Psychotropic medication use among nursing home residents in Austria: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The use of psychotropic medications and their adverse effects in frail elderly has been debated extensively. However, recent data from European studies show that these drugs are still frequently prescribed in nursing home residents. In Austria, prevalence data are lacking. We aimed to determine the prevalence of psychotropic medication prescription in Austrian nursing homes and to explore characteristics associated with their prescription.</p> <p>Methods</p> <p>Cross-sectional study and association analysis in forty-eight out of 50 nursing homes with 1844 out of a total of 2005 residents in a defined urban-rural region in Austria. Prescribed medication was retrieved from residents' charts. Psychotropic medications were coded according to the Anatomical Therapeutic Chemical Classification 2005. Cluster-adjusted multiple logistic regression analysis was performed to investigate institutional and residents' characteristics associated with prescription.</p> <p>Results</p> <p>Residents' mean age was 81; 73% of residents were female. Mean cluster-adjusted prevalence of residents with at least one psychotropic medication was 74.6% (95% confidence interval, CI, 72.0–77.2). A total of 45.9% (95% CI 42.7–49.1) had at least one prescription of an antipsychotic medication. Two third of all antipsychotic medications were prescribed for bedtime use only. Anxiolytics were prescribed in 22.2% (95% CI 20.0–24.5), hypnotics in 13.3% (95% CI 11.3–15.4), and antidepressants in 36.8% (95% CI 34.1–39.6) of residents. None of the institutional characteristics and only few residents' characteristics were significantly associated with psychotropic medication prescription. Permanent restlessness was positively associated with psychotropic medication prescription (AOR 1.54, 95% CI 1.32–1.79) whereas cognitive impairment was inversely associated (AOR 0.70, 95% CI 0.56–0.88).</p> <p>Conclusion</p> <p>Frequency of psychotropic medication prescription is high in Austrian nursing homes compared to recent published data from other countries. Interventions should aim at reduction and optimisation of prescriptions.</p

Use of antipsychotic medications in older home-care patients. Report from nine European countries.

BACKGROUND AND AIMS: Data on the use of antipsychotics among older people in need of regular home care services are rare. The aim of this study was to ascertain the differences in the use and type of antipsychotic medications between European home-care sites. METHODS: A cross-sectional study was designed by means of RAI (Resident Assessment Instrument for Home Care) assessments. A random sample of 3251 assessments was gathered during the period September 2001-January 2002 from home care patients aged 65 and over in nine European countries (Czech Republic, Denmark, Finland, Germany, Iceland, Italy, Netherlands, Norway and United Kingdom). RESULTS: Two hundred of the home care patients (6.2%) received antipsychotic medication. The prevalence of the use of one or more antipsychotics varied widely between study sites, ranging from 3.0% in Denmark to 12.4% in Finland. Factors independently associated with the use of antipsychotics were: delusions (OR 3.09, 95% CI 1.66-5.76), any diagnosis of dementia (OR 2.57, 95% CI 1.70-3.87), youngest age group (65-74 yrs) (OR 2.37, 95% CI 1.53-3.66) and hallucinations (OR 2.28, 95% CI 1.17-4.45). Concomitant use of anxiolytics (OR 2.32, 95% CI 1.58- 3.41), hypnotics (OR 2.08, 95% CI 1.44-3.03) and antidepressants (OR 2.06, 95% CI 1.41-3.00) together with signs of depression (OR 1.78, 95% CI 1.24- 2.56), moderate to severe cognitive impairment (OR 1.30, 95% CI 1.12-1.51) and residing in Finland (OR 2.52, 95% CI 1.21-5.24) or Italy (OR 2.15, 95% CI 1.10-4.19) were associated with the use of antipsychotics. The most commonly used antipsychotic agent was risperidone (n=42, 21%). CONCLUSIONS: The frequency of antipsychotic drug use in older home-care patients varied considerably among the European countries studied. Antipsychotic drug treatment in older home-care recipients seems to be less common than in residents in long-term institutional care, and more common than among the independently-living elderly

Natural Gas Engine Emission Reduction by Catalysts

In order to meet stringent emission limits, after-treatment systems are increasingly utilized in natural gas engine applications. In this work, two catalyst systems were studied in order to clarify how the catalysts affect, e.g. hydrocarbons, NOx and particles present in natural gas engine exhaust. A passenger car engine modified to run with natural gas was used in a research facility with possibilities to modify the exhaust gas properties. High NOx reductions were observed when using selective catalytic reduction, although a clear decrease in the NOx reduction was recorded at higher temperatures. The relatively fresh methane oxidation catalyst was found to reach reductions greater than 50% when the exhaust temperature and the catalyst size were sufficient. Both the studied catalyst systems were found to have a significant effect on particulate emissions. The observed particle mass reduction was found to be due to a decrease in the amount of organics passing over the catalyst. However, especially at high exhaust temperatures, high nanoparticle concentrations were observed downstream of the catalysts together with higher sulphate concentrations in particles. This study contributes to understanding emissions from future natural gas engine applications with catalysts in use