Factors associated with antidepressant use in residents with and without dementia in Australian aged care facilities

Hiltunen, Henna; Tan, Edwin C.K.; Ilomäki, Jenni; Hilmer, Sarah N.; Visvanathan, Renuka; Emery, Tina; Robson, Leonie; Jones, Mary Jeanne A.; Hartikainen, Sirpa; Bell, John

doi:10.1177/2042098616641355

Cited by 6 publications

(5 citation statements)

References 42 publications

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“…than encouraging individualized assessments of the benefit and risk of continuing or discontinuing FRIDs based on each resident's current clinical indications (Hiltunen et al, 2016;Nguyen et al, 2012). Assessing the benefits and risks of FRIDs is dependent on access to high-quality evidence on medication safety and effectiveness in the residential aged care setting, including among people with dementia.…”

Section: Discussionmentioning

confidence: 99%

“…Most residents using antidepressants and renin–angiotensin system inhibitors had a documented diagnosis of depression and hypertension, respectively. This suggests that generic initiatives to reduce medication-related falls based on simple avoidance of FRIDs may be less successful than encouraging individualized assessments of the benefit and risk of continuing or discontinuing FRIDs based on each resident’s current clinical indications (Hiltunen et al, 2016; Nguyen et al, 2012). Assessing the benefits and risks of FRIDs is dependent on access to high-quality evidence on medication safety and effectiveness in the residential aged care setting, including among people with dementia.…”

Section: Discussionmentioning

confidence: 99%

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Use of Falls Risk Increasing Drugs in Residents at High and Low Falls Risk in Aged Care Services

et al. 2019

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Falls are associated with considerable morbidity and mortality in aged care services and falls risk increasing drugs (FRIDs) are often overlooked as a contributor to falls. This study aims to investigate the association between the risk of falling and use of FRIDs from aged care services. Inverse-probability-weighted multinomial logistic regression was used to estimate the association between falls risk and regular FRIDs in 383 residents from six Australian aged care services. Overall, residents at high and low falls risk had similar prevalence of FRIDs. Prevalence of antipsychotics and sedative-hypnotics was low. Residents at high falls risk had higher adjusted odds of using ≥2 psychotropic medications (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.17-2.61) and ≥2 medications that cause/worsen orthostatic hypotension (OR = 3.59, 95% CI = 2.27-5.69). High prevalence of FRIDs was mainly attributable to medications for which residents had clinical indications. Clinicians appeared to have largely avoided FRIDs that explicit criteria deem potentially inappropriate for high falls risk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of Falls Risk Increasing Drugs in Residents at High and Low Falls Risk in Aged Care Services

et al. 2019

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“…There was a major change in the pattern of prescribing in aged care homes from the late 1990s, when TCAs, particularly amitriptyline and nortriptyline, were largely replaced by SSRIs, especially sertraline, citalopram and escitalopram. The latter became the most frequently used antidepressants in aged care homes in most countries, including Belgium [6,27,51], Finland [14], Norway [10,52,53], Sweden [54,55,56,57], Austria [15], Slovenia [42], US [37,58,59], and Singapore [60], as well as ANZ [61,62,63,64]. However, mirtazapine, which is an atypical antidepressant, was most frequently prescribed in other studies conducted in the US and Sweden [17,39].…”

Section: Discussionmentioning

confidence: 99%

Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis

Hasan

Zaidi

Nirwan

et al. 2019

JCM

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Background: Both old age and institutionalization in aged care homes come with a significant risk of developing several long-term mental and neurological disorders, but there has been no definitive meta-analysis of data from studies to determine the pooled estimate of central nervous system (CNS) medicines use in aged care homes. We conducted this systematic review to summarize the use of CNS drugs among aged care home residents. Methods: MEDLINE, EMBASE, CINAHL, Scopus, and International Pharmaceutical Abstracts (IPA) databases were searched (between 1 January 2000 and 31 December 2018) to identify population-based studies that reported the use of CNS medicines in aged care homes. Pooled proportions (with 95% confidence interval), according to study location were calculated. Results: A total of 89 studies reported the use of CNS medicines use in aged care. The pooled estimate of CNS drug use varied according to country (from 20.3% in Ireland to 49.0% in Belgium) and region (from 31.7% in North America to 42.5% in Scandinavia). The overall pooled estimate of psychotropic medicines use was highest in Europe (72.2%, 95% CI, 67.1–77.1%) and lowest in the ANZ region (56.9%, 95% CI, 52.2–61.4%). The pooled estimate of benzodiazepines use varied widely, from 18.9% in North America to 44.8% in Europe. The pooled estimate of antidepressant use from 47 studies was 38.3% (95% CI 35.1% to 41.6%), with the highest proportion in North America (44.9%, 95% CI, 35.3–54.5%). Conclusion: The overall use of CNS drugs varied among countries, with studies from Australia New Zealand reporting the lowest use of CNS drugs. The criteria for prescribing CNS drugs in clinical practice should be evidence-based. The criteria should be used not to prohibit the use of the listed medications but to support the clinical judgement as well as patient safety.

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“…Over the years, there has been an increase in use of antidepressant in NH [ 3 ], especially among residents with dementia or cognitive impairment [ 4 ]. In NH, misconducts in medication therapy may represent a potential risk of adverse drug reactions and accidental poisonings [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Forensic investigation on a combined death by food aspiration and acute escitalopram intoxication occurred to a psychiatric subject in a nursing home

Zuccarello,

Carnazza,

Salerno

et al. 2024

Int J Legal Med

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Food aspiration is one of the major health risks for elderly people in nursing homes which could lead to death. Moreover, misconducts in pharmacotherapy may represent a potential risk of adverse drug reactions. It is reported here the toxicological evaluation of a combined death by food aspiration and acute escitalopram intoxication of a psychiatric subject, occurred in a nursing home. An 89-year-old man, suffering from dysphagia and Alzheimer’s, was resident in a nursing home. He was fed with a liquid diet administered directly in mouth using a syringe. The man was also being treated with escitalopram 10 mg tablet. One evening, after receiving the meal in the usual way, the man complained of sudden illness. Carried to the emergency room, the man died about 3 h later with a diagnosis of cardiogenic shock subsequentially to ab ingestis. The histological findings revealed the presence of exogenous material, probably food, up to the finest bronchial branches. The toxicological examination revealed the presence of escitalopram and its main metabolite, desmethylcitalopram: in the blood 1972 ng/ml and 285 ng/ml, in the brain 4657 ng/g and 1025 ng/g, in the gastric content 2317 ng/g and 423 ng/g, in the lung 21,771 ng/g and 468 ng/g, respectively. The bad practice of the nurses to dissolve the escitalopram tablet in the liquefied food and to administer the therapy with a syringe directly into the mouth emerged thanks this investigation. Following food aspiration, escitalopram was absorbed by inhalation route, reaching high concentrations in blood and tissues. The death occurred due to a combined mechanism between food aspiration and the escitalopram toxic action.

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Factors associated with antidepressant use in residents with and without dementia in Australian aged care facilities

Abstract: The prevalence of antidepressant use was similar in residents with and without dementia. Clinician-observed pain was inversely associated with antidepressant use but there was no association between self-reported pain and antidepressant use.

Cited by 6 publications

References 42 publications

Use of Falls Risk Increasing Drugs in Residents at High and Low Falls Risk in Aged Care Services

Use of Falls Risk Increasing Drugs in Residents at High and Low Falls Risk in Aged Care Services

Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis

Forensic investigation on a combined death by food aspiration and acute escitalopram intoxication occurred to a psychiatric subject in a nursing home

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