Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Methods
2.1. Scope of Review: Eligibility Criteria
2.2. Information Sources
2.3. Search Strategy
2.4. Data Extraction
2.5. Assessment of Quality in Included Studies
2.6. Data Synthesis and Statistical Analysis
3. Results
3.1. Characteristics of the Included Studies
3.2. Trends in Global Use of CNS Drugs
3.3. Use of Psychotropic Drugs
3.4. Use of Antipsychotic Drugs
3.5. Use of Antidepressant Drugs
3.6. Use of Benzodiazepines
3.7. Use of Antiepileptic and Antiparkinson Drugs
4. Discussion
4.1. Trend in the Global Use of CNS Drugs
4.2. Benzodiazepines
4.3. Antidepressants
4.4. Antipsychotics
4.5. Antiepileptic and Antiparkinson Medicines
5. Conclusions
Supplementary Materials
Author Contributions
Conflicts of Interest
References
- Global Age Watch Index 2015. Available online: https://www.helpage.org/global-agewatch/ (accessed on 6 July 2019).
- Gellis, Z.; McGinty, J.; Horowitz, A.; Bruxe, M.L.; Misener, E. Problem-solving therapy for late-life depression in home care: A randomized field trial. Am. J. Geriatr. Psychiatry 2007, 15, 968–978. [Google Scholar] [CrossRef] [PubMed]
- Kaye, H.S.; Harrington, C.; LaPlante, M.P. Long-term care: Who gets it, who provides it, who pays, and how much? Health Aff. (Millwood) 2010, 29, 11–21. [Google Scholar] [CrossRef] [PubMed]
- Seitz, D.; Purandare, N.; Conn, D. Prevalence of psychiatric disorders among older adults in long-term care homes: A systematic review. Int. Psychogeriatr. 2010, 22, 1025–1039. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Mental Health of Older Adults. 2017. Available online: https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults (accessed on 8 July 2019).
- Azermai, M.; Elseviers, M.; Petrovic, M.; Van Bortel, L.; Stichele, R.V. Geriatric drug utilisation of psychotropics in Belgian nursing homes. Hum. Psychopharmacol. 2011, 26, 12–20. [Google Scholar] [CrossRef] [PubMed]
- Hartikainen, S.; Lonnroos, E.; Louhivuori, K. Medication as a risk factor for falls: Critical systematic review. J. Gerontol. Ser. A Biol. Sci. Med Sci. 2007, 62, 1172–1181. [Google Scholar] [CrossRef] [PubMed]
- Sterke, C.; Verhagen, A.; Van Beeck, E.F.; van der Cammen, T.J. The influence of drug use on fall incidents among nursing home residents: A systematic review. Int. Psychogeriatr. 2008, 20, 890–910. [Google Scholar] [CrossRef] [PubMed]
- Wright, R.M.; Roumani, Y.F.; Boudreau, R.; Newman, A.B.; Ruby, C.M.; Studenski, S.A. Impact of Central Nervous System (CNS) Medication Use on Cognition Decline in Community Dwelling Older Adults: Findings from the Health, Aging and Body Composition Study. J. Am. Geriatr. Soc. 2009, 57, 243–250. [Google Scholar] [CrossRef] [PubMed]
- Barca, M.; Engedal, K.; Laks, J.; Selbaek, G. A 12 months follow-up study of depression among nursing-home patients in Norway. J. Affect Disord. 2010, 120, 141–148. [Google Scholar] [CrossRef]
- Moher, D.; Liberati, A.; Tetzlaff, J.; Altman, D.G.; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009, 151, 264–269. [Google Scholar]
- Scottish Intercollegiate Guidelines Network. Methodology Checklist 3: Cohort Studies; Scottish Intercollegiate Guidelines Network: Edinburgh, UK, 2012. [Google Scholar]
- MetaXL Version 5.3. 2019. Available online: https://www.epigear.com/index_files/metaxl.html (accessed on 2 July 2019).
