States: lessons for the United Kingdom • Commentary: A new script for nursing home care in the United Kingdom?. BMJ
319: 1060-1063
[Full Text]
McKenzie, D. A., Mullooly, J. P., McFarland, B. H., Semradek, J. A., McCamant, L. E.
(1999). Changes in Antipsychotic Drug Use Following Shifts in Policy: A Multilevel Analysis. Research on Aging
21: 304-337
[Abstract]
Reichman, W. E., Coyne, A. C., Borson, S., Negrón, A. E., Rovner, B. W., Pelchat, R. J., Sakauye, K. M., Katz, P., Cantillon, M., Hamer, R. M.
(1998). Psychiatric Consultation in the Nursing Home: A Survey of Six States. AJGP
6: 320-327
[Abstract][Full Text]
Devanand, D.P., Marder, K., Michaels, K. S., Sackeim, H. A., Bell, K., Sullivan, M. A., Cooper, T. B., Pelton, G. H., Mayeux, R.
(1998). A Randomized, Placebo-Controlled Dose-Comparison Trial of Haloperidol for Psychosis and Disruptive Behaviors in Alzheimer's Disease. Am. J. Psychiatry
155: 1512-1520
[Abstract][Full Text]
Fitz, D., Mallya, A.
(1992). Discontinuation of a Psychogeriatric Program for Nursing Home Residents: Psychotropic Medication Changes and Behavioral Reactions. Journal of Applied Gerontology
11: 50-63
[Abstract]
(1989). Topics in Geriatrics. J Geriatr Psychiatry Neurol
2: 113-115
Seifert, R. D.
(1989). Therapeutic Drug Monitoring: Psychotropic Drugs. Journal of Pharmacy Practice
2: 403-415
[Abstract]
Previous
