Factors associated with drug prescribing practices in long-term care patients with cognitive impairment
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RESEARCH PAPER
Factors associated with drug prescribing practices in long‑term care patients with cognitive impairment Violetta Kijowska1 · Ilona Barańska1 · Katarzyna Szczerbińska1 Received: 23 January 2020 / Accepted: 30 April 2020 © The Author(s) 2020
Key summary points Aim To examine factors related to resident’s characteristics which are associated with prescribing anti-dementia medicines, atypical antipsychotics, typical antipsychotics, anxiolytics and other psychostimulants in the individuals with cognitive impairment residing in long-term care institutions. Findings There are still many long-term care (LTC) residents who receive medications that are not recommended or even contraindicated in dementia. Despite existing clinical recommendations for treatment of cognitive impairment and neuropsychiatric symptoms, the physicians taking care for LTC residents do not follow them properly. Message Since ca. 70% of LTC residents have cognitive impairment, all physicians taking care of these patients should be trained in clinical guidelines of dementia treatment. Abstract Purpose To examine factors associated with prescribing anti-dementia medicines (ADM), atypical antipsychotics (A-APM), typical antipsychotics (T-APM), anxiolytics and other psychostimulants (OP) in the residents of long-term care institutions (LTCIs). Methods A cross-sectional survey of a country-representative sample of randomly selected LTCIs in Poland, conducted in 2015– 2016. First, we identified 1035 residents with cognitive impairment (CI) among all 1587 residents. Next, we randomly selected 20 residents from each institution. Study sample consists of 455 residents with CI: 214 recruited from 11 nursing homes and 241 from 12 residential homes. We used InterRAI-LTCF questionnaire and drug dispensary cards administered on the day of data collection to assess use of drugs. Multiple correspondence analysis (MCA), descriptive and logistic regression analyses were performed. Results The residents were treated with ADM (13.4%), OP (14.3%), antipsychotics (46.4%) including A-APM (24.2%) and T-APM (27.9%), and anxiolytics (28.4%). Hydroxyzine was used most often among anxiolytics (71.3%). Prescribing of ADM was more likely in Alzheimer’s disease (OR = 4.378; 95%CI 2.173–8.823), while OP in other dementia (OR = 1.873; 95%CI 1.007–3.485). Administration of A-APM was more likely in older residents (OR = 1.032, 95%CI 1.009–1.055), and when delusions appeared (OR = 2.082; 95%CI 1.199–3.613), while there were no neuropsychiatric factors increasing the odds of T-APM use. Prescribing of anxiolytics was less likely in moderate CI (by 47.2%) than in residents with mild CI. Conclusion Current practices of prescribing psychotropics are inadequate in Polish LTCIs, especially in terms of use of T-APM and hydroxyzine. More attention should be given to motivate physicians to change their prescribing practices. Keywords Cognitive impairment · Antipsychotics · Antianxiety agents · Nursing homes · Residential facilities · InterRAILTCF tool Electronic suppleme
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