A RANDOMIZED TRIAL OF A PROGRAM TO REDUCE THE USE OF PSYCHOACTIVE-DRUGS IN NURSING-HOMES
A RANDOMIZED TRIAL OF A PROGRAM TO REDUCE THE USE OF PSYCHOACTIVE-DRUGS IN NURSING-HOMES
复制标题
DOI：
10.1056/nejm199207163270306
复制
发表时间：
1992-07-16
影响因子：
158.5
通讯作者：
FIELDS, D
中科院分区：
文献类型：
--
作者：
AVORN, J;SOUMERAI, SB;FIELDS, D
背景虽然精神药物对老年人有很大的副作用，但这些药物在疗养院经常使用。很少有干预措施成功地改变了这种情况，很少有人知道这种干预的临床效果。我们研究了六对配对的疗养院，在每对随机选择的疗养院，医生，护士和助手参加了老年精神药理学的教育计划。在基线，我们确定了所有居民（n = 823）接受的药物的类型和数量，并设盲观察员进行了标准化的临床评估的居民谁正在服用精神药物。在五个月的计划后，重新评估药物使用和患者状况。精神活性药物使用指数的得分，测量药物使用的程度和可能的不适当性，在实施该计划的养老院（实验性养老院）中比对照养老院下降得更明显（下降27% vs. 8%; P = 0.02）。在实验疗养院中，停止使用抗精神病药物的人数多于对照疗养院（32%比14%）;停止使用长效苯二氮卓类药物的可比数字是20%比9%，抗组胺催眠药是45%比21%。在实验疗养院，最初服用抗精神病药物的居民在几项认知功能指标上的恶化程度低于对照机构的类似居民，但他们更有可能报告抑郁症。那些最初服用苯二氮卓类药物或抗组胺催眠药的人比对照组报告的焦虑少，但记忆丧失更多。两组中大多数其他临床状态指标均保持不变。针对医生、护士和助手的教育计划可以减少疗养院中精神活性药物的使用，而不会对居民的整体行为和功能水平产生不利影响。
Background. Although psychoactive medications have substantial side effects in the elderly, these drugs are used frequently in nursing homes. Few interventions have succeeded in changing this situation, and little is known about the clinical effects of such interventions.Methods. We studied six matched pairs of nursing homes; at one randomly selected nursing home in each pair, physicians, nurses, and aides participated in an educational program in geriatric psychopharmacology. At base line we determined the type and quantity of drugs received by all residents (n = 823), and a blinded observer performed standardized clinical assessments of the residents who were taking psychoactive medications. After the five-month program, drug use and patient status were reassessed.Results. Scores on an index of psychoactive-drug use, measuring both the magnitude and the probable inappropriateness of medication use, declined significantly more in the nursing homes in which the program was carried out (experimental nursing homes) than in the control nursing homes (decrease, 27 percent vs. 8 percent; P = 0.02). The use of antipsychotic drugs was discontinued in more residents in the experimental nursing homes than in the control nursing homes (32 percent vs. 14 percent); the comparable figures for the discontinuation of long-acting benzodiazepines were 20 percent vs. 9 percent, and for antihistamine hypnotics, 45 percent vs. 21 percent. In the experimental nursing homes residents who were initially taking antipsychotic drugs showed less deterioration on several measures of cognitive function than similar residents in the control facilities, but they were more likely to report depression. Those who were initially taking benzodiazepines or antihistamine hypnotic agents reported less anxiety than controls but had more loss ot memory. Most other measures of clinical status remained unchanged in both groups.Conclusions. An educational program targeted to physicians, nurses, and aides can reduce the use of psychoactive drugs in nursing homes without adversely affecting the overall behavior and level of functioning of the residents.