The dispensing of psychotropic medicines to older people before and after they enter residential aged care
The dispensing of psychotropic medicines to older people before and after they enter residential aged care
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DOI：
10.5694/mja2.50501
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发表时间：
2020-02-11
影响因子：
11.4
通讯作者：
Inacio, Maria C.
中科院分区：
文献类型：
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作者：
Harrison, Stephanie L.;Sluggett, Janet K.;Inacio, Maria C.
目的调查老年人入住养老院前后精神药物的发放情况。澳大利亚老年人登记处（ROSA）数据分析。所有持有政府优惠卡的居民-在2008年4月1日至2009年6月30日期间进入澳大利亚养老院至少三个月的澳大利亚受资助养老院2015年。主要结果测量居民在开始住院护理前一年和后一年内分发抗精神病药物、苯二氮卓类药物或抗抑郁药物的比例，按季度划分。结果在322 120名纳入老年护理居民中，68 483名接受至少一种抗精神病药物（21.3%; 95% CI，21.1-21.4%），98 315至少一种苯二氮卓类（30.5%; 95%CI，30.4-30.7%），122224名居民至少服用一种抗抑郁药（37.9%; 95% CI，37.8-38.1%）; 31 326名分发的抗精神病药物（45.7%）、38529名获发苯二氮卓类药物（39.2%）及25259名获发抗抑郁药（19.8%）的居民在接受护理前一年内没有接受过药物治疗。在住院治疗的前三个月，（患病率[PR]，3.37; 95% CI，3.31-3.43）和抗抑郁药处方（PR，1.05; 95% CI，1.04-1.07），痴呆患者均高于非痴呆患者;两组苯二氮卓类药物的分配相似结论：澳大利亚老年人在进入寄宿护理之前，精神药物的使用率很高，但在进入护理后不久，精神药物的使用率就明显增加。非药物性行为管理战略对于限制社区或住宿护理中老年人的精神药物处方非常重要。
Objective To examine the prevalence of psychotropic medicine dispensing before and after older people enter residential care.Design Retrospective national cohort study; analysis of Registry of Senior Australians (ROSA) data.Setting, participants All concession card-holding residents of government-subsidised residential aged care facilities in Australia who entered residential care for at least three months between 1 April 2008 and 30 June 2015.Main outcome measures Proportions of residents dispensed antipsychotic, benzodiazepine, or antidepressant medicines during the year preceding and the year after commencing residential care, by quarter.Results Of 322 120 included aged care residents, 68 483 received at least one antipsychotic (21.3%; 95% CI, 21.1-21.4%), 98 315 at least one benzodiazepine (30.5%; 95% CI, 30.4-30.7%), and 122 224 residents at least one antidepressant (37.9%; 95% CI, 37.8-38.1%) during their first three months of residential care; 31 326 of those dispensed antipsychotics (45.7%), 38 529 of those dispensed benzodiazepines (39.2%), and 25 259 residents dispensed antidepressants (19.8%) had not received them in the year preceding their entry into care. During the first three months of residential care, the prevalence of antipsychotic (prevalence ratio [PR], 3.37; 95% CI, 3.31-3.43) and antidepressant dispensing (PR, 1.05; 95% CI, 1.04-1.07) were each higher for residents with than for those without dementia; benzodiazepine dispensing was similar for both groups (PR, 1.01; 95% CI, 0.99-1.02).Conclusions Dispensing of psychotropic medicines to older Australians is high before they enter residential care but increases markedly soon after entry into care. Non-pharmacological behavioural management strategies are important for limiting the prescribing of psychotropic medicines for older people in the community or in residential care.