Potentially inappropriate prescriptions for elderly people taking antidepressant: comparative tools

Abstract

BackgroundThe use of psychotropic drugs by elderly people is widely spread around the world, given that prevalence of inappropriate medication is frequent. Strictly speaking, in Brazil, the vulnerable population of elderly people is more likely to use Potentially Inappropriate Psychotropic (PIP) due to the impact of social-economic characteristics, to the Brazilian Public Health System, and to the lack of patient monitoring. However, neither the use pattern nor the prevalence rate of PIP have been studied in Brazil so far. The objectives of this study were to determine the prevalence of PIP in elderly outpatients taking antidepressants, and to compare the performance of two different tools (Beers, STOPP).MethodsThis cross-sectional study involved all the aged outpatients (≥ 60 years of age) taking antidepressants attended by the public health system in a city of the State of São Paulo, Brazil. Data were obtained from a pharmacy database and medical records. All psychotropic drugs evaluated included: antidepressants, antipsychotics, anti-epileptics and benzodiazepines. STOPP and Beers criteria were applied to detect PIP.ResultsOne thousand one hundred forty prescriptions from 174 outpatients were subjected to two different screening tools. The average patient age was 67 (interquartile range 63–74) and the median number of drugs used was 3.0 (interquartile 2–4) per patient. The overall prevalence of PIP was 121 (69.5%). The levels of PIP observed according to tools were 39.6% (STOPP) and 29.9% (Beers).The long-term use of benzodiazepines was the most common PIP recognized, and the one which contributed more significantly to higher levels of PIP than other medications.ConclusionsThe prevalence of PIP was high among the elderly. STOPP criteria identified more PIP than Beers criteria. Knowledge of PIP prevalence should gear efforts to reduce the level of inappropriate prescriptions and may provide the need for developing national criteria.

Potentially inappropriate medication use among older patients attending a geriatric centre in south-west Nigeria

“… 21 , 22 The benzodiazepines are commonly prescribed medications as anxiolytic or as sleep aid among older persons. 22 , 23 Long term use of these medications are contraindicated in older persons and considered as potentially inappropriate medications in Beer’s criteria owing to the danger of continued sedation, confusion, psychomotor impairment, falls and physical dependence. 21 The outcomes of this study correlates with those from Europe and United States of America.…”

Concurrent antipsychotic use in older adults treated with antidepressants in Asia

“…Antipsychotics (APs), such as aripiprazole, quetiapine and olanzapine, are often used for augmenting ADs for depression . Over half of older adults who received ADs are also prescribed other psychotropic drugs, particularly benzodiazepines (BZDs) and APs . Compared to younger adults, due to their poorer general health status and age‐related physiological changes, older adults are more likely to experience medication‐induced adverse events .…”

“…14 Over half of older adults who received ADs are also prescribed other psychotropic drugs, particularly benzodiazepines (BZDs) and APs. 15 Compared to younger adults, due to their poorer general health status and age-related physiological changes, older adults are more likely to experience medicationinduced adverse events. 16,17 Therefore, polypharmacy using psychotropic medications in older adults, if indicated at all, should be cautiously prescribed.…”

Prevalência do uso de medicamentos potencialmente inapropriados ao idoso no Brasil: uma revisão sistemática

“…É possível observar as três classes de medicamentos mais prescritas, para cada estudo de amostra domiciliar; em ordem decrescente foram, segundo de (Baldoni, et al, 2014;Cassoni, et al, 2014;Faustino, et al, 2011;Fulone, & Lopes, 2017;Martins, Acurcio, Franceschini, Priore, & Ribeiro, 2015;Oliveira, Amorim, De Jesus, Rodrigues, & Passos, 2012;Reis, dos Santos, de Jesus Souza, & Reis, 2017;Varallo, et al, 2011).…”

“…Foi possível observar a maior prevalência de SF em todos os estudos com amostra ambulatorial, entre 55,8% (Martins, et al, 2015) a 81,1% (Fulone, & Lopes, 2017). Quanto à prevalência de MPI, esteve entre 19,1% (Varallo, et al, 2011) e 59,2% (Baldoni, et al, 2014) e a prevalência de PF entre 26,2% (Lopes, et al, 2016) e 64,5% (Oliveira, et al, 2012).…”