- Hosia-Randell, H.; Pitkälä, K. Use of psychotropic drugs in elderly nursing home residents with and without dementia in Helsinki, Finland. Drugs Aging 2005, 22, 793–800. [Google Scholar] [CrossRef] [PubMed]
- Mann, E.; Köpke, S.; Haastert, B.; Pitkala, K.; Meyer, G. Psychotropic medication use among nursing home residents in Austria: A cross-sectional study. BMC Geriatr. 2009, 9, 18. [Google Scholar] [CrossRef] [PubMed]
- Richter, T.; Mann, E.; Meyer, G.; Haastert, B.; Köpke, S. Prevalence of psychotropic medication use among German and Austrian nursing home residents: A comparison of 3 cohorts. J. Am. Med. Dir. Assoc. 2012, 13, 187.e7–187.e13. [Google Scholar] [CrossRef] [PubMed]
- Shah, S.; Schoenbachler, B.; Streim, J.; Meeks, S. Antidepressant prescribing patterns in the nursing home: Second-generation issues revisited. J. Am. Med. Dir. Assoc. 2012, 13, 406.e13–406.e18. [Google Scholar] [CrossRef] [PubMed]
- Taxis, K.; Kochen, S.; Wouters, H.; Boersma, F.; Jan Gerard, M.; Mulder, H.; Pavlovic, J.; McLachlan, A.; Pont, L.G. Cross-national comparison of medication use in Australian and Dutch nursing homes. Age Ageing 2017, 46, 320–323. [Google Scholar] [CrossRef] [PubMed]
- Halvorsen, K.; Johannessen Landmark, C.; Granas, A. Prevalence of different combinations of antiepileptic drugs and cns drugs in elderly home care service and nursing home patients in Norway. Epilepsy Res. Treat. 2016, 2016, 8. [Google Scholar] [CrossRef] [PubMed]
- Sundseth, A.C.; Gjelstad, S.; Straand, J.; Rosvold, E.O. General practitioners’ prescriptions of benzodiazepines, Z-hypnotics and opioid analgesics for elderly patients during direct and indirect contacts. A cross-sectional, observational study. Scand. J. Prim. Health Care 2018, 36, 115–122. [Google Scholar] [CrossRef] [PubMed]
- Auer, S.R.; Hofler, M.; Linsmayer, E.; Berankova, A.; Prieschl, D.; Ratajczak, P.; Steffl, M.; Holmerova, I. Cross-sectional study of prevalence of dementia, behavioural symptoms, mobility, pain and other health parameters in nursing homes in Austria and the Czech Republic: Results from the DEMDATA project. BMC Geriatr. 2018, 18, 178. [Google Scholar] [CrossRef] [PubMed]
- Helvik, A.S.; Benth, J.S.; Wu, B.; Engedal, K.; Selbaek, G. Persistant use of psychotropic drugs in nursing home residents in Norway. BMC Geriatr. 2017, 17, 52. [Google Scholar] [CrossRef] [PubMed]
- Verrue, C.; Petrovic, M.; Mehuys, E.; Boussery, K.; Somers, A.; Spinewine, A.; Bauwens, M.; Elseviers, M.M.; Vander Stichele, R. Organization of the medication management process in Belgian nursing homes. J. Am. Med. Dir. Assoc. 2011, 12, 308–311. [Google Scholar] [CrossRef] [PubMed]
- Hukins, D.; Macleod, U.; Boland, J.W. Identifying potentially inappropriate prescribing in older people with dementia: A systematic review. Eur. J. Clin. Pharmacol. 2019, 75, 467–481. [Google Scholar] [CrossRef] [PubMed]
- Westaway, K.; Sluggett, J.; Alderman, C.; Moffat, A.; Procter, N.; Roughead, E. The extent of antipsychotic use in Australian residential aged care facilities and interventions shown to be effective in reducing antipsychotic use: A literature review. Dementia (London) 2018, 28. [Google Scholar] [CrossRef] [PubMed]
- National Institute for Health and Care Excellence (NICE). Managing Medicines in Care Homes (Guidelines 2018). Available online: https://www.nice.org.uk/guidance/sc1/evidence/full-guideline-pdf-2301173677 (accessed on 4 July 2019).
