International Psychogeriatrics

Research Article

Psychotropic drug prescription in nursing home patients with dementia: influence of environmental correlates and staff distress on physicians’ prescription behavior

Sytse U. Zuidemaa1 c1, Jos F. M. de Jonghea2, Frans R. J. Verheya3 and Raymond T. C. M. Koopmansa1

a1 Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

a2 Departments of Clinical Psychology and Geriatric Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands

a3 School of Mental Health and Neuroscience/ Alzheimer Centre Limburg, Maastricht University Medical Centre, Maastricht, The Netherlands


Background: The aim of the study was to examine whether staff distress and aspects of the nursing home environment were associated with psychotropic drug use (PDU) in patients with dementia.

Methods: This was a cross-sectional study of 1289 nursing home patients with dementia from 56 Dementia Special Care Units (SCUs) in the Netherlands. The primary outcome was PDU. Potential correlates of PDU were staff distress, environmental correlates (the number of patients per unit or per living room, staff/patient ratio, and the presence of a walking circuit), and patient factors (gender, age, dementia severity, and neuropsychiatric symptoms (NPS)). Multilevel logistic regression analysis was used to estimate the relative contributions of predictor variables in explaining PDU.

Results: Staff distress, aspects of the physical nursing home environment and patients’ neuropsychiatric symptoms were independently associated with PDU. Staff distress at patients’ agitation was associated with antipsychotic and anxiolytic drug use (OR 1.66, 95% CI (1.16–2.36) and 1.62 (1.00–2.61), respectively). SCUs with more patients per living room had higher hypnotic drug use (OR 1.08, 95% CI (1.02–1.14)). Low staff/patient ratio was associated with high antidepressant drug use (OR 0.13, 95% CI (0.04–0.47)). The effects of nursing home environment on study outcome were smallest for antidepressant use (intra-SCU correlation 0.005) and highest for hypnotic use (intra-SCU correlation 0.171).

Conclusion: Staff distress and other environmental aspects are independently associated with PDU. These findings raise questions about the appropriateness of psychoactive drug prescriptions for nursing home patients with dementia.

(Received April 29 2011)

(Revised June 02 2011)

(Revised June 06 2011)

(Accepted June 08 2011)

(Online publication August 04 2011)


c1 Correspondence should be addressed to: S. U. Zuidema, Department of Primary and Community Care, 117 ELG, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Phone: +31 (0)243655324; Fax: +31 (0)243619558. Email: