Clinical Practice and Service Development
Neuroleptic Use and Behavioral Disturbance in Nursing Homes: A 1-Year Study
|Lynda C. Burton a1, Barry W. Rovner a2, Pearl S. German a1, Larry J. Brant a3 and Rebecca D. Clark a1|
a1 Department of Health Policy and Management, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, Maryland, U.S.A.
a2 Department of Psychiatry and Human Behavior, Thomas Jefferson University, School of Medicine and Wills Eye Hospital, Geriatric Psychiatry, Philadelphia, Pennsylvania, U.S.A.
a3 Gerontology Research Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, U.S.A.
This article discusses a longitudinal study of change in disruptive behaviors among nursing home residents treated with neuroleptics compared with those not treated with neuroleptics. Observations were made of 201 participants on admission to and after 1 year in eight skilled nursing facilities. Nine disruptive behaviors were measured using the Psychogeriatric Dependency Rating Scale with nursing assistants. Neuroleptic use was documented from medication records. Odds ratios are reported for the association of behavior at baseline and use of neuroleptics on nine problem behaviors. For those who received neuroleptics during the year, there was greater change in both developing and resolving disruptive behaviors than for those not receiving neuroleptics. For both groups, restless or pacing behavior and belligerent behavior manifested by refusing instructions changed the most, both in developing and in apparently resolving. Our results show that change in disruptive behaviors occurs among nursing home residents regardless of neuroleptic use, but it occurs more frequently among those who receive neuroleptic medication. Knowledge of which disruptive behaviors are most likely to resolve or develop is important in training nursing home staff to cope with the behaviors as well as in planning interventions that may modify such behaviors.