- Bourgeois, J.; Elseviers, M.; Azermai, M.; Van Bortel, L.; Petrovic, M.; Vander Stichele, R.R. Benzodiazepine use in Belgian nursing homes: A closer look into indications and dosages. Eur. J. Clin. Pharmacol. 2012, 68, 833–844. [Google Scholar] [CrossRef] [PubMed]
- Stevenson, D.; Decker, S.; Dwyer, L.; Huskamp, H.A.; Grabowski, D.C.; Metzger, E.D.; Mitchell, S.L. Antipsychotic and benzodiazepine use among nursing home residents: Findings from the 2004 National Nursing Home Survey. Am. J. Geriatr. Psychiatry 2010, 18, 1078–1092. [Google Scholar] [CrossRef] [PubMed]
- Olfson, M.; King, M.; Schoenbaum, M. Benzodiazepine use in the United States. JAMA Psychiatry 2015, 72, 136–142. [Google Scholar] [CrossRef] [PubMed]
- Hill, K.D.; Wee, R. Psychotropic drug-induced falls in older adults: A review of interventions aimed at reducing the problem. Drugs Aging 2012, 29, 15–30. [Google Scholar] [CrossRef] [PubMed]
- Bakken, M.S.; Engeland, A.; Engesæter, L.B.; Ranhoff, A.H.; Hunskaar, S.; Ruths, S. Risk of hip fracture among older adults using anxiolytic and hypnotic drugs: A nationwide prospective cohort study. Eur. J. Clin. Pharmacol. 2014, 70, 873–880. [Google Scholar] [CrossRef] [PubMed]
- Cumming, R.G.; Le Couteur, D.G. Benzodiazepines and risk of hip fractures in older adults: A review of the evidence. CNS Drugs 2003, 17, 825–837. [Google Scholar] [CrossRef] [PubMed]
- Moore, N.; Pariente, A.; Bégaud, B. Why are benzodiazepines not yet controlled substances? JAMA Psychiatry 2015, 72, 110–111. [Google Scholar] [CrossRef] [PubMed]
- Xing, D.; Ma, X.L.; Ma, J.X.; Wang, J.; Yang, Y.; Chen, Y. Association between use of benzodiazepines and risk of fractures: A meta-analysis. Osteoporos. Int. 2014, 25, 105–120. [Google Scholar] [CrossRef]
- Rummans, T.A.; Davis, L.J., Jr.; Morse, R.M.; Ivnik, R.J. Learning and memory impairment in older, detoxified, benzodiazepine-dependent patients. Mayo Clin. Proc. 1993, 68, 731–737. [Google Scholar] [CrossRef]
- Barker, M.J.; Greenwood, K.M.; Jackson, M.; Crowe, S.F. Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: A meta-analysis. Arch. Clin. Neuropsychol. 2004, 19, 437–454. [Google Scholar] [CrossRef]
- Bhattacharjee, S.; Karkare, S.; Kamble, P.; Aparasu, R.R. Datapoints: Psychotropic drug utilization among elderly nursing home residents in the United States. Psychiatr. Serv. 2010, 61, 655. [Google Scholar] [CrossRef] [PubMed]
- De Souto Barreto, P.; Lapeyre-Mestre, M.; Mathieu, C.; Piau, C.; Bouget, C.; Cayla, F.; Vellas, B.; Rolland, Y. Indicators of benzodiazepine use in nursing home residents in France: A cross-sectional study. J. Am. Med Dir. Assoc. 2013, 14, 29–33. [Google Scholar] [CrossRef] [PubMed]
- Johnell, K.; Fastbom, J. Comparison of prescription drug use between community-dwelling and institutionalized elderly in Sweden. Drugs Aging 2012, 29, 751–758. [Google Scholar] [CrossRef] [PubMed]
- Kerse, N. Medication use in residential care. N. Z. Fam. Physician 2005, 32, 251–255. [Google Scholar]
- Olazarán, J.; Valle, D.; Serra, J.; Cano, P.; Muniz, R. Psychotropic medications and falls in nursing homes: A cross-sectional study. J. Am. Med. Dir. Assoc. 2013, 14, 213–217. [Google Scholar] [CrossRef]
- Petek Šter, M.; Cedilnik Gorup, E. Psychotropic medication use among elderly nursing home residents in Slovenia: Cross-sectional study. Croat. Med. J. 2011, 52, 16–24. [Google Scholar] [CrossRef]
- Pasina, L.; Marengoni, A.; Ghibelli, S.; Suardi, F.; Djade, C.D.; Nobili, A.; Franchi, C.; Guerrini, G. A multicomponent intervention to optimize psychotropic drug prescription in elderly nursing home residents: An Italian multicenter, prospective, pilot study. Drugs Aging 2016, 33, 143–149. [Google Scholar] [CrossRef]
- Blazer, D.G.; Hybels, C.F.; Pieper, C.F. The association of depression and mortality in elderly persons: A case for multiple, independent pathways. J. Gerontol. Ser. A Biol. Sci. Med Sci. 2001, 56, M505–M509. [Google Scholar] [CrossRef]
- National Institute for Health and Care Excellence. Depression in Adults: Recognition and Management. CG90. October 2009 (updated April 2016). Available online: https://www.nice.org.uk/guidance/cg90 (accessed on 1 July 2019).
