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Pharmacopsychiatry 2006; 39(4): 142-149
DOI: 10.1055/s-2006-946704
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Does the Context Matter? Utilization of Sedative Drugs in Nursing Homes - A Multilevel Analysis

A. Sonntag1 , H. Matschinger1 , M. C. Angermeyer1 , S. G. Riedel-Heller1
  • 1Department of Psychiatry, University of Leipzig, Leipzig, Germany
Weitere Informationen

Publikationsverlauf

Received: 25.6.2005 Revised: 18.4.2006

Accepted: 8.5.2006

Publikationsdatum:
27. Juli 2006 (online)

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Background: The aim of this study is to assess the utilization of sedative drugs in nursing homes by means of a multilevel approach taking into account individual as well as institutional characteristics. Methods: A retrospective chart review of the drugs consumed in nursing homes in an urban region of Germany was conducted. Individual characteristics were measured by analyzing nursing home files, by staff assessment and by a structured interview conducted by trained psychologists and physicians. Institutional characteristics were assessed by interviewing the management of each facility and ward and by using a staff questionnaire survey. The sample consisted of 1903 residents from 27 nursing homes with a total of 96 wards. Data analysis was carried out by means of a multilevel analysis, a strategy for analyzing hierarchically structured data. Results: The utilization of sedative drugs (low potency neuroleptics, anxiolytics, hypnotics) in nursing homes is remarkably high. Thus, 33.3 % of the residents used sedative drugs on a regular basis. PRN prescriptions existed for 13.1 % of the residents, 5.3 % had been using sedative medication prescribed as PRN. Results indicate the influence of individual as well as institutional characteristics on residents’ sedative drug utilization. In particular, the use of PRN medicine is determined by characteristics of the ward the individuals are living in. Conclusion: Methodological implications: The data analysis concerning the drug utilization of residents of nursing homes requires multilevel models and a distinction between regular and PRN medicine. Further research should focus on explaining institutional variance. Practical implications: Staff training in nonpharmacological strategies to manage disturbing behavior of residents is required.

