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首页> 外文期刊>The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry >Trends in Psychotropic Dispensing Among Older Adults with Dementia Living in Long-Term Care Facilities: 2004-2013
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Trends in Psychotropic Dispensing Among Older Adults with Dementia Living in Long-Term Care Facilities: 2004-2013

机译：2004-2013年居住在长期护理机构中的老年痴呆症患者的精神药物分配趋势

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Objective: Guidelines worldwide have cautioned against the use of antipsychotics as first-line agents to treat neuropsychiatric symptoms of dementia. We aimed to investigate the changes over time in the dispensing of antipsychotics and other psychotropics among older adults with dementia living in long-term care facilities. Methods: We used drug claims data from Ontario, Canada, to calculate quarterly rates of prescription dispensing of six psychotropic drug classes among all elderly (>= 65 years of age) long-term care residents with dementia from January 1, 2004, to March 31, 2013. Psychotropic drugs were classified into the following categories: atypical and conventional antipsychotics, non-sedative and sedative antidepressants, anti-epileptics, and benzodiazepines. We used time-series analysis to assess trends over time. Results: The study sample increased by 21% over the 10-year study period, from 49,251 patients to 59,785 patients. The majority of patients (within the range of 75%-79%) were dispensed at least one psychotropic medication. At the beginning of the study period atypical antipsychotics (38%) were the most frequently dispensed psychotropic, followed by benzodiazepines (28%), non-sedative antidepressants (27%), sedative antidepressants (17%), anti-epileptics (7%), and conventional antipsychotics (3%). Dispensing of anti-epileptics (2% increase) and conventional antipsychotics (1% decrease) displayed modest changes over time, but we observed more pronounced changes in dispensing of benzodiazepines (11% decrease) and atypical antipsychotics (4% decrease). Concurrently, we observed a substantial growth in the dispensing of both sedative (15% increase) and non-sedative (9% increase) antidepressants. The proportion of patients dispensed two or more psychotropic drug classes increased from 42% in 2004 to 50% in 2013. Conclusions: Utilization patterns of psychotropic drugs in institutionalized patients with dementia have changed over the past decade. Although their use declined slightly over the study period, atypical antipsychotics continue to be used at a high rate. A decline in the use of benzodiazepines along with an increased use of sedative and non-sedative antidepressants suggests that the latter class of drugs is being substituted for the former in the management of neuropsychiatric symptoms. Psychotropic polypharmacy continues to be highly prevalent in these patient samples.
机译：目的：全球指南均告诫不要将抗精神病药用作治疗痴呆症的神经精神症状的一线药物。我们旨在调查居住在长期护理机构中的老年痴呆症患者中抗精神病药和其他精神药物配药的时间变化。方法：我们使用了来自加拿大安大略省的药物声明数据，计算了2004年1月1日至3月期间所有老年（> = 65岁）患有痴呆症的长期护理居民中六种精神药物的处方配发率。 2013年3月31日。精神药物分为以下几类：非典型和常规抗精神病药，非镇静和镇静抗抑郁药，抗癫痫药和苯二氮卓类。我们使用时间序列分析来评估一段时间内的趋势。结果：在10年的研究期内，研究样本增加了21％，从49,251位患者增加到59,785位患者。大多数患者（在75％-79％的范围内）分配了至少一种精神药物。在研究期开始时，非典型抗精神病药（38％）是最常分配的精神药物，其次是苯二氮卓类药物（28％），非镇静抗抑郁药（27％），镇静抗抑郁药（17％），抗癫痫药（7％ ）和常规抗精神病药（3％）。随着时间的流逝，抗癫痫药的分配（增加2％）和常规抗精神病药物的分配（减少1％）显示出适度的变化，但我们观察到苯二氮卓类药物（减少11％）和非典型抗精神病药（减少4％）的分配变化更为明显。同时，我们观察到镇静剂（增加了15％）和非镇静剂（增加了9％）抗抑郁药的分配量都有了大幅增长。分配两种或两种以上精神药物类别的患者比例从2004年的42％增加到2013年的50％。结论：在过去十年中，制度化痴呆患者中精神药物的使用模式发生了变化。尽管在研究期间它们的使用量略有下降，但非典型抗精神病药的使用率仍很高。苯二氮卓类药物的使用减少以及镇静和非镇静抗抑郁药的使用增加表明，在神经精神症状的管理中，后一类药物正在代替前者。在这些患者样品中，精神药物多药继续很普遍。

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