- Kirby, D.; Harrigan, S.; Ames, D. Hyponatraemia in elderly psychiatric patients treated with Selective Serotonin Reuptake Inhibitors and venlafaxine: A retrospective controlled study in an inpatient unit. Int. J. Geriatr. Psychiatry 2002, 17, 231–237. [Google Scholar] [CrossRef]
- Gill, D.; Hatcher, S. Antidepressants for depression in adults with physical illness. Cochrane Database Syst. Rev. 2000, CD001312. [Google Scholar] [CrossRef]
- Glassman, A.H.; O’Connor, C.M.; Califf, R.M.; Swedberg, K.; Schwartz, P.; Bigger, J.T., Jr.; Krishnan, K.R.; van Zyl, L.T.; Swenson, J.R.; Finkel, M.S.; et al. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 2002, 288, 701–709. [Google Scholar] [CrossRef] [PubMed]
- Mottram, P.G.; Wilson, K.; Strobl, J. Antidepressants for depressed elderly. Cochrane Database Syst. Rev. 2006, 1, CD003491. [Google Scholar] [CrossRef] [PubMed]
- Nelson, J.C.; Delucchi, K.; Schneider, L.S. Efficacy of second generation antidepressants in late-life depression: A meta-analysis of the evidence. Am. J. Geriatr. Psychiatry 2008, 16, 558–567. [Google Scholar] [CrossRef] [PubMed]
- Verhoeven, V.; Lopez Hartmann, M.; Wens, J.; Sabbe, B.; Dieleman, P.; Tsakitzidis, G.; Van Royen, P.; Remmen, R. Happy pills in nursing homes in Belgium: A cohort study to determine prescribing patterns and relation to fall risk. J. Clin. Gerontol. Geriatr. 2014, 5, 53–57. [Google Scholar] [CrossRef] [Green Version]
- Ruths, S.; Sørensen, P.; Kirkevold, Ø.; Husebø, B.S.; Krüger, K.; Halvorsen, K.H.; Selbæk, G. Trends in psychotropic drug prescribing in Norwegian nursing homes from 1997 to 2009: A comparison of six cohorts. Int. J. Geriatr. Psychiatry 2013, 28, 868–876. [Google Scholar] [CrossRef] [PubMed]
- Gulla, C.; Selbaek, G.; Flo, E.; Kjome, R.; Kirkevold, O.; Husebo, B.S. Multi-psychotropic drug prescription and the association to neuropsychiatric symptoms in three Norwegian nursing home cohorts between 2004 and 2011. BMC Geriatr. 2016, 16, 115. [Google Scholar] [CrossRef] [PubMed]
- Chermá, M.; Löfgren, U.; Almkvist, G.; Hallert, C.; Bengtsson, F. Assessment of the prescription of antidepressant drugs in elderly nursing home patients: A clinical and laboratory follow-up investigation. J. Clin. Psychopharmacol. 2008, 28, 424–431. [Google Scholar] [CrossRef]
- Holmquist, I.; Svensson, B.; Höglund, P. Psychotropic drugs in nursing- and old-age homes: Relationships between needs of care and mental health status. Eur. J. Clin. Pharmacol. 2003, 59, 669–676. [Google Scholar] [CrossRef]
- Lövheim, H.; Gustafson, Y.; Karlsson, S.; Sandman, P.O. Comparison of behavioral and psychological symptoms of dementia and psychotropic drug treatments among old adults in geriatric care in 2000 and 2007. Int. Psychogeriatr. 2011, 23, 1616–1622. [Google Scholar] [CrossRef]
- Midlöv, P.; Andersson, M.; Östgren, C.J.; Molstad, S. Depression and use of antidepressants in Swedish nursing homes: A 12-month follow-up study. Int. Psychogeriatr. 2013, 26, 669–675. [Google Scholar] [CrossRef] [PubMed]
- Karkare, S.; Bhattacharjee, S.; Kamble, P.; Aparasu, R. Prevalence and Predictors of Antidepressant Prescribing in Nursing Home Residents in the United States. Am. J. Geriatr. Pharmacother. 2011, 9, 109–119. [Google Scholar] [CrossRef] [PubMed]
- Simoni-Wastila, L.; Wei, Y.; Luong, M.; Franey, C.; Huang, T.Y.; Rattinger, G.B.; Zuckerman, I.H.; Brandt, N.; Lucas, J.A. Quality of psychopharmacological medication use in nursing home residents. Res. Soc. Adm. Pharm. 2014, 10, 494–507. [Google Scholar] [CrossRef] [PubMed]
- Mamun, K.; Goh-Tan, C.Y.; Ng, L.L. Prescribing psychoactive medications in nursing homes: Current practice in Singapore. Singap. Med. J. 2003, 44, 625–629. [Google Scholar]
