Prevalence and appropriateness of psychotropic drug use in old age: results from the Berlin Aging Study (BASE)

Abstract

Background: The aim of this epidemiological study is to examine the prevalence and correlates of psychotropic drug use in the very old and to evaluate the appropriateness of psychotropic drug use in very old age.Methods: Data from the Berlin Aging Study (BASE), a multidisciplinary study of an age- and gender-stratified, randomly selected sample of elderly people living in Berlin are presented. Over-sampling, especially very old men, allows for powerful analyses of this population. All participants went through extensive psychiatric and somatic examinations. Medication intake was assessed by different data sources (interviewing patients and their family physicians, drug inspection at home). Results were brought together in a consensus-conference and research physicians gave operationalized ratings of medication appropriateness.Results: The prevalence of elderly people who were taking at least one psychotropic medication within the 14 days immediately preceding investigation was 29.8%. Of these medications, 68.4% had been taken for longer than one year. There was no effect of age or gender on the scope of psychotropic drug use. Benzodiazepines were taken by 19.8% of the elderly. Antidepressants, neuroleptics and anti-dementia drugs were taken by about 3–4% each. People taking psychotropic drugs had significantly higher levels of psychiatric morbidity, as measured by syndromes and specified diagnoses. Psychotropic drugs were significantly less often judged to be indicated than somatic medications. This is mostly due to benzodiazepines.Conclusions: Psychotropic drug use is common in old age, but there is no additional increase in usage beyond the age of 70. Intake of psychotropics is mostly oriented at symptoms or syndromes, which explains why benzodiazepines are still the most commonly prescribed psychotropics

Uso de psicofármacos entre idosos residentes em comunidade: prevalência e fatores associados

“…In our study, the prevalence of psychotropic drug use was found to be 13.8%, a value lower than the one found among elderly people living in higher income countries 3,[6][7][8][9] , and slightly higher than the one observed among Brazilian elderly in previous research 16 . Such differences between studies may have arisen due to issues related to the morbidity profile of studied populations and prescription patterns, which change according to context and time of conduction of studies.…”

“…This result is not surprising, and is often mentioned in the literature in different scenarios 6,7,9,10,16 . Depression and sleep disorders are highly correlated 10 .…”

“…The elderly individuals, in special, are the most frequent users of psychotropic drugs, due to this population's prevalence of psychiatric comorbidities and the use of these drugs in relieving somatic conditions 4,5 . Among elderly Europeans, psychotropic drug use ranged between 20.5 and 29.8% [6][7][8] , numbers higher than those observed among elderly North Americans (14.9 and 19.0%) 3,9 . In the elderly population, the female sex, a negative self-assessment of one's health and the presence of depressive symptom are the characteristics most frequently associated with the use of psychotropic drugs.…”

To what extent does the indicator “concurrent use of three or more psychotropic drugs” capture use of potentially inappropriate psychotropics among the elderly?

“…The proposal is based on Swedish recommendations, internationally published explicit criteria and expert opinions. This indicator has been used in several research studies [9,[18][19][20][21][22][23] as well as in recent national assessments of quality and efficiency in the Swedish healthcare system [24]. The indicator is considered to be a proxy for polypharmacy (concurrent use of multiple drugs) and to signal poor quality in the treatment of psychiatric disorders.…”

Habilidades cognitivas e uso de benzodiazepínicos em idosas institucionalizadas

“…Grande parte das idosas entrevistadas não soube informar desde quando utiliza benzodiazepínicos, informação esta que também não foi encontrada nos prontuários médicos. Esta limitação também foi encontrada por Linden et al 31 em um estudo sobre a prevalência do uso de benzodiazepínicos, em que as participantes não conseguiram dar informações mais consistentes sobre essa prática.…”