Assessment of Potentially Inappropriate Medication Use in Korean Elderly Patients with Parkinson's Disease

OBJECTIVES: The present study assessed the prevalence of the potentially inappropriate medication (PIM) use in Korean elderly patients with Parkinson's disease. In addition, this study examined risk factors that affect PIM use. METHOD: A retrospective, observational study was conducted using Korean National Health Insurance claims database of 2009. PIM use in Parkinson's disease patients aged 65 years or older was examined based on 2012 Beers Criteria. Multivariable logistic regression was conducted to identify risk factors for PIM use. RESULTS: Among 5,277 elderly patients with Parkinson's disease, 88.9% of patients used PIM(s) at least once. The average number of PIM items used per patient was 4.2. PIM use ratio, the proportion of total amount of PIMs to all medications per patient, was 12.6%. Frequently used PIM therapeutic classes were benzodiazepines (32.7%), first-generation antihistamines (19.2%), and prokinetics (17.5%). Individual PIMs most commonly used included chlorpheniramine (11.4%), levosulpiride (10.9%), diazepam (9.0%), and alprazolam (7.6%). Women (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.11-1.16), medical aid (OR 1.18, 95% CI 1.15-1.21), and long-term facilities (OR 2.43, 95% CI 2.22-2.65) were shown to be risk factors associated with PIM use. Of particular, wide variation in PIM use was associated with the types of healthcare facility. CONCLUSION: The PIM prevalence was very high in elderly Parkinson's disease patients. Nationally effective and systematic efforts to identify and prevent PIM use should be made to ensure patient safety and to improve quality of care in the elderly.

Developing a Tool to Assess Competency to Consent to Psychiatric Hospitalization (KATOC): Reliability and Validity

OBJECTIVE: The justification of informed consent requires that a patient be provided with the information necessary for deciding treatment and able to use such information based on reasonable thinking. The clinical decision to consider anyone who has mental disorder as incompetence without objective assessment does not only encroach human rights of the persons with mental illness, but seriously prevent them from being recovered. Hence the objective assessment of competency is needed in mental health. Our study aimed to develop the Korean Tool of Competency to Consent to Psychiatric Hospitalization and to analyze the reliability and validity of this tool. METHODS: Totally 98 patients with mental illness who were hospitalized in mental hospital, participated in this study. For the subjects a questionnaire composing of 22 questions of understanding, appreciation, reasoning and expression of a choice was used. To investigate validity of this tool, MMSE-K, insight test, estimated IQ, BPRS were conducted. Its reliability and usefulness were examined with Cronbach's alpha, ICC and ROC analysis respectively and criterion related validation performed. RESULTS: As results, this tool shows that agreement between raters is relatively high and the confirmatory factor analysis for constructive validation shows that the tool is valid. Also, for criterion related validation, estimated IQ, insight and MMSE are significantly correlated to understanding, appreciation and reasoning. However competence to express a choice did not show any significant correlation with criterion variables, nor showed BPRS any significant correlation with sub-competences. CONCLUSION: Our study developed the Korean Tool of Competency to Consent to Psychiatric Admission Treatment in the Mentally Ill, verified the reliability and validity of the tool and analyzed the optimum cutoff to distinguish between competence and incompetence in sub-competences. Korean Assessment Tool of Competency to Consent to Psychiatric Hospitalization (KATOC), analyzed the reliability and validity of this tool and presented the cutoff points by subarea. As a result, the reliability and validity of satisfactory levels were verified, the ROC analysis was implemented based on the clinical assessment and the cutoff points were found in understanding, appreciation, expression of a choice and reasoning. Such findings showed that the tool developed by researchers could be very favorably used in Korea.

A Study on the Parents of Adult with the Mental Disabilities: Comparison between Parents of the Mentally Ill and Parents of the Mentally Retarded / 신경정신의학

OBJECTIVE: As social welfare practice for the disabled has been changed institution -based to community- based care, burden of primary care takers to the mentally disabled(generally, their parents) was increased. This study aims to compare the parents of the mentally ill and the parents of the mentally retarded regarding social support, care burden, level of permanency planning, and type of residential planning and to finding out service needs of the each group. METHOD: For the purpose of the study, 93 parents of the adult with the chronic mental illness and 99 parents of the adult with mental retardation conducted a survey which included social functioning level of the mentally disabled, care burden, social support, level of permanency planning, type of residential planing and service needs. RESULTS: Even though little differences of social functioning level was found, significant differences existed between the two groups regarding care burden and social support. Parents of the mentally ill were perceiving more burden and less social support than parents of the mentally retarded. And they were having pooer permanency planning than parents of the mentally retarded. However little difference was found between the groups regarding type of residential planning. Fifty-one percent of the parents were having a plan for institution and 28% of them were having a plan for living with offsprings without mental disabilities as residential planning. The most needed services of all subjects were institution and community living facility. Secondly, it was income security, such as disability allowances, financial support to caretaker, and so on. CONCLUSION: Parents of the mentally ill are perceiving more burden than parents of the mentally retarded by reason of the fluctuating course, aggressive symptoms, unpredictable prognosis of mental illness. Therefore this study concluded that policy for mental health which secure various types of community living facilities was needed. At the same time, income security was strongly needed for social integration of the mentally disabled. In the mental health professions, it is needed to have more active interest of meeting needs of the parents.