- Hiltunen, H.; Tan, E.; Ilomäki, J.; Hilmer, S.N.; Visvanathan, R.; Emery, T.; Robson, L.; Jones, M.J.; Hartikainen, S.; Bell, J.S. Factors associated with antidepressant use in residents with and without dementia in Australian aged care facilities. Ther. Adv. Drug Saf. 2016, 7, 79–88. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Nishtala, P.; McLachlan, A.; Bell, J.S.; Chen, T.F. Determinants of antidepressant medication prescribing in elderly residents of aged care homes in Australia: A retrospective study. Am. J. Geriatr. Pharmacother. 2009, 7, 210–219. [Google Scholar] [CrossRef] [PubMed]
- Snowdon, J.; Galanos, D.; Vaswani, D. Patterns of psychotropic medication use in nursing homes: Surveys in Sydney, allowing comparisons over time and between countries. Int. Psychogeriatr. 2011, 23, 1520–1525. [Google Scholar] [CrossRef]
- Tucker, M.; Hosford, I. Use of psychotropic medicines in residential care facilities for older adults in Hawke’s Bay, New Zealand. N. Z. Med. J. 2008, 121, 18–25. [Google Scholar]
- Cool, C.; Cestac, P.; Laborde, C.; Lebaudy, C.; Rouch, L.; Lepage, B.; Vellas, B.; de Souto Barreto, P.; Rolland, Y.; Lapeyre-Mestre, M. Potentially inappropriate drug prescribing and associated factors in nursing homes. J. Am. Med. Dir. Assoc. 2014, 15, 850.e1–850.e9. [Google Scholar] [CrossRef]
- Iden, K.; Engedal, K.; Hjorleifsson, S.; Ruths, S. Prevalence of depression among recently admitted long-term care patients in Norwegian nursing homes: Associations with diagnostic workup and use of antidepressants. Dement. Geriatr. Cogn. Disord. 2014, 37, 154–162. [Google Scholar] [CrossRef]
- Shin, J.Y.; Choi, N.K.; Jung, S.Y.; Lee, J.; Kwon, J.S.; Park, B.J. Risk of ischemic stroke with the use of risperidone, quetiapine and olanzapine in elderly patients: A population-based, case-crossover study. J. Psychopharmacol. 2013, 27, 638–644. [Google Scholar] [CrossRef] [PubMed]
- Ray, W.A.; Chung, C.P.; Murray, K.T.; Hall, K.; Stein, C.M. Atypical antipsychotic drugs and the risk of sudden cardiac death. N. Engl. J. Med. 2009, 360, 225–235. [Google Scholar] [CrossRef] [PubMed]
- Aarsland, D.; Larsen, J.P.; Lim, N.G.; Tandberg, E. Olanzapine for psychosis in patients with Parkinson’s disease with and without dementia. J. Neuropsychiatry Clin. Neurosci. 1999, 11, 392–394. [Google Scholar] [CrossRef] [PubMed]
- Alexopoulos, G.S.; Streim, J.; Carpenter, D.; Docherty, J.P. Using antipsychotic agents in older patients. J. Clin. Psychiatry 2004, 65, 5–99. [Google Scholar] [PubMed]
- Barak, Y.; Shamir, E.; Weizman, R. Would a switch from typical antipsychotics to risperidone be beneficial for elderly schizophrenic patients? A naturalistic, long-term, retrospective, comparative study. J. Clin. Psychopharmacol. 2002, 22, 115–120. [Google Scholar] [CrossRef] [PubMed]
- Meltzer, H.Y. The role of serotonin in antipsychotic drug action. Neuropsychopharmacology 1999, 21, 106S–115S. [Google Scholar] [CrossRef]
- Gareri, P.; De Fazio, P.; Stilo, M.; Ferreri, G.; De Sarro, G. Conventional and atypical antipsychotics in the elderly: A review. Clin. Drug Investig. 2003, 23, 287–322. [Google Scholar] [CrossRef]
- Seeman, P. Atypical antipsychotics: Mechanism of action. Can. J. Psychiatry 2002, 47, 27–38. [Google Scholar] [CrossRef]
- Jeste, D.V.; Blazer, D.; Casey, D.; Meeks, T.; Salzman, C.; Schneider, L.; Tariot, P.; Yaffe, K. ACNP White Paper: Update on use of antipsychotic drugs in elderly persons with dementia. Neuropsychopharmacology 2008, 33, 957–970. [Google Scholar] [CrossRef]
- Kech, P.E., Jr.; McElroy, S.L.; Arnold, L.M. Ziprasidone: A new atypical antipsychotic. Expert Opin. Pharmacother. 2001, 2, 1033–1042. [Google Scholar]
