Antipsychotic drug prescription in nursing home residents with dementia: perspectives of staff and proxies in a complex decision process

Sarah I.M. Janus

Research output: ThesisPhD Thesis - Research UT, graduation UT

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Dementia is characterized by progressive deterioration in cognitive ability and capacity for independent living. Neuropsychiatric symptoms, like agitation/aggression, apathy and irritability, are known to contribute to the high disease burden. Often these symptoms lead to an admission in a nursing home. In the pharmacotherapy of these symptoms a big gap exists between the available scientific evidence on its limited effectiveness and the reality of its frequent use in daily clinical practice. While several studies conclude a limited success of psychotropic drug treatment, especially with regards to antipsychotic drugs, and a high risk of adverse effects, these drugs are still widely used in patients with dementia. This thesis aimed to reduce this gap and extend the knowledge on the reasons for prescribing antipsychotic drugs. In the first part of this thesis we identified the magnitude of this gap and investigated possible associations between the use of psychotropic drugs and the risk of falling. In the second part of this thesis we investigated the reasons for prescribing psychotropic drugs. Decision making by health professionals is a complex process and requires a diverse knowledge base with multiple variables and individuals involved. Many factors might influence the approach towards a specific treatment such as the patients’ preferences, family members’ preferences, nursing staff’s preferences, the physicians’ knowledge and beliefs as well as the culture within the nursing home organization. The third section of this thesis focused on the preferences of physicians, nurses and proxies for the different treatments for neuropsychiatric symptoms.
We conclude that the three stakeholders, physicians, nurses and proxies, should discuss antipsychotic drug prescriptions in multidisciplinary consultations. This would lead to more awareness by the physicians of the different parties involved in the prescription process, more realistic expectations for the treatment by the nurses and proxies and would lead to more individualized non-pharmacological treatments since proxies have a better understanding of the patient’s identity. This can lead to more appropriate antipsychotic drug prescriptions for these patients.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • University of Twente
  • IJzerman, Maarten J., Supervisor
  • Zuidema, Sytse U., Supervisor, External person
  • van Manen, J.G., Supervisor
Award date22 Jun 2017
Place of PublicationEnschede
Print ISBNs978-90-365-4344-6
Publication statusPublished - 22 Jun 2017


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