USE OF PSYCHOACTIVE MEDICATION AND THE QUALITY OF CARE IN REST HOMES - FINDINGS AND POLICY IMPLICATIONS OF A STATEWIDE STUDY
USE OF PSYCHOACTIVE MEDICATION AND THE QUALITY OF CARE IN REST HOMES - FINDINGS AND POLICY IMPLICATIONS OF A STATEWIDE STUDY
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DOI：
10.1056/nejm198901263200406
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发表时间：
1989-01-26
影响因子：
158.5
通讯作者：
SOUMERAI, SB
中科院分区：
文献类型：
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作者：
AVORN, J;DREYER, P;SOUMERAI, SB
疗养院已成为为体弱老年人和脱离机构的精神病患者提供的保健系统的一个主要组成部分。虽然精神药物经常在疗养院使用，但关于这种使用的程度，其监督或其影响的详细信息很少。在对美国马萨诸塞州55家养老院的随机抽样调查中，我们发现55%的居民至少服用一种精神药物。39%的人服用了抗精神病药物，其中18%的人服用了两种或两种以上的药物。在一项后续调查中，我们研究了44家疗养院的837名居民，这些疗养院的抗精神病药物使用水平特别高。大约一半的居民没有证据表明医生在研究期间参与了关于他们心理健康的决定。三分之一的居民在精神状态测试中表现出严重的认知障碍，尽管这种障碍与药物使用的因果关系尚不能确定。有中度或重度迟发性运动障碍的证据，可能是药物的副作用。对工作人员能力的评估显示，对常用精神活性药物的目的和副作用的理解程度很低。我们的结论是，精神活性药物被广泛使用的养老院，很少有医疗监督或了解其可能的副作用的工作人员。
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 Massachusettes, USA, 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. Sic 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.