失智症病人使用精神用藥影響因子之研究

背景：大多數的失智病人會出現一項以上的精神行為症狀，而這會對他們的照顧者帶來極大的負擔。失智症精神行為症狀的治療分為藥物和非藥物兩種，雖然目前的指引建議以非藥物治療為優先並避免使用精神用藥，但臨床上使用精神用藥仍是常見的醫療行為。方法：本研究為回溯性世代研究，使用彰化基督教醫院失智症個案管理系統的資料進行分析，自2015年10月至2021年9月共計有808名失智症病人及其照顧者之資料被納入。以迴歸分析探討失智症病人及其照顧者各項特徵是否會影響病人精神用藥之開立，本研究中討論之精神用藥包括抗思覺失調藥物、抗憂鬱藥物及鎮靜安眠藥物等三類。結果：52.5 %失智症個案使用一種以上的精神用藥，21.9 %之照顧者顯示有中度到重度之照顧負荷，而有36.1 %之照顧者具有憂鬱傾向或已有憂鬱症狀。迴歸分析結果顯示「有高血壓共病症、使用巷弄長照站及失智社區服務據點」的個案使用精神用藥的機會較低；而「有精神、行為、情緒症狀或睡眠問題，主要照顧者仍在就業中，照顧模式為於各家庭輪流照顧或由外籍看護一人照顧，照顧者憂鬱程度高」的個案使用精神用藥機會較高，利用上述這些變項預測失智個案是否使用精神用藥之正確度達68.4 %。結論：居住於社區的失智症個案使用精神用藥的比例相當高；研究結果顯示，運用失智症個案管理系統分析出的9項特徵，可做為社區中失智症個案使用精神用藥的預測因子。

關鍵字

精神用藥；失智症精神行為症狀；照顧者憂鬱；邏輯斯迴歸

並列摘要

Objectives: Most of patients with dementia have more than one kind of behavioral and psychological symptoms, which cause great burden to their caregivers. There are two types of managements to reduce behavioral and psychological symptoms of dementia (BPSD): pharmacological and non-pharmacological treatments. People living with dementia are frequently prescribed psychotropic medications due to BPSD. However, non-pharmacological therapies and reducing prescription of psychotropic medications are the golden standard of BPSD treatment. Methods: We conducted a retrospective cohort study using dementia case management system data from Changhua Christian Hospital. 808 patients and their caregivers were included between October 2015 and September 2021. The psychotropic medication usage of interest included antipsychotics, antidepressants, and hypnotics/sedatives. Regression analysis tested dementia patient and caregiver factors in comparison with psychotropic medication usage. Results: 52.5% of the patients received at least one psychotropic medication. 21.9% of caregivers had moderate to severe burden, and 36.1% of caregivers were at risk for clinical depression. Regression analysis suggests that the presence of hypertension and utilization of community elderly stations or Community Service Center for Dementia were associated with less psychotropic medication use. Patients presenting with BPSD, caring alternately at different children’s house or only by a foreign care worker, and caregivers who are still employed or experience depression symptoms are associated with more psychotropic medication use. The accuracy of the model to predict the psychotropic medications usage in community-dwelling patients with dementia is 68.4%. Conclusions: Psychotropic medications are prescribed frequently for community-dwelling patients. The evaluation of dementia case management systems for these characteristics as predictive factors for psychotropic medications usage in community-dwelling patients with dementia is suggested by the results.