- Deberdt, W.; Dysken, M.W.; Rappaport, S.A.; Feldman, P.D.; Young, C.A.; Hay, D.P.; Lehman, D.L.; Dossenbach, M.; Degenhardt, E.K.; Breier, A. Comparison of olanzapine and risperidone in the treatment of psychosis and associated behavioral disturbances in patients with dementia. Am. J. Geriatr. Psychiatry 2005, 13, 722–730. [Google Scholar] [CrossRef] [PubMed]
- Azermai, M.; Elseviers, M.; Petrovic, M.; van Bortel, L.; Stichele, R.V. Assessment of antipsychotic prescribing in Belgian nursing homes. Int. Psychogeriatr. 2011, 23, 1240–1248. [Google Scholar] [CrossRef] [PubMed]
- Briesacher, B.; Limcangco, M.; Simoni-Wastila, L.; Doshi, J.A.; Levens, S.R.; Shea, D.G.; Stuart, B. The quality of antipsychotic drug prescribing in nursing homes. Arch. Intern. Med. 2005, 165, 1280. [Google Scholar] [CrossRef] [PubMed]
- Murphy, J.; O’Keeffe, S. Frequency and appropriateness of antipsychotic medication use in older people in long-term care. Ir. J. Med. Sci. 2008, 177, 35–37. [Google Scholar] [CrossRef] [PubMed]
- Furniss, L.; Burns, A.; Craig, S.K.; Scobie, S.; Cooke, J.; Faragher, B. Effects of a pharmacist’s medication review in nursing homes: Randomised controlled trial. Br. J. Psychiatry 2000, 176, 563–567. [Google Scholar] [CrossRef] [PubMed]
- Laffon de Mazières, C.; Lapeyre-Mestre, M.; Vellas, B.; de Souto Barreto, P.; Rolland, Y. Organizational factors associated with inappropriate neuroleptic drug prescribing in nursing homes: A multilevel approach. J. Am. Med. Dir. Assoc. 2015, 16, 590–597. [Google Scholar] [CrossRef] [PubMed]
- Frankenthal, D.; Zandman-Goddard, G.; Ben-Muvhar, Y.; Porat-Katz, B.S. The impact of facility characteristics on the use of antipsychotic medications in nursing homes: A cross-sectional study. Isr. J. Health Policy Res. 2016, 5, 12. [Google Scholar] [CrossRef] [PubMed]
- Huying, F.; Klimpe, S.; Werhahn, K. Antiepileptic drug use in nursing home residents: A cross-sectional, regional study. Seizure 2006, 15, 194–197. [Google Scholar] [CrossRef] [PubMed]
- Huber, D.; Griener, R.; Trinka, E. Antiepileptic drug use in Austrian nursing home residents. Seizure 2013, 22, 24–27. [Google Scholar] [CrossRef] [Green Version]
- Gil-Nagel, A.; Gómez Alonso, J. Experiencia clínica de la pregabalina en el tratamiento de las epilepsias focales. Rev. Neurol. 2005, 40, 609–613. [Google Scholar] [CrossRef]
- Gidal, B.E.; Sheth, R.D.; Magnus, L.; Herbeuval, A.F. Levetiracetam does not alter body weight: Analysis of randomized, controlled clinical trials. Epilepsy Res. 2003, 56, 121–126. [Google Scholar] [CrossRef] [PubMed]
- Galimberti, C.; Magri, F.; Magnani, B.; Arbasino, C.; Cravello, L.; Marchioni, E.; Tartara, A. Antiepileptic drug use and epileptic seizures in elderly nursing home residents: A survey in the province of Pavia, Northern Italy. Epilepsy Res. 2006, 68, 1–8. [Google Scholar] [CrossRef] [PubMed]
- Galimberti, C.; Tartara, E.; Dispenza, S.; Marchese, D.; Bonizzoni, E.; Perucca, E. Antiepileptic drug use and epileptic seizures in nursing home residents in the Province of Pavia, Italy: A reappraisal 12 years after a first survey. Epilepsy Res. 2016, 119, 41–48. [Google Scholar] [CrossRef] [PubMed]
- Johnell, K.; Fastbom, J. Antiepileptic drug use in community-dwelling and institutionalized elderly: A nationwide study of over 1 300 000 older people. Eur. J. Clin. Pharmacol. 2011, 67, 1069–1075. [Google Scholar] [CrossRef] [PubMed]
- National Institute for Health and Care Excellence (NICE). Parkinson’s Disease in Adults: Diagnosis and Management. 2017. Available online: https://www.nice.org.uk/guidance/ng71/documents/short-version-of-draft-guideline (accessed on 2 July 2019).
