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Determinants of antipsychotic medication use among older people living in aged care homes in Australia
No full textObjective To investigate determinants of antipsychotic medication use among older people living in aged care homes in Australia. Design Retrospective study of a random sample of de-identified medication reports using cross-sectional data gathered between 1 January 2008 and 30 June 2008 in Australia. Subjects The mean (SD) age of the residents was 84.0 (9.0) years. Seventy-five per cent were females. Measures Resident demographics, clinical characteristics, medical diagnoses and prescribed medication were systematically recorded. Logistic regression (LR) models were used to determine predictors for any antipsychotic, atypical and conventional antipsychotic use. Results Twenty-three per cent of the residents were prescribed one or more antipsychotics. In the LR model, factors for predicting the odds ratio and 95% confidence interval (CI) for any antipsychotic medication use were agitation (7.11, 95% CI 3.15–16.03), challenging behaviours (7.47, 95% CI 2.53–22.10), dementia (2.35, 95% CI 1.36–4.06), dementia with mood disorder (0.39, 95% CI 0.16–0.92), paranoia (6.70, 95% CI 1.08–41.55), psychosis (14.79, 95% CI 3.64–60.00) and any psychiatric diagnosis (3.30, 95% CI 1.82–6.00). Use of atypical antipsychotic medication was significant for agitation (4.58, 95% CI 2.05–10.23), aggression (2.25, 95% CI 1.05–4.78), challenging behaviours (8.01, 95% CI 2.76–23.24), dementia (3.64, 95% CI 1.99–6.67), dementia with mood disorder (0.16, 95% CI 0.06–0.43), psychosis (16.51, 95% CI 4.28–63.66) and any psychiatric diagnosis (4.44, 95% CI 2.33–8.46). Conclusions Psychiatric diagnosis, psychosis and dementia were associated with significantly greater odds for the use of antipsychotic medications. Older people suffering from dementia and comorbid mood disorders treated with antidepressants were less likely to be prescribed atypical antipsychotics.
Sedative load among long-term care facility residents with and without dementia : a cross-sectional study
No full textBackground and Objective People with cognitive impairment are particularly susceptible to adverse drug events linked to sedative and psychotropic drugs. A model to calculate sedative load has been developed to quantify the cumulative effect of taking multiple drugs with sedative properties. The objective of this study was to describe the sedative load and use of sedative and psychotropic drugs among long-term care facility residents with and without dementia. Methods Cross-sectional data were collected from all 53 long-term care wards in Helsinki, Finland, in September 2003. Of the 1444 eligible residents, consent to participate was obtained for 1087 (75%) residents. Medication and diagnostic data were available for 1052 residents. All drugs were classified using the Anatomical Therapeutic Chemical (ATC) classification system. Sedative load was calculated for each resident using a previously published four-group model. Results Of the 1052 residents, 781 (74.2%) were determined to have dementia. Residents with and without dementia had a similar sedative load (mean 3.0 vs 2.7, p?=?0.267), but residents with dementia were taking fewer drugs than residents without dementia (mean 6.7 vs 7.4, p?=?0.011). Residents with dementia were more frequent users of antipsychotics (42.8% vs 32.8%, p?=?0.004), but less frequent users of antidepressants (35.6% vs 46.1%, p?=?0.002) and sedative-hypnotics (22.8% vs 27.7%, p?=?0.003) than residents without dementia. The most frequently used primary sedatives among people with dementia were temazepam (n?=?122, 15.6%), oxazepam (n?=?98, 12.5%) and lorazepam (n?=?95, 12.2%). The most frequently used drugs with sedation as a prominent adverse effect or preparations with a sedating component among people with dementia were citalopram (n?=?183, 23.4%), risperidone (n?=?155, 19.8%) and olanzapine (n?=?73, 9.3%). Conclusions Residents with dementia were less frequent users of sedative-hypnotic drugs than residents without dementia. However, residents with and without dementia had a similar sedative load. Clinicians should be aware of the extent to which all individual drugs, not only those prescribed for intentional sedation, contribute to a resident's sedative load. The very high rates of sedative and psychotropic use observed in long-term care facility residents highlight the need for new strategies to optimize drug use.
Pharmacokinetic / pharmacodynamic relationships of transdermal buprenorphine and fentanyl in experimental human pain models
No full textPharmacokinetic ⁄ pharmacodynamic (PK⁄PD) modelling can be used to characterize the relationship between dose regimen of opioids, plasma concentration and effect of opioids, which in turn can lead to more rational treatment regimens of pain. The aim of this study was to investigate the concentration–effect relationship for transdermal buprenorphine and fentanyl in experimentally induced pain. Twenty-two healthy volunteers were randomized to receive transdermal patches with fentanyl (25 lg ⁄ hr, 72 hr), buprenorphine (20 lg ⁄ hr, 144 hr) or placebo. The experimental pain tests were pressure at the tibial bone, cutaneous thermal stimulation, cold pressor test (conditioning stimulus (3 € 0.3 C cold water), nerve growth factor– induced muscle soreness and intradermal capsaicin-induced hyperalgesia and allodynia. Experiments were carried out at baseline, 24, 48, 72 and 144 hr after application of patches. Time-course of placebo was described first and was afterwards added to the description of the time-courses of buprenorphine and fentanyl. This was either described by zero (no drug effect), linear or Emax model concentration–effect relationships. Time-dependent changes in pain measures in the placebo arm were described by linear or quadratic functions. The time-course of fentanyl and buprenorphine plasma concentrations was complex but could be represented by cubic spline interpolation in the models. Buprenorphine significantly attenuated bone-associated pain, heat pain, nerve growth factor–induced soreness and cold pressor pain. Fentanyl significantly attenuated cold pressor pain for the administered dose regimens. Although the PK⁄PD relationship for both drugs could be described with similar models, tissue-differentiated analgesic effects between buprenorphine and fentanyl was shown.
