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IS1.07: A consensus guideline for antipsychotic drug use for dementia in long-term care. Collecting expert opinion through Delphi-consensus and focus groups
Invited symposia / European Geriatric Medicine 5S1 (2014) S1–S15
Community and member states initiatives and actions namely EIP AHA, EIT, AAL, etc. European Geriatricians are facing needs for choices and actions. They need to cope with these evolutions and defend the basic principles of Geriatric medicine, otherwise risks of competition with other disciplines and other health professions, could replace idealistic and expected interdisciplinary or inter-professional synergies. They need to move together towards European Geriatric Common Standards, Medical Sciences, Practice, and Ethics; (Syllabus, Examination, Quality of education, Quality and Security of care. Reference(s) [1] Charcot JM. Lecons ¸ cliniques sur les maladies des vieillerds. Delahaye ed., Paris, 1867. [2] Nasher IL. Geriatrics. New York Journal of Medicine 1909; 90: 358– 359. [3] Ritch A. History of Geriatric Medicine: from Hippocrates to Marjory Warren. J R Coll Physicians Edinb 2012; 42: 368–74. [4] Barrington R, Hyland M. The elderly: a challenge to the general hospital. Dublin, Hospital Committee of the European Community, 1994. [5] Schroots JJF, Fernandez-Ballesteros R, Rudinger G. Aging in Europe. IQS Press, Amsterdam 1999. [6] Hastie IR, Duursma SA, (UEMS-GS) Geriatric Medicine in The European Union: Unification of Diversity, http://uemsgeriatricmedicine.org/ UEMS1/dok/geriatric_medicine_in_the_eu.pdf [7] Stahelin ¨ H, Beregi E, Duursma SA, Evans JG, Michel J-P, Ruiz-Torris A, Steen B. Teaching Medical Gerontology in Europe. Group of professors of medical gerontology (GEPMG). Age Ageing 1994; 3:197–8. [8] Paul C. European Union of Medical Specialists. In: U.E.M.S. 1958–1998. Secretariat UEMS, Brussels 1998:4–5. [9] Franco AA, Bouma H, van Bronswijk JEMH. Health care paradigms in transition. Gerontechnology 2014; 13(1): 5–10; doi:10.4017/ gt.2014.13.1.001.00.
Behavioural symptoms in dementia: Crossing the border from antipsychotic treatment to non-pharmacological approaches IS1.06 The use of antipsychotic drugs and mortality risk in nursing homes G. Selbæk Norwegian Advisory Unit on Ageing and Health, Norway Introduction: Antipsychotic drugs (APs) are frequently used in nursing homes (NH) with reported prevalence estimates between 25% and 46%. APs are often prescribed for neuropsychiatric symptoms such as psychosis or agitation. Randomized controlled trials and large registry-based studies have reported an increased mortality risk associated with AP use among home-dwelling old people and people in nursing homes. In contrast, observational clinical studies have failed to confirm this association. We investigated the long-term mortality risk of AP use in a large sample of NH patients. Methods: A representative sample of 1163 NH patients were included at baseline. There were five assessments over a 75-month follow-up period. An extended Cox-Model with time-dependent main predictor (psychotropic drug use) and covariates was applied. Results: In bivariate Cox regression use of ‘other psychotropic drugs’ but not AP was associated with increased mortality risk, compared to non-users. In the adjusted model, we found no association between AP use or use of ‘other psychotropic drug’ and increased mortality risk. Higher age, male gender, not being married, medical disease burden, lower level of functioning, more severe dementia, and a higher number of drugs were associated with increased mortality risk.
