International Psychogeriatrics

Research Article

The course of behavioral problems in elderly nursing home patients with dementia when treated with antipsychotics

B. C. Kleijera1, R. J. van Maruma1 c1, A. C. G. Egbertsa2a3, P. A. F. Jansena1, D. Frijtersa4, E. R. Heerdinka3 and M. Ribbea4

a1 Department of Geriatrics, University Medical Center Utrecht, The Netherlands

a2 Department of Clinical Pharmacy, University Medical Center Utrecht, The Netherlands

a3 Department of Pharmaceutical Sciences, University of Utrecht, The Netherlands

a4 Department of Nursing Home Medicine, VU Medical Center and EMGO-Institute, Amsterdam, The Netherlands

ABSTRACT

Background: Although antipsychotic treatment of behavioral problems in dementia is common, studies investigating the course of these symptoms in nursing homes are scarce. Our primary objective is therefore to describe the course of behavioral problems during antipsychotic treatment in a large sample of elderly nursing home patients with dementia.

Methods: The course of behavioral problems during antipsychotic treatment was studied by comparing the characteristics of patients before, during and after antipsychotic treatment. The study was conducted using the VURAIDB, a database with over 40,000 assessments of over 10,000 nursing home residents in the Netherlands. We used the Challenging Behavior Profile (CBP) to measure an overall behavior score.

Results: In total, 556 patients starting with antipsychotics were studied. Of these, 101 (18.2%) improved and 260 (46.8%) deteriorated at three months on the behavior score, compared with their scores before therapy (z = −7.955; P<0.0001). Patients with severe challenging behavior showed improvement more often than patients with mild disturbances. The course of behavioral symptoms after withdrawal was evaluated in 520 patients. Of these patients, 352 (68%) remained stable or improved at 3 months compared with their scores before withdrawal (z = −0.697; p = 0.486), this figure was 58% at 6 months after withdrawal (z = −2.77; p = 0.006).

Conclusions: During treatment of nursing home residents with dementia with antipsychotics the severity of most behavioral problems continues to increase in most patients, with only one out of six patients showing improvement. After withdrawal of antipsychotics, behavioral problems remained stable or improved in 58% of patients.

(Received March 19 2009)

(Revised April 09 2009)

(Revised April 22 2009)

(Accepted April 23 2009)

(Online publication June 22 2009)

Correspondence:

c1 Correspondence should be addressed to: Dr. R. J. van Marum, Department of Geriatrics, University Medical Center Utrecht, The Netherlands, PO Box 85500, 3508 GA Utrecht, The Netherlands. Phone: +31 887558280; Fax: +31 302544397. Email: r.j.vanmarum@umcutrecht.nl.

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