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Neuroleptic prescriptions for acutely ill geriatric patients
K A Hesse1, A Driscoll, S Jacobson
1Mount Auburn Hospital, Cambridge, Mass.
Archives of Internal Medicine
|November 22, 1993
Summary
Neuroleptic use in acutely ill geriatric patients is common, but documentation and diagnostic evaluation are often inadequate. This highlights a need for better physician education on managing agitation in elderly patients.
Area of Science:
- Geriatric Medicine
- Psychopharmacology
- Health Services Research
Background:
- Neuroleptic medication use is established in general hospitals and long-term care settings.
- This study specifically investigates neuroleptic prescribing patterns in acutely ill medical/surgical geriatric patients.
Purpose of the Study:
- To examine the utilization of neuroleptic drugs in acutely ill geriatric patients.
- To assess the indications, documentation, and prescription strategies for neuroleptic use in this population.
Main Methods:
- Retrospective chart review of geriatric patients prescribed neuroleptics over a 2-month period.
- Data collected included patient characteristics, reasons for drug use, and cognitive/behavioral evaluations.
- Specific analysis of haloperidol prescription orders and strategies.
Main Results:
- Neuroleptics were prescribed to 10.7% of 848 geriatric patients, who were older and had longer hospital stays.
- Indications included dementia/delirium (58%) and agitation/unspecified reasons (31.9%).
- Haloperidol was the predominant neuroleptic (91.2%), with unclear prescription rationales.
Conclusions:
- Concerns exist regarding the quality of documentation and diagnostic evaluation preceding neuroleptic prescription in this cohort.
- Prescription strategies did not consistently align with pharmacological knowledge or diagnosis-based treatment plans.
- Future research should prioritize physician education for improved diagnosis and management of agitated elderly patients.