S3
Conclusions: Our findings of no association between AP use and increased mortality risk confirm results from a number of other observational studies, but contrast with results from large, registry-based studies and randomized controlled trials. The results should be interpreted with caution. Non-pharmacological treatment remains the first-line approach for psychosis and agitation in dementia. IS1.07 A consensus guideline for antipsychotic drug use for dementia in long-term care. Collecting expert opinion through Delphi-consensus and focus groups S.U. Zuidema1 , A. Johansson2 , G. Selbæk3 , C. Ballard4 , R.T.C.M. Koopmans2 1 University Medical Center Groningen, The Netherlands; 2 Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; 3 Innlandet Hospital Trust, Ottestad, Norway, Oslo, Norway; 4 Wolfson Centre for Age-Related Diseases, Kings College London, London, United Kingdom Objective: To gather expert opinions and reach consensus on recommendations for appropriate use of antipsychotic drugs for people with dementia in long-term care settings, using the Delphi methodology and focus groups. Methods: The Delphi rounds and focusgroups were carried out in the UK, Norway and the Netherlands in 5 phases: (1) identification of relevant themes by a group of 20 handpicked scientific experts in the UK and the Netherlands, (2) testing relevance of the themes identified through a questionnaire sent to 127 international scientific experts (worldwide), (3) First delphi questionnnaire of 164 items formulated on a 9-point Likert scale among 46 clinical and scientific experts in the three countries, (4) one focus group of 14 consumer experts (UK) and 3 focus groups of (in total 21) medical/ scientific experts in the 3 countries, (5) second delphi questionnaire of 71 items among 38 experts. The RAND/UCLA methodology was used to identify the level of agreement with the statements. Results: The responses in phase 2, 3, 5 were 40 (32%), 34 (76%) and 33 (69%) respectively and consensus was reached on 150 statements (119/164 in phase 3 and 31/71 in phase 5) covering five topics: (1) General prescription stipulations, (2) assessments prior to prescription, (3) care and treatment plan, (4) discontinuation and (5) long-term treatment. Conclusion: In a repeated cycle of Delphi rounds in combination with focus groups of scientific, medical and consumer experts, we were able to identify and reach consensus about practical issues related to appropriate antipsychotic drug use. This material will be published in a practice guideline which we regard as a valuable for physicians and other professionals working with residents with dementia. We expect that this guideline will contribute to a more rational, and safer antipsychotic drug prescription in long-term care. IS1.09 Act in case of depression: a care program for reducing depression in nursing homes D.L. Gerritsen1 , R. Leontjevas2 , M. Smalbrugge3 , M. VernooijDassen1 , R.T.C.M. Koopmans1 1 Radboud University Medical Center, Nijmegen, The Netherlands; 2 Open University, Heerlen, The Netherlands; 1 VU Medical Center, Amsterdam, The Netherlands To improve depression recognition and treatment in nursing homes (NHs), the multidisciplinary care programme Act in case of Depression (AiD) was developed by the Nijmegen University long term care network (UKON). This is a collaboration between 14 care organizations and the Department of Primary and Community Care of the Radboud University Medical Centre. AiD prescribes procedures for how to detect depression, pathways for psychosocial
Community and member states initiatives and actions namely EIP AHA, EIT, AAL, etc. European Geriatricians are facing needs for choices and actions. They need to cope with these evolutions and defend the basic principles of Geriatric medicine, otherwise risks of competition with other disciplines and other health professions, could replace idealistic and expected interdisciplinary or inter-professional synergies. They need to move together towards European Geriatric Common Standards, Medical Sciences, Practice, and Ethics; (Syllabus, Examination, Quality of education, Quality and Security of care. Reference(s) [1] Charcot JM. Lecons ¸ cliniques sur les maladies des vieillerds. Delahaye ed., Paris, 1867. [2] Nasher IL. Geriatrics. New York Journal of Medicine 1909; 90: 358– 359. [3] Ritch A. History of Geriatric Medicine: from Hippocrates to Marjory Warren. J R Coll Physicians Edinb 2012; 42: 368–74. [4] Barrington R, Hyland M. The elderly: a challenge to the general hospital. Dublin, Hospital Committee of the European Community, 1994. [5] Schroots JJF, Fernandez-Ballesteros R, Rudinger G. Aging in Europe. IQS Press, Amsterdam 1999. [6] Hastie IR, Duursma SA, (UEMS-GS) Geriatric Medicine in The European Union: Unification of Diversity, http://uemsgeriatricmedicine.org/ UEMS1/dok/geriatric_medicine_in_the_eu.pdf [7] Stahelin ¨ H, Beregi E, Duursma SA, Evans JG, Michel J-P, Ruiz-Torris A, Steen B. Teaching Medical Gerontology in Europe. Group of professors of medical gerontology (GEPMG). Age Ageing 1994; 3:197–8. [8] Paul C. European Union of Medical Specialists. In: U.E.M.S. 1958–1998. Secretariat UEMS, Brussels 1998:4–5. [9] Franco AA, Bouma H, van Bronswijk JEMH. Health care paradigms in transition. Gerontechnology 2014; 13(1): 5–10; doi:10.4017/ gt.2014.13.1.001.00.
