Evaluation of Psychotropic Drug Consumption Related to Psychological Distress in the Elderly: Hospitalized vs. Nonhospitalized

Abstract

The use of psychotropic drugs in general has become more extended in the past 20 years. The elderly, particularly geriatric inpatients, are the group with the highest consumption. The aim of the present study was to evaluate in two groups of elderly, hospitalized patients (H) vs. nonhospitalized subjects (nH), psychotropic drug consumption related to psychological distress. This was carried out in a total 238 subjects aged above 65 years (112 geriatric inpatients and 126 interviewed in social welfare centers). Sociodemographic, clinical and pharmacological data, general health and psychological distress were evaluated. The latter was assessed by means of the Symptom Distress Checklist (SCL-90) which included 9 subscales. 23% of the subjects received psychotropic drugs (P), of which 84% were benzodiazepines, 10% antidepressants and 1.5% antipsychotics. After evaluating the SCL-90 sub-scales, it was noted that anxiety, depression and obsessiveness/compulsiveness scored higher in P subjects than in those not receiving psychotropic drugs (nP). When treated nH and H were analyzed separately, it was observed that the former scored higher in anxiety and depression, while the latter showed higher scores in anxiety and obsessiveness/compulsiveness. Considered globally, the H group compared to nH showed higher scores in depression. Although evaluating psychotropic drug utilization in geriatric patients is complex due to the large number of influencing factors, SCL-90 has proved to be useful for assessing the qualitative aspects of this drug consumption in the elderly.

Use of Psychotropic Drugs and Alcohol among Non-Institutionalised Elderly Adults in Germany

“…The lower use of psychotropic drugs can be further evidenced by the use of specifi c therapeutic classes of psychotropic drugs. For example, in the present study the prevalence of benzodiazepine use was 3.7 % , as opposed to previously reported prevalence estimates of 14.9 % in France [39] , 17.3 % in Ireland [27] , 13.7 % in Spain [4] and 10.8 % in the UK [49] . The same applies to the use of antidepressants, anxiolytics, sedatives / hypnotics and neuroleptics as reported from other European countries [20,37,41,52] .…”

“…Although no confi rmatory nationally representative data exist, it seems likely that the slightly lower use of psychotropic drugs in the general population may extend to Germany ' s older population. The prevalence of use of all psychotropic drugs among community-dwelling elderly adults has been reported as being 22.1 % in France [39] , 21.9 % in Ireland [27] , 16 % in Spain [4] , 37 % in Sweden [19] , 25 % in Finland [32] and 18.8 % in the ESEMeD study for the old population subgroup [2] , compares with 20.1 % for the use of all psychotropic drugs and 14.1 % for synthetic psychotropic drug use in our study, and 12.2 % in an earlier regional study conducted in the south of Germany [53] . A much higher prevalence (29.8 % ) of psychotropic drug use has been reported in a regional study among Berlin ' s elderly aged between 70 and 100 + , years which can largely be explained by the disproportionate over-sampling of the very old and of men [31] .…”

Current benzodiazepine issues

“…Community surveys in the United States (Swartz et al 1991) and Western Europe (Fichter et al 1989;Pakesch et al 1989;Vazquez-Barquero et al 1989) have found significant positive correlations between benzodiazepine use and psychiatric disturbance as measured using standard rating instruments. Among patients of general practices, those who had receipted prescriptions for benzodiazepines scored significantly higher on such ratings than matched controls who had not received such prescriptions (Salinsky and Dore 1987;Gen6e-Badia et al 1988) Other studies of general medical patients in the United States (Haskell et al 1986;Ried et al 1990) and Western Europe (Magni et al 1986;Bellantuono et al 1989;Antonijoan et al 1990) also showed that benzodiazepine users were distinguished by significant psychiatric morbidity; some of these (Magni et aI. 1986;Antonijoan et al 1990;Ried et al 1990) specifically studied elderly patient populations.…”

Psychotropic Drug Use and the Relation Between Social Support, Life Events, and Mental Health in the Elderly

“…Despite the abundance of studies on the interaction between mental health and stress-related factors such as life events (i.e., major events such as loss of a spouse or a serious illness) or social support (Flannery & Wieman, 1989;Swindle, Cronkite, & Moos, 1989), little is known of this relationship when prescribed psychoactive drug use is introduced into the equation. When users are simply contrasted with nonusers on various chosen health and psychosocial variables (Antonijoan, Barbanoj, Torrent, & Jane, 1990;Pariente, Lepine, & Lellouch, 1992;Pérodeau, Jomphe Hill, Hay-Paquin, & Amyot, 1996;Weyerer & Dilling, 1991), they invariably appear under a more negative light than the latter group. However, when associative patterns between variables are examined, results are more ambiguous.…”