Introduction: Psychiatric symptoms, with or without dementia, are very common among institutionalized elderly and often treated with medications. Because of age-related changes in pharmacokinetics and polypharmacy in this age group, such treatment is precarious. A recent study showed that use of psychotropics in Icelandic nursing homes is two to three times more common than in Sweden and Denmark. The goal of this study was to register psychiatric symptoms, indications for treatment, psychotropic drug use, dosages and treatment efficacy with quality in mind.
Material and methods: One hundred and fifteen individuals in five residential and nursing homes in the Greater Reykjavík area were evaluated. Fifty were on three specialized dementia units, and 65 on two residential units. Information on the number of psychotropic medications, types, dosages and treatment duration were collected. Nurses, familiar with the residents, evaluated the symptoms and treatment efficiacy.
Results: Only 16% were without psychotropic medications, 39% on one type, 36% on two types and 9% on three types. On the dementia and residential units there was similar use of antidepressants (30% vs 38%), and hypnotics and tranquilizers (66% vs 71%). On specialized dementia units 62% took neuroleptic medications but only 15% on residential units. On residential units the most common symptoms were sleep disturbances and depression. Symptoms improved during treatment in 60-98% of cases according to the caring nurses. In the antidepressant drug group dosages or medications had been chanced in 65% of cases over six months. For the other groups a change of dose had been made in 45% of cases over six months. Half of those using antidepressant medications received newer types of antidepressants. Of those who received hypnotics or tranquilizers, 46 individuals received medications with t1/2 >20 hours.
Discussion: The use of psychotrophic medications in the institutionalized elderly is prevalent. The greater use of antidepressants in Iceland compared to Sweden and Denmark might suggest better treatment of depression in Iceland, as many foreign studies have suggested that depression among the elderly is underdiagnosed and undertreated. The high use of hypnotics and tranquilizers, the choice and dosages however evoke concern considering possible side effects, such as falls, and raises the question if there are any alternative non-pharmacologic forms of treatment.