Aging & Mental Health ( IF 3.4 ) Pub Date : 2021-05-13 , DOI: 10.1080/13607863.2021.1922601 Daisy A Wiggin 1 , Suzanne Timmons 1 , Aphie Rukundo 1 , Kieran A Walsh 1
Abstract
Objectives
Psychotropic medications are commonly inappropriately prescribed for people with dementia (PwD) residing in nursing homes. This population is often multi-morbid, receiving multiple medications and therefore at an increased risk of mortality. This overview aimed to collate all synthesised quantitative, qualitative, and mixed-method evidence pertaining to the effectiveness of interventions aimed at reducing inappropriate psychotropic prescribing for nursing home residents with dementia; the perceived barriers and facilitators to the implementation of these interventions; and the attitudes and experiences of stakeholders toward prescribing. Method: An overview of reviews was conducted (PROSPERO protocol registration CRD42020187288). Five databases were systematically searched from January 2010 through June 2020, supplemented by grey literature searching. Reviews presenting evidence pertaining to either randomised controlled trials (RCT) aiming to reduce inappropriate prescribing or qualitative/mixed method studies of stakeholder views, were included.
Results
Of 273 records identified, 11 systematic reviews were included. The quality of reviews ranged from critically low to moderate. There was mixed evidence for the use of education-only interventions. Multicomponent interventions (typically staff education combined with organisational and structural components), medication review, and interventions aimed at cultural change were evidenced as effective compared to care as usual. Stakeholders cited the importance of multidisciplinary collaboration and targeting organisational climate in changing psychotropic prescribing behaviours.
Conclusions
The inappropriate use of psychotropic medications in nursing homes for PwD is a complex issue with many contextual factors. The evidence suggests a comprehensive approach, targeting organisational climate and multidisciplinary collaboration, along with staff education and training, may be an effective strategy.
中文翻译:
提高老年痴呆症疗养院居民精神药物处方的适当性:综述综述
摘要
目标
精神药物通常不适合居住在疗养院的痴呆症 (PwD) 患者。该人群通常患有多种疾病,接受多种药物治疗,因此死亡风险增加。本概述旨在整理所有与干预措施的有效性有关的综合定量、定性和混合方法证据,这些干预措施旨在减少对患有痴呆症的疗养院居民的不适当精神药物处方;实施这些干预措施的障碍和促进因素;以及利益相关者对处方的态度和经验。方法:对审查进行了概述(PROSPERO 协议注册 CRD42020187288)。从 2010 年 1 月到 2020 年 6 月,系统检索了 5 个数据库,并辅以灰色文献检索。提供与旨在减少不适当处方的随机对照试验 (RCT) 或利益相关者观点的定性/混合方法研究相关的证据的评论被纳入。
结果
在确定的 273 条记录中,包括 11 条系统评价。评论的质量从极低到中等不等。使用纯教育干预的证据好坏参半。与常规护理相比,多成分干预(通常是员工教育与组织和结构成分相结合)、药物审查和旨在文化变革的干预被证明是有效的。利益相关者提到了多学科合作和针对组织氛围在改变精神药物处方行为方面的重要性。
结论
在 PwD 疗养院中不当使用精神药物是一个复杂的问题,涉及许多背景因素。证据表明,针对组织氛围和多学科合作以及员工教育和培训的综合方法可能是一种有效的策略。