Reply
We are grateful to French et al. for their interest in our study ‘Use of antipsychotic medications among nonagenarian residents in long-term care’ published in Age and Ageing, September 2006 [1]. The authors highlight two important points regarding the common use of antipsychotics in nursing homes. First, the frequent use of antipsychotics does not necessarily indicate misuse of these drugs, but there is a considerable gap between the recommendations for antipsychotic medication and clinical practice. Second, many residents had inappropriate indications according to the guideline requirements or there was no documentation of indications for antipsychotic use.Although earlier studies from different countries have reported heavy use of antipsychotic medication (23–42%) in long-term institutional care [2, 3], prescription rates may vary between countries and are affected by various factors. There will be differences in the types of residents admitted to long-term care facilities and the way they are diagnosed and treated. French et al. reported that 42.3% of residents received antipsychotics, which concurs with our studies, in which around 42% of residents aged 65 years and over and 29.5% of nonagenarian residents accordingly were taking antipsychotic medications [1, 3]. However, it seems that there is a population difference between our studies and that of French et al. Among the residents taking antipsychotics in our studies, 2–9.8% were diagnosed with schizophrenia, whereas in the study by French and colleagues, schizophrenia was diagnosed in 43.8% of the residents who were taking antipsychotics.
In our study, there was no association between psychiatric symptoms and the diagnosis carried out and use of antipsychotics [1]. Querulous residents received antipsychotics more commonly than those with good social skills. This indication is strongly discouraged by a recently convened expert panel on the appropriate use of antipsychotics in older adults.
It has previously been reported that antipsychotic drugs may be used by the staff in care facilities as a substitute chemical restraint. In those facilities where staff levels are commensurate with resident needs, the use of antipsychotic drugs is less prevalent [4]. It may be that staff turnover in long-term care facilities is high and psychiatric consultation services are rarely available.
These findings raise important questions about the indications for antipsychotic drug treatment in relation to residents' quality of life and the impact on nonagenarian residents' functioning ability. We agree with the authors that continued research, better education and support for the staff are needed for a better recognition of the inappropriate use of antipsychotics and for improved care.
1 University of Tampere, Medical School, University of Tampere, 33014 Tampere, Finland
2 Tampere University Hospital, Department of Psychiatry, 33380 Pitkäniemi, Finland
3 STAKES, Center for Health Economics CHESS, PO Box 220, 00530 Helsinki, Finland
* To whom correspondence should be addressed Email: hanna-mari.alanen{at}uta.fi
References
- Alanen HM, Finne-Soveri H, Noro A, Leinonen E. (2006) Use of antipsychotics among nonagenarian residents in long-term care in Finland. Age Ageing 35 508–13.
[Abstract/Free Full Text] - Snowdon J, Day S, Baker W. (2006) Current use of psychotropic medication in nursing homes. Int Psychoger 18 241–50.[CrossRef]
- Alanen HM, Finne-Soveri H, Noro A, Leinonen E. (2006) Use of antipsychotic medications among elderly residents in long-term institutional care: a three-year follow-up. Int J Geriatr Psychiatry 21 288–95.[CrossRef][Web of Science][Medline]
- Hughes CM, Lapane KL, Mor V. (2000) Influence of facility characteristics on use of antipsychotic medications in nursing homes. Med Care 38 1164–73.[CrossRef][Web of Science][Medline]
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