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Objectives: To describe the criterion validity of nursing home staff's assessment of organic disorder compared with ICD-10 criteria, and to identify determinants of staff assessment of organic disorder., Method: Two hundred and eighty-eight residents were diagnosed using the GMS-AGECAT. Nursing staff members were interviewed about the residents' activities of Daily Living, behavioural problems, orientation in surroundings and communication skills, and asked if the resident had an organic disorder. Multiple logistic regression was used to select the items that most strongly determined staff assessment of organic disorder., Results: Sixty-two per cent of the residents were diagnosed by GMS-AGECAT as having organic disorder, 78% of these were correctly identified by the staff. Whether analysed among residents with or without organic disorder, or in the total group of residents, the staff assessment of the presence of organic disorder depended on a limited set of behavioural characteristics of the resident, namely 'going to the toilet in inappropriate places', 'saying things that do not make sense' and impairment in orientation., Conclusions: Staff comprehension of organic disorder resulted in over- as well as under-labelling of residents, a tendency that will affect communication with medical personnel and may lead to inadequate or wrong medical treatment and to negative performance as well as negative role expectations in everyday life in nursing homes.

Purpose: To characterise the prescription pattern of psychotropics in Danish nursing homes and to identify diagnostic, behavioural, cognitive and performance characteristics associated with prevalent psychotropic drug use., Methods: Prescribed daily medication was recorded from nurses' files. Based on the Anatomical Therapeutical Chemical (ATC) classification index, psychotropics were categorised into neuroleptics, benzodiazepines and antidepressants. Two hundred and eighty-eight residents were diagnosed using the GMS-AGECAT. One hundred and eighteen staff members were interviewed about the residents's Activities of Daily Living (ADL), behavioural problems (Nursing Home Behavior Problem Scale), orientation, communication skills and if the resident had any psychiatric disorder. Multiple logistic regression was used to select the items that determined the use of psychotropics., Results: Fifty-six percent of the residents received a psychotropic, 21% received neuroleptics, 38% received benzodiazepines and 24% received antidepressants. In the multivariate analysis, staff assessment of the resident's mental health was a determinant for the use of all types of specific psychotropics, whereas a GMS-AGECAT diagnosis only determined the use of neuroleptics. Behavioural problems were a determinant for the use of neuroleptics and the use of benzodiazepines irrespective of the psychiatric diagnosis of the resident. Use of antidepressants was associated with male gender and increasing age., Conclusions: Staff perceptions of psychiatric morbidity and norms have a greater impact on the prescription of psychotropics than standardised clinical criteria., (Copyright 2001 John Wiley & Sons, Ltd.)

The purpose of the study was to describe a Danish nursing home population. The study consists of 288 nursing home residents (median age 84.6 years, 68% females). The psychiatric morbidity of the residents was diagnosed with the GMS-AGECAT. The staff was interviewed about the residents' ADL, disturbing behaviour and therapeutic measures. Seventy-one percent had a psychiatric disorder, with organic disorder as the most frequent (61%). Demented residents received significantly less hypnotics, were more often physically restrained and had lower ADL levels compared to other residents. The situation in Denmark can be seen as a paradox. While substantial effort has been made to increase the possibility of choice and to "deinstitutionalize" nursing homes, the majority of the residents are demented and thus not capable of making valid choices.

In 32 nursing homes selected at random in the 16 counties in Denmark, the use of psychotropic medication was studied in all residents aged over 65 years (1454 persons) by interview of nursing staff and review of treatment records regarding drug group, dose, duration of treatment and target symptoms. Psychotropic prescriptions were recorded in 56% of the elderly. The frequency of residents receiving daily treatment with neuroleptics was 20% and for anxiolytics, hypnotics and antidepressants 13%, 33% and 11%, respectively. The duration of treatment was two to three years. The indications were mostly unspecified behavioural disturbances. The use reflects the high psychiatric morbidity in nursing home residents, especially regarding dementia. From what is known of therapeutic efficacy and side-effects, it is concluded that the prescription rate is too high, duration of treatment much longer than necessary and that drugs inappropriate for elderly are often used.