References

  • 1 Avorn J, Gurwitz J H. Drug use in the nursing home.  Ann Intern Med. 1995;  123 195-204
    PubMedSuche in Google Scholar
  • 2 Avorn J, Soumerai S B, Everitt D E, Ross-Degnan D, Beers M H, Sherman D. et al . A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes.  N Engl J Med. 1992;  327 168-173
    PubMedSuche in Google Scholar
  • 3 Beers M H, Avorn J, Soumerai S B, Everitt D E, Sherman D S, Salem S. Psychoactive medication use in intermediate-care facility residents.  JAMA. 1988;  260 3016-3020
    CrossrefPubMedSuche in Google Scholar
  • 4 Buck J A. Psychotropic drug practice in nursing homes.  J Am Geriatr Soc. 1988;  36 409-418
    PubMedSuche in Google Scholar
  • 5 Damnitz B M. [Drug utilization by elderly patients in Bremen old age and nursing homes with special reference to psychotropic drugs].  Gesundheitswesen. 1997;  59 83-86
    PubMedSuche in Google Scholar
  • 6 Diez-Roux A V. Bringing context back into epidemiology: Variables and fallacies in multilevel analysis.  Am J Public Health. 1998;  88 216-222
    PubMedSuche in Google Scholar
  • 7 Folstein M F, Folstein S E, McHugh P R. ”Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.  J Psychiatr Res. 1975;  12 189-198
    CrossrefPubMedSuche in Google Scholar
  • 8 Furniss L, Craig S KL, Burns A. Medication use in nursing homes for elderly people.  Int J Geriatr Psychiatry. 1998;  13 433-439
    CrossrefPubMedSuche in Google Scholar
  • 9 Gurwitz J H, Field T S, Avorn J, McCormick D, Jain S, Eckler M. et al . Incidence and preventability of adverse drug events in nursing homes.  Am J Med. 2000;  109 87-94
    CrossrefPubMedSuche in Google Scholar
  • 10 Hacker W, Reinhold S. Beanspruchungsscreening bei Humandienstleistungen (BHD-System). Manual. Frankfurt/Main; Swets Test Services GmbH 1999
    Suche in Google Scholar
  • 11 Harrington C, Tompkins C, Curtis M, Grant L. Psychotropic drug use in long-term care facilities: a review of the literature.  Gerontologist. 1992;  32 822-833
    PubMedSuche in Google Scholar
  • 12 Hughes C, Berg L, Danziger W, Coben L, Martin R. A new clinical scale for the staging of dementia.  Br J Psychiatry. 1982;  140 566-572
    CrossrefPubMedSuche in Google Scholar
  • 13 Kempe P, Closs C. Das Betriebsklima in 22 Hamburger Alteneinrichtungen aus der Sicht des Personals.  Z Gerontol. 1981;  14 444-458
    PubMedSuche in Google Scholar
  • 14 Kreft I, De Leeuw J. Int Multilevel Modelling. London; SAGE Publications 1998
    Suche in Google Scholar
  • 15 Mahoney F I, Barthel D W. Functional evaluation. The Barthel Index.  Maryland State Med J. 1965;  2 61-65
    PubMedSuche in Google Scholar
  • 16 Nolan L, Omalley K. The need for a more rational approach to drug prescribing for elderly people in nursing-homes.  Age Ageing. 1989;  18 52-56
    PubMedSuche in Google Scholar
  • 17 Pittrow D, Krappweis J, Rentsch A, Schindler C, Hach I, Bramlage P. et al . Pattern of prescriptions issued by nursing home-based physicians versus office-based physicians for frail elderly patients in German nursing homes.  Pharmacoepidemiol Drug Saf. 2003;  12 595-599
    CrossrefPubMedSuche in Google Scholar
  • 18 Raudenbusch S, Bryk A, Congdon R. Hierarchical linear and nonlinear modelling. Manual. New Jersey; Lawrence Erlbaum Associates Inc 2000
    Suche in Google Scholar
  • 19 Ray W A, Federspiel C F, Schaffner W. A study of antipsychotic drug use in nursing homes: epidemiologic evidence suggesting misuse.  Am J Public Health. 1980;  70 485-491
    PubMedSuche in Google Scholar
  • 20 Ray W A, Taylor J A, Meador K G, Lichtenstein M J, Griffin M R, Fought R. et al . Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education.  Arch Intern Med. 1993;  153 713-721
    CrossrefPubMedSuche in Google Scholar
  • 21 Roth M, Tym E, Mountjoy C Q, Huppert F A, Hendrie H, Verma S. et al . CAMDEX: A standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia.  Br J Psychiatry. 1986;  149 698-709
    PubMedSuche in Google Scholar
  • 22 Ruths S, Straand J, Nygaard H A. Psychotropic drug use in nursing homes - diagnostic indications and variations between institutions.  Eur J Clin Pharmacol. 2001;  57 523-528
    CrossrefPubMedSuche in Google Scholar
  • 23 Schmidt I, Claesson C B, Westerholm B, Nilsson L G, Svarstad B L. The impact of regular multidisciplinary team interventions on psychotropic prescribing in Swedish nursing homes.  J Am Geriatr Soc. 1998;  46 77-82
    PubMedSuche in Google Scholar
  • 24 Schmidt I, Claesson C B, Westerholm B, Svarstad B L. Resident characteristics and organizational factors influencing the quality of drug use in Swedish nursing homes.  Soc Sci Med. 1998;  47 961-971
    CrossrefPubMedSuche in Google Scholar
  • 25 Shorr R I, Fought R L, Ray W A. Changes in antipsychotic drug-use in nursing-homes during implementation of the Obra-87 regulations.  JAMA. 1994;  271 358-362
    CrossrefPubMedSuche in Google Scholar
  • 26 Snijders T, Bosker R. Multilevel Analysis. An introduction to basic and advanced multilevel modeling. London; SAGE Publications 1999
    Suche in Google Scholar
  • 27 Snowdon J. A follow-up survey of psychotropic drug use in Sydney nursing homes.  Med J Aust. 1999;  170 299-301
    PubMedSuche in Google Scholar
  • 28 Sorensen L, Foldspang A, Gulmann N C, Munk-Jorgensen P. Determinants for the use of psychotropics among nursing home residents.  Int J Geriatr Psychiatry. 2001;  16 147-154
    PubMedSuche in Google Scholar
  • 29 Svarstad B L, Mount J K. Nursing home resources and tranquilizer use among the institutionalized elderly.  J Am Geriatr Soc. 1991;  39 869-875
    PubMedSuche in Google Scholar
  • 30 Waxman H M, Klein M, Carner E A. Drug misuse in nursing homes: an institutional addiction?.  Hosp Community Psychiatry. 1985;  36 886-887
    PubMedSuche in Google Scholar
  • 31 Weyerer S, El-Barrawy R, König S, Zimber A. Epidemiologie des Gebrauchs von Psychopharmaka in Altenheimen.  Gesundheitswesen. 1996;  58 201-206
    PubMedSuche in Google Scholar
  • 32 Weyerer S, Schäufele M. Medikamentenabhängigkeit und Multimedikation. In Kretschmar C, Hirsch RD, Haupt M, Ihl R, Kortus R, Stoppe G et al., editors Angst - Sucht - Anpassungsstörungen im Alter. Schriftenreihe der Deutschen Gesellschaft für Gerontopsychiatrie und -psychotherapie Düsseldorf, Bonn, Saarbrücken, Göttingen, Hamburg: DGGPP; 2000: pp 234-248
    Suche in Google Scholar

Prof. Dr. med. Steffi G. Riedel-Heller, MPH

Department of Psychiatry

University of Leipzig

Johannisallee 20

04317 Leipzig

Germany

Telefon: +49 341 9724530

Fax: +49 341 9724539

eMail: ries@medizin.uni-leipzig.de