Behavioural symptoms in dementia: Crossing the border from antipsychotic treatment to non-pharmacological approaches IS1.06 The use of antipsychotic drugs and mortality risk in nursing homes G. Selbæk Norwegian Advisory Unit on Ageing and Health, Norway Introduction: Antipsychotic drugs (APs) are frequently used in nursing homes (NH) with reported prevalence estimates between 25% and 46%. APs are often prescribed for neuropsychiatric symptoms such as psychosis or agitation. Randomized controlled trials and large registry-based studies have reported an increased mortality risk associated with AP use among home-dwelling old people and people in nursing homes. In contrast, observational clinical studies have failed to confirm this association. We investigated the long-term mortality risk of AP use in a large sample of NH patients. Methods: A representative sample of 1163 NH patients were included at baseline. There were five assessments over a 75-month follow-up period. An extended Cox-Model with time-dependent main predictor (psychotropic drug use) and covariates was applied. Results: In bivariate Cox regression use of ‘other psychotropic drugs’ but not AP was associated with increased mortality risk, compared to non-users. In the adjusted model, we found no association between AP use or use of ‘other psychotropic drug’ and increased mortality risk. Higher age, male gender, not being married, medical disease burden, lower level of functioning, more severe dementia, and a higher number of drugs were associated with increased mortality risk.
S3
Conclusions: Our findings of no association between AP use and increased mortality risk confirm results from a number of other observational studies, but contrast with results from large, registry-based studies and randomized controlled trials. The results should be interpreted with caution. Non-pharmacological treatment remains the first-line approach for psychosis and agitation in dementia. IS1.07 A consensus guideline for antipsychotic drug use for dementia in long-term care. Collecting expert opinion through Delphi-consensus and focus groups S.U. Zuidema1 , A. Johansson2 , G. Selbæk3 , C. Ballard4 , R.T.C.M. Koopmans2 1 University Medical Center Groningen, The Netherlands; 2 Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; 3 Innlandet Hospital Trust, Ottestad, Norway, Oslo, Norway; 4 Wolfson Centre for Age-Related Diseases, Kings College London, London, United Kingdom Objective: To gather expert opinions and reach consensus on recommendations for appropriate use of antipsychotic drugs for people with dementia in long-term care settings, using the Delphi methodology and focus groups. Methods: The Delphi rounds and focusgroups were carried out in the UK, Norway and the Netherlands in 5 phases: (1) identification of relevant themes by a group of 20 handpicked scientific experts in the UK and the Netherlands, (2) testing relevance of the themes identified through a questionnaire sent to 127 international scientific experts (worldwide), (3) First delphi questionnnaire of 164 items formulated on a 9-point Likert scale among 46 clinical and scientific experts in the three countries, (4) one focus group of 14 consumer experts (UK) and 3 focus groups of (in total 21) medical/ scientific experts in the 3 countries, (5) second delphi questionnaire of 71 items among 38 experts. The RAND/UCLA methodology was used to identify the level of agreement with the statements. Results: The responses in phase 2, 3, 5 were 40 (32%), 34 (76%) and 33 (69%) respectively and consensus was reached on 150 statements (119/164 in phase 3 and 31/71 in phase 5) covering five topics: (1) General prescription stipulations, (2) assessments prior to prescription, (3) care and treatment plan, (4) discontinuation and (5) long-term treatment. Conclusion: In a repeated cycle of Delphi rounds in combination with focus groups of scientific, medical and consumer experts, we were able to identify and reach consensus about practical issues related to appropriate antipsychotic drug use. This material will be published in a practice guideline which we regard as a valuable for physicians and other professionals working with residents with dementia. We expect that this guideline will contribute to a more rational, and safer antipsychotic drug prescription in long-term care. IS1.09 Act in case of depression: a care program for reducing depression in nursing homes D.L. Gerritsen1 , R. Leontjevas2 , M. Smalbrugge3 , M. VernooijDassen1 , R.T.C.M. Koopmans1 1 Radboud University Medical Center, Nijmegen, The Netherlands; 2 Open University, Heerlen, The Netherlands; 1 VU Medical Center, Amsterdam, The Netherlands To improve depression recognition and treatment in nursing homes (NHs), the multidisciplinary care programme Act in case of Depression (AiD) was developed by the Nijmegen University long term care network (UKON). This is a collaboration between 14 care organizations and the Department of Primary and Community Care of the Radboud University Medical Centre. AiD prescribes procedures for how to detect depression, pathways for psychosocial