Depression and drug utilization in an elderly population

Incalzi, Raffaele Antonelli; Corsonello, Andrea; Corica, Francesco; Carbonin, Pierugo

doi:10.2147/tcrm.1.1.55.53603

Cited by 18 publications

(11 citation statements)

References 32 publications

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“…Greater number of all prescribed drugs was an important patient’s characteristic that predicted prescribing of psychotropic medications. This is in accordance with other studies that also found that patients with a greater number of all prescribed drugs had more morbidities ( 35 ) and that the presence of physical illness was also a risk factor for psychical illness ( 36 ). Restlessness was the second important predictor of psychotropic medication prescribing.…”

Section: Discussionsupporting

confidence: 93%

Psychotropic medication use among elderly nursing home residents in Slovenia: cross-sectional study

Šter¹,

Gorup²

2011

Croat Med J

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AimTo determine the prevalence of psychotropic medication prescribing in elderly nursing home residents in Slovenia and to explore the residents’, physicians’, and nursing home characteristics associated with prescribing.MethodsIn a cross-sectional study, we collected the data for 2040 nursing home residents aged 65 years and older in 12 nursing homes in Slovenia between September 25 and November 30, 2006. Prescribed medications lists were retrieved from patients’ medical records. Psychotropic medications were coded according to Anatomical Therapeutic Chemical Classification 2005, which we adjusted for the purposes of the study. Multivariate logistic regression analysis was performed to determine the residents’, physicians’, and nursing home characteristics associated with prescribing.ResultsResidents were from 65 to 104 years old (median, 83 years) and 1606 (79%) of them were female. A total of 970 (48%) residents had dementia and 466 had depression (23%). In 1492 (73%) residents, at least one psychotropic medication was prescribed. Nine hundred sixty residents were prescribed hypnotics and sedatives (47%), 572 (28%) antipsychotics, 460 (23%) antidepressants, and 432 (21%) anxiolytics. Residents’ characteristics associated with psychotropic medication use were female sex (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.03-1.80), age (OR, 0.97; 95% CI, 0.95-0.98), permanent restlessness (OR, 2.54; 95% CI, 1.71-3.78), dementia (OR, 1.76; 95% CI, 1.33-2.34), depression (OR, 5.51; 95% CI, 3.50-7.58), and the number of prescribed medications (OR, 1.29; 95% CI, 1.23-1.35). Of physicians’ characteristics (sex, age, specialization in general practice, years of working experiences as a general practitioner, and years of experiences working in a nursing home), male sex was associated with psychotropic medication prescribing (OR, 1.80; 95% CI, 1.17-2.76).ConclusionFrequency of psychotropic medication prescribing in elderly nursing home residents in Slovenia is high and is comparable to Western European countries. Our next step should be optimizing the prescribing in patients with the highest prescription rate.

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Section: Discussionsupporting

confidence: 93%

Psychotropic medication use among elderly nursing home residents in Slovenia: cross-sectional study

Šter¹,

Gorup²

2011

Croat Med J

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“… 34 However, Rimm and Moats 35 conclude that the sick quitter hypothesis has been refuted by a wide range of evidence. The inverse association between alcohol consumption and polypharmacy was also detected by Incalzi et al, 31 although they appear to discount a genuine association and rather attribute this to bias (ie, patients in better health are less motivated to correct unhealthy habits).…”

Section: Discussionmentioning

confidence: 65%

“… 30 However, another study reports that smoking is inversely associated with polypharmacy (adjusted OR 0.42; 95% CI 0.33 to 0.53). 31 …”

Section: Discussionmentioning

confidence: 99%

Factors associated with polypharmacy in primary care: a cross-sectional analysis of data from The English Longitudinal Study of Ageing (ELSA)

