Physicians' practice and familiarity with treatment for agitation associated with dementia in Israeli nursing homes

Int Psychogeriatr. 2013 Feb;25(2):236-44. doi: 10.1017/S104161021200172X. Epub 2012 Oct 30.

Abstract

Background: To clarify physicians' actual practice in treating agitation in the nursing home and to elucidate the relationship between background factors, familiarity with interventions, and practice.

Methods: A survey of actual practice for agitation in persons with dementia was administered to 67 physicians aged 31-70+ working in nursing homes in Israel. Questionnaires were administered by personal interview, self-completed, or a combination of the two.

Results: Psychotropic medications are prescribed by 92.5% of physicians for treating agitation, most notably, Haloperidol (39%). Non-pharmacological treatment was also reported to be common, though to a lesser extent, with environmental change being the most prevalent non-pharmacological intervention. Generally, physicians showed low familiarity levels with non-pharmacological interventions, with higher levels noted for physicians with a specialty in geriatrics compared to those who were non-specialized. Physicians who were non-Israeli and younger also reported higher familiarity levels compared to their respective counterparts (i.e. Israeli and older) but this difference did not reach significance.

Conclusion: The findings indicate that, despite current guidelines, psychotropic medications are the treatment of choice among nursing home physicians in Israel. While rates of use of non-pharmacological interventions are substantial, their in-practice application may be hindered by lack of familiarity as well as system barriers. The results have implications for system and education changes.

MeSH terms

  • Adult
  • Aged
  • Clinical Competence / standards
  • Dementia / complications*
  • Environment Design / standards*
  • Environment Design / statistics & numerical data
  • Female
  • Geriatric Assessment
  • Guideline Adherence
  • Harm Reduction
  • Health Care Surveys
  • Health Services for the Aged
  • Humans
  • Israel
  • Male
  • Middle Aged
  • Needs Assessment
  • Nursing Homes / standards
  • Nursing Homes / statistics & numerical data
  • Physicians / standards*
  • Practice Patterns, Physicians' / standards
  • Psychomotor Agitation / diagnosis
  • Psychomotor Agitation / drug therapy*
  • Psychomotor Agitation / etiology
  • Psychotropic Drugs* / classification
  • Psychotropic Drugs* / therapeutic use
  • Surveys and Questionnaires
  • Workforce

Substances

  • Psychotropic Drugs