Pharmacological treatments are often used in treating the behavioural and psychological symptoms of dementia (BPSD) in nursing homes, despite the fact that non-pharmacological treatments are recommended as a first-line treatment and can provide a suitable alternative. Because the course of BPSD is known to fluctuate depending on individual symptoms over time, the frequencies of drug use and BPSD — as well as their association — should be observed over a longer period.
A team of investigators from Hokkaido University, Sapporo, Japan, and the University of Kentucky College of Public Health investigated the association between the changes in psychotropic drug (PD) use and BPSD, focusing on the number of symptoms, severity, and care burden over one year among long-term care facility residents. The resulting publication appears in Psychogeriatrics. The first author is Dr. Takashi Ozak of the Hokkaido University School of Medicine. Co-authors are Dr. Yuriko Katsumata of the University of Kentucky College of Public Health department of biostatistics, and corresponding author Dr. Asuna Arai of Hokkaido University Graduate School of Medicine.
A one-year follow-up study was conducted among older residents with dementia or similar symptoms (n = 312 at baseline; n = 237 at follow-up) by using a care staff questionnaire in ten long-term care facilities in Hokkaido, Japan. Medication use was determined based on prescription information. The brief questionnaire form of the Neuropsychiatric Inventory was used to assess BPSD.
The investigators found that among residents followed for one year, new users of PD — particularly anxiolytics and hypnotics — had a significantly increased number and severity of BPSD, compared with non-PD users. Continuing PDs was also related to increased severity over the year. Among residents with any persistent BPSD for 1 year, new use of PDs-particularly anxiolytics and hypnotics-was significantly associated with an increased care burden of BPSD, compared with the non-use of PDs. The discontinuation of PDs was significantly associated with a decreased care burden, compared with the non-use of PDs.
The authors conclude: “Our study suggests that PDs, particularly anxiolytics and hypnotics, may be prescribed carefully in response to exacerbation of BPSD in terms of the number of symptoms, severity, and care burden in long-term care facilities. Continuous monitoring of PDs use and BPSD is important to effectively address BPSD.”