et al. 2018

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ObjectivesWhile older age and ill health are known to be associated with polypharmacy, this paper aims to identify whether wealth, body mass index (BMI), smoking and alcohol consumption are also associated with polypharmacy (5–9 prescribed medications) and hyperpolypharmacy prevalence (≥10 prescribed medications), among older people living in England.DesignCross-sectional study.SettingThe English Longitudinal Study of Ageing Wave 6 (2012–2013).Participants7730 participants aged over 50 years.Data synthesisTwo multivariate models were created. HR with corresponding 95% CI, for polypharmacy and hyperpolypharmacy, were calculated after adjusting for gender, age, wealth, smoking, alcohol consumption, BMI, self-rated health and the presence of a chronic health condition.ResultsLower wealth (lowest wealth quintile vs highest wealth quintile, adjusted HR 1.28; 95% CI 1.04 to 1.69, P=0.02) and obesity (adjusted HR 1.81; 95% CI 1.53 to 2.15, p<0.01) were significantly associated with polypharmacy. Increasing age (50–59 years vs 70–79 years, adjusted HR 3.42; 95% CI 2.81 to 4.77, p<0.01) and the presence of a chronic health condition (adjusted HR 2.94; 95% CI 2.55 to 3.39, p<0.01) were also associated with polypharmacy. No statistically significant association between smoking and polypharmacy (adjusted HR 1.06; 95% CI 0.86 to 1.29, P=0.56) was established; while, very frequent alcohol consumption (consuming alcohol >5 times per week) was inversely associated with polypharmacy (never drank alcohol vs very frequently, adjusted HR 0.64; 95% CI 0.52 to 0.78, p<0.01). The adjusted HR for hyperpolypharmacy was accentuated, compared with polypharmacy.ConclusionThis study has identified that lower wealth, obesity, increasing age and chronic health conditions are significantly associated with polypharmacy and hyperpolypharmacy prevalence. The effect of these factors, on polypharmacy and especially hyperpolypharmacy prevalence, is likely to become more pronounced with the widening gap in UK wealth inequalities, the current obesity epidemic and the growing population of older people. The alcohol findings contribute to the debate on the relationship between alcohol consumption and health.

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“…[2][3][4][5] Negative consequences of polypharmacy include drugdrug interactions, adverse drug reactions, poor adherence and increased treatment burden, alongside greater medication costs. [6][7][8][9][10] Polypharmacy and inappropriate prescribing are common in people with all stages of chronic kidney disease (CKD), including those receiving renal replacement therapy (RRT). [11][12][13][14][15][16] For people with advanced CKD, two key factors which influence prescribing are the high levels of comorbidity and the development and treatment of CKD related complications; for example, renal anaemia and renal bone disease.…”

Section: Introductionmentioning

confidence: 99%

International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the European Quality study

Hayward

Hole

Denholm

et al. 2020

Nephrology Dialysis Transplantation

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Background People with chronic kidney disease (CKD) are at high risk of polypharmacy. However, no previous study has investigated international prescribing patterns in this group. This article aims to examine prescribing and polypharmacy patterns among older people with advanced CKD across the countries involved in the European Quality (EQUAL) study. Methods The EQUAL study is an international prospective cohort study of patients ≥65 years of age with advanced CKD. Baseline demographic, clinical and medication data were analysed and reported descriptively. Polypharmacy was defined as ≥5 medications and hyperpolypharmacy as ≥10. Univariable and multivariable linear regressions were used to determine associations between country and the number of prescribed medications. Univariable and multivariable logistic regression were used to determine associations between country and hyperpolypharmacy. Results Of the 1317 participants from five European countries, 91% were experiencing polypharmacy and 43% were experiencing hyperpolypharmacy. Cardiovascular medications were the most prescribed medications (mean 3.5 per person). There were international differences in prescribing, with significantly greater hyperpolypharmacy in Germany {odds ratio (OR) 2.75 [95% confidence interval (CI) 1.73–4.37]; P < 0.001, reference group UK}, the Netherlands [OR 1.91 (95% CI 1.32–2.76); P = 0.001] and Italy [OR 1.57 (95% CI 1.15–2.15); P = 0.004]. People in Poland experienced the least hyperpolypharmacy [OR 0.39 (95% CI 0.17–0.87); P = 0.021]. Conclusions Hyperpolypharmacy is common among older people with advanced CKD, with significant international differences in the number of medications prescribed. Practice variation may represent a lack of consensus regarding appropriate prescribing for this high-risk group for whom pharmacological treatment has great potential for harm as well as benefit.

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Depression and drug utilization in an elderly population

Cited by 18 publications

References 32 publications

Psychotropic medication use among elderly nursing home residents in Slovenia: cross-sectional study

Psychotropic medication use among elderly nursing home residents in Slovenia: cross-sectional study

Factors associated with polypharmacy in primary care: a cross-sectional analysis of data from The English Longitudinal Study of Ageing (ELSA)

International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the European Quality study

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