Objective: Several European studies investigated the trends in psychotropic drug prescriptions (PDPs) among nursing home (NH) residents and reported a decline in antipsychotics prescriptions. Since... Show moreObjective: Several European studies investigated the trends in psychotropic drug prescriptions (PDPs) among nursing home (NH) residents and reported a decline in antipsychotics prescriptions. Since the Dutch long-term care system differs from other European systems (e.g. higher threshold for NH admission and trained elderly care physicians), this study explores the trends in PDPs in Dutch NH residents with dementia.Methods: The study used data from nine studies, comprising two cross-sectional studies, one cohort study, and six cluster-randomized controlled trials, collected in Dutch NHs between 2003 and 2018. With multilevel logistic regression analysis, NHs as a random effect, we estimated the trends in PDPs overall and for five specific psychotropic drug groups (antipsychotics, antidepressants, anxiolytics, hypnotics, and anti-dementia drugs), adjusting for confounders: age, gender, severity of dementia, severity of neuropsychiatric symptoms, and length of stay in NHs.Results: The absolute prescription rate of antipsychotics was 37.5% in 2003 and decreased (OR = 0.947, 95% CI [0.926, 0.970]) every year. The absolute prescription rate of anti-dementia drugs was 0.8% in 2003 and increased (OR = 1.162, 95% CI [1.105, 1.223]) per year, The absolute rate of overall PDPs declined from 62.7% in 2003 to 40.4% in 2018.Conclusions: Among Dutch NH residents with dementia, the odds of antipsychotics prescriptions decreased by 5.3% per year while the odds of anti-dementia drug prescriptions increased by 16.2%. There were no distinct trends in antidepressants, anxiolytics, and hypnotics prescriptions. However, overall PDPs were still high. The PDPs in NH residents remain an issue of concern. Show less
Purpose: Does participating in a multicomponent intervention targeting caregivers change the prescription rates of psychotropic drugs of caregivers or the person with dementia (PWD) they live with... Show morePurpose: Does participating in a multicomponent intervention targeting caregivers change the prescription rates of psychotropic drugs of caregivers or the person with dementia (PWD) they live with and care for.Patients and Methods: Participants were 142 dyads of community-dwelling cohabiting caregivers and PWD randomized to intervention or control (care as usual). Participating caregivers received the intervention in a holiday accommodation over five days in groups of two to six dyads. During this time, caregivers attended 14 psychoeducational group sessions on relevant emotional, relational, practical, financial, and social changes related to living with PWD. These sessions were delivered by a psychologist, a physiotherapist, an occupational therapist, an elderly care physician, a dietician and a social worker and included combating social isolation, planning for the future, re-rolling, medical aspects of dementia, fitness, therapeutic use of facilities, nutrition and using community services. The design was a randomized controlled trial. Outcomes were compared 3 months after baseline. Drug use for both caregivers and PWD were reported as all psychotropic drug use and specified as antipsychotic, antidepressant, and anxiolytic and hypnotic drug use based on Anatomical Therapeutic Chemical (ATC) classifications.Results: Compared to the control group, no significant difference was observed in psycho tropic drug use by 3 months after baseline among caregivers (p 0.22 MD -0.08 95% CI -0.20-0.05) or PWD (p 0.61, MD 0.04 95% -0.12-0.21) in the intervention group.Conclusion: A multicomponent course for caregivers living with PWD did not affect psychotropic drug use by either person. This may be explained by the low level of baseline drug use and the lack of the prescribing physician involvement in the present study. The low baseline drug use likely reflects selection bias for caregiver participants who were more inclined to use psychosocial interventions in preference to psychotropic medication, making them more likely to participate in caregiver training. Show less
