| Behavioral symptoms such as aggressive behavior frequently accompany the cognitive degeneration of dementia patients, and remain a major reason for psychotropic drug (PD) usage. The use of psychotropic drugs for the treatment of such behavioral symptoms has been controversial due to the high prevalence rate of behavioral symptoms among dementia patients, and concerns about appropriate clinical use of these agents. The purposes of this study were to describe PD usage and to examine its determinants and behavioral consequences among nursing home residents with dementia. This study used existing data from the parent study. Three major resident variables (i.e., cognitive ability, physical functioning, and depressive symptoms) and three nursing home variables (i.e., type of ownership, nursing home size, and RN staffing) were examined as potential predictors of PD usage. In addition, resident demographic and clinical characteristics were included in the analysis because of their possible impact on the PD usage. Nine aggressive behaviors (AB) were used to measure the behavioral outcomes.; A total of 282 bath observations for 107 residents were included in the study. Of those residents, 73% were taking at least one PD. Antidepressants were the most frequently prescribed PD, followed by antipsychotics. Presence of depressive symptoms, history of AB, age (<84 years old), and a greater number of comorbid diseases were found to be resident predictors significantly associated with the PD usage. Non-profit, larger size, and fewer RNs were the nursing home characteristics significantly associated with the PD usage. While no PD significantly predicted the occurrence of AB, fewer numbers of RNs, history of AB, and bathing during the night shift, were found to be significant predictors of AB.; The results of this study suggest that despite PD treatment, behavioral symptoms in dementia remain during the course of this disease and become manifested during certain situations which are associated with resident's unmet-needs. A system-based and environmental approach that addresses resident's physiological and psychosocial needs would likely be effective for behavioral problems and might produce better outcomes among nursing home residents with dementia. |