- Ahlskog, J.E. Parkinson’s Disease Treatment Guide for Physicians; Oxford University Press: Oxford, UK, 2009. [Google Scholar]
- Canning, C.G.; Paul, S.S.; Nieuwboer, A. Prevention of falls in Parkinson’s disease: A review of fall risk factors and the role of physical interventions. Neurodegener. Dis. Manag. 2014, 4, 203–221. [Google Scholar] [CrossRef]
Cross-Sectional Surveys or Observational (Prospective or Retrospective) Studies |
---|
Recruited adults (>90% of participants aged ≥60 years) |
Participants recruited from the aged care homes |
Reported frequency and/ or percentage of CNS drug use (total sample and number of users) |
Sample size of ≥50 participants |
Broad definition of CNS drugs including psychotropic, antipsychotic, antidepressant, benzodiazepines, antiparkinson, and antiepileptic medicines |
Region | Studies (n) | Pooled Proportion (%) | 95% CI (%) | I2 (%) | p-Value for I2 |
---|---|---|---|---|---|
Scandinavia | 23 | 42.5 | 39.8–45.3 | 99.4 | <0.001 |
Europe | 32 | 41.2 | 36.0–46.6 | 99.8 | <0.001 |
South East Asia | 2 | 38.2 | 13.8–65.8 | 97.4 | <0.001 |
ANZ | 15 | 34.3 | 28.1–40.8 | 99.7 | <0.001 |
North America | 17 | 31.7 | 27.8–35.7 | 99.9 | <0.001 |
All studies | 89 | 35.0 | 33.1–36.8 | 99.9 | <0.001 |
Country | No. Studies | Pooled Proportion (%) | 95% CI (%) |
---|---|---|---|
Belgium | 4 | 49.0 | 37.5–60.4 |
Finland | 4 | 44.8 | 37.9–51.8 |
Austria | 3 | 44.3 | 33.6–55.2 |
France | 4 | 41.3 | 30.1–52.9 |
Sweden | 9 | 38.9 | 30.0–48.2 |
Norway | 10 | 38.7 | 31.6–46.0 |
Spain | 2 | 37.0 | 19.5–56.3 |
US | 12 | 31.7 | 26.9–36.7 |
Australia | 11 | 31.7 | 24.6–39.3 |
New Zealand | 4 | 31.3 | 15.1–49.9 |
Canada | 5 | 30.0 | 23.3–37.3 |
Italy | 5 | 27.7 | 9.5–50.3 |
Germany | 3 | 25.1 | 14.1–38.0 |
UK | 5 | 22.3 | 16.5–28.7 |
Ireland | 2 | 20.3 | 14.7–26.6 |
Drug | Studies (n) | Pooled Proportion (%) | 95% CI (%) | I2 (%) | p-Value for I2 |
---|---|---|---|---|---|
Psychotropic drugs | 32 | 68.0 | 65.7–70.2 | 98.5 | <0.001 |
Europe | 10 | 72.2 | 67.1–77.1 | 99.0 | 0.001 |
Scandinavia | 10 | 71.6 | 69.2–74.0 | 91.0 | 0.001 |
North America | 3 | 69.3 | 65.0–73.6 | 98.0 | 0.001 |
ANZ | 9 | 56.9 | 52.2–61.4 | 98.0 | 0.001 |
Antipsychotics | 57 | 26.1 | 25.1–27.2 | 99.6 | <0.001 |
Europe | 18 | 27.7 | 23.9–31.6 | 99.0 | <0.001 |
Scandinavia | 14 | 26.3 | 22.8–30.0 | 98.0 | <0.001 |
North America | 15 | 24.6 | 22.7–26.6 | 100 | <0.001 |
ANZ | 10 | 23.5 | 20.7–26.4 | 96.0 | <0.001 |
Antidepressants | 47 | 38.3 | 35.1–41.6 | 99.7 | <0.001 |
North America | 10 | 44.9 | 35.3–54.5 | 100.0 | <0.001 |
Scandinavia | 18 | 41.0 | 39.2–42.9 | 93.0 | 0.001 |
Europe | 13 | 33.5 | 29.3–37.7 | 99.0 | <0.001 |
ANZ | 6 | 30.5 | 23.6–37.7 | 96.0 | 0.001 |
Benzodiazepines | 70 | 36.2 | 32.2–40.4 | 99.8 | <0.001 |
Europe | 14 | 44.8 | 38.4–51.2 | 100 | <0.001 |
Scandinavia | 18 | 42.3 | 37.8–46.8 | 99.0 | <0.001 |
ANZ | 8 | 29.4 | 21.1–38.2 | 99.0 | <0.001 |
North America | 9 | 18.9 | 13.5–24.8 | 99.0 | <0.001 |
Antiepileptics | 17 | 10.8 | 9.1–12.6 | 98.4 | <0.001 |
Antiparkinsons | 4 | 6.5 | 5.2–8.0 | 79.0 | 0.003 |
Country | No. Studies | Drug Class | Pooled Proportion (%) | 95% CI (%) |
---|---|---|---|---|
Australia | 5 | Psychotropic | 60.2 | 54.5–65.8 |
7 | Antipsychotic | 24.8 | 21.3–28.5 | |
5 | Antidepressant | 30.6 | 21.8–40.1 | |
6 | Benzodiazepine | 27.4 | 17.4–38.7 | |
Austria | 2 | Antipsychotic | 45.9 | 44.3–47.5 |
2 | Antidepressant | 36.8 | 35.3–38.4 | |
2 | Benzodiazepine | 35.0 | 33.5–36.5 | |
Belgium | 2 | Psychotropic | 77.2 | 72.9–81.2 |
2 | Antipsychotic | 24.2 | 10.6–41.0 | |
3 | Antidepressant | 40.3 | 38.8–41.8 | |
3 | Benzodiazepine | 54.1 | 51.8–56.4 | |
Canada | 5 | Antipsychotic | 28.6 | 24.5–32.9 |
3 | Antidepressant | 27.7 | 8.9–51.2 | |
4 | Benzodiazepine | 23.9 | 12.3–37.7 | |
Finland | 2 | Psychotropic | 78.0 | 74.2–81.6 |
6 | Antipsychotic | 37.0 | 31.9–42.2 | |
4 | Antidepressant | 43.3 | 41.2–45.5 | |
4 | Benzodiazepine | 40.8 | 26.6–55.8 | |
3 | Antiepileptic | 10.8 | 6.5–15.9 | |
France | 3 | Antipsychotic | 26.0 | 23.8–28.3 |
2 | Antidepressant | 43.3 | 42.2–44.5 | |
2 | Benzodiazepine | 48.4 | 38.4–58.4 | |
Germany | 2 | Antipsychotic | 31.6 | 25.0–38.7 |
Italy | 3 | Antiepileptic | 13.5 | 3.5–28.0 |
New Zealand | 4 | Psychotropic | 52.5 | 40.4–64.4 |
3 | Antipsychotic | 20.3 | 16.6–24.4 | |
2 | Antidepressant | 25.4 | 16.5–35.5 | |
2 | Benzodiazepine | 35.1 | 32.6–37.7 | |
Norway | 8 | Psychotropic | 70.4 | 68.0–72.8 |
10 | Antipsychotic | 23.5 | 22.5–24.5 | |
12 | Antidepressant | 38.7 | 35.5–42.0 | |
10 | Benzodiazepine | 44.8 | 39.2–50.4 | |
3 | Antiepileptic | 9.8 | 7.2–12.7 | |
Spain | 2 | Benzodiazepine | 41.4 | 32.2–50.9 |
Sweden | 4 | Psychotropic | 70.1 | 67.7–72.5 |
5 | Antipsychotic | 20.3 | 16.4–24.7 | |
8 | Antidepressant | 43.9 | 41.2–46.6 | |
4 | Benzodiazepine | 37.1 | 34.0–40.3 | |
UK | 5 | Antipsychotic | 18.9 | 17.5–20.3 |
2 | Antidepressant | 35.3 | 30.1–40.7 | |
US | 2 | Psychotropic | 71.2 | 68.1–74.1 |
10 | Antipsychotic | 22.8 | 20.7–24.9 | |
7 | Antidepressant | 52.0 | 43.2–60.7 | |
5 | Benzodiazepine | 14.7 | 8.8–21.8 |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Hasan, S.S.; Zaidi, S.T.R.; Nirwan, J.S.; Ghori, M.U.; Javid, F.; Ahmadi, K.; Babar, Z.-U.-D. Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis. J. Clin. Med. 2019, 8, 1292. https://doi.org/10.3390/jcm8091292
Hasan SS, Zaidi STR, Nirwan JS, Ghori MU, Javid F, Ahmadi K, Babar Z-U-D. Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2019; 8(9):1292. https://doi.org/10.3390/jcm8091292
Chicago/Turabian StyleHasan, Syed Shahzad, Syed Tabish Razi Zaidi, Jorabar Singh Nirwan, Muhammad Usman Ghori, Farideh Javid, Keivan Ahmadi, and Zaheer- Ud-Din Babar. 2019. "Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis" Journal of Clinical Medicine 8, no. 9: 1292. https://doi.org/10.3390/jcm8091292