Use of Antipsychotics in Older Home Care Patients in Finland
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ORIGINAL RESEARCH ARTICLE
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Use of Antipsychotics in Older Home Care Patients in Finland Hanna-Mari Alanen,1 Harriet Finne-Soveri,2 Anja Noro2 and Esa Leinonen1,3 1
Medical School, University of Tampere, Tampere, Finland
2
STAKES, Center for Health Economics CHESS, Helsinki, Finland
3
Department of Psychiatry, Tampere University Hospital, Pitk¨aniemi, Finland
Abstract
Objective: To investigate the use of antipsychotic medications, and factors associated with such use, in elderly patients in home care in Finland. Method: A retrospective study was designed using cross-sectional data gathered between 1 July and 31 December 2004 in Finland. Data were extracted from the Resident Assessment Instrument (RAI) database, based on Minimum Data Set for Home Care (MDS-HC) assessments. Patients aged ≥65 years from five home care units in different parts of Finland (urban and rural) were included, yielding a total of 1106 patient assessments. Results: The prevalence of antipsychotic use was 11% among home care patients. Factors independently associated with use of antipsychotics in the logistic regression model were: any psychiatric diagnosis (odds ratio [OR] 6.62, 95% CI 4.19, 10.45), delusions (OR 4.19, 95% CI 2.22, 7.90), parkinsonism (OR 3.08, 95% CI 1.07, 8.87), not at ease interacting with others (OR 1.88, 95% CI 1.06, 3.36) and moderate-to-severe cognitive impairment (OR 1.47, 95% CI 1.06, 2.04). By contrast, patients aged ≥85 years (OR 0.59, 95% CI 0.43, 0.81) were significantly less likely to be taking antipsychotics. Use of atypical antipsychotic medication was associated in the logistic regression model with delusions (OR 4.05, 95% CI 2.01, 8.17), parkinsonism (OR 3.66, 95% CI 1.10, 12.19), any psychiatric diagnosis (OR 3.06, 95% CI 1.66, 5.63), moderate-to-severe cognitive impairment (OR 2.0, 95% CI 1.32, 3.03) and age ≥85 years (OR 0.66, 95% CI 0.44, 0.99). However, use of conventional antipsychotics was associated only with any psychiatric diagnosis (OR 8.88, 95% CI 5.05, 15.61) and age ≥85 years (OR 0.65, 95% CI 0.44, 0.98). Conclusion: The prevalence of antipsychotic medication use in elderly home care patients was higher than that previously reported among elderly people living in the community in Finland and Sweden (3–9%). Several predictive factors such as psychiatric diagnosis, delusions and cognitive impairment were associated with use of antipsychotics whereas there was a negative association between age ≥85 years and use of antipsychotics.
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Introduction There has been concern about extensive use of antipsychotic medications in long-term institutional care resulting in inappropriate medication use and a high risk of adverse effects. According to the Expert Consensus Guidelines (US 2004), antipsychotics in elderly people are indicated for disorders with psychotic symptoms, i.e. schizophrenia, mania with psychosis, psychotic major depression and delusional disorders, and sometimes for people with agitated dementia with delusions.
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