Psychotropic drug use in elderly people with and without dementia

Girón, Manuel; Forsell, Yvonne; Bernsten, Cecilia; Thorslund, Mats; Winblad, Bengt; Fastbom, Johan

doi:10.1002/gps.438

Cited by 69 publications

(62 citation statements)

References 28 publications

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“…Proportion of individuals taking three and more psychotropic drugs: (includes antipsychotics, anxiolytics, hypnotic-sedatives. and antidepressants) Proportion of individuals with potential drug/drug interactions, category C or D: Drug Ádrug interaction category C or D according to the Swedish classification system described in the annual publication of Pharmaceutical Specialities in Sweden (FASS) [17] Category C (1Á4): Drug Ádrug interaction that could lead to a changed effect or adverse events but which can be managed with individual dosage Category D (1Á4): Drug combinations that should be avoided (category D) The degree of documentation is classified in groups 1 Á4 Note: The lower the proportion of each indicator, the better the quality of drug therapy. compared with 13% in 1998 [14].…”

Section: Quality Indicatorsmentioning

confidence: 99%

Evaluation of the quality of drug therapy among elderly patients in nursing homes

Bergman¹,

Olsson

Carlsten

et al. 2007

Scandinavian Journal of Primary Health Care

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Section: Quality Indicatorsmentioning

confidence: 99%

Evaluation of the quality of drug therapy among elderly patients in nursing homes

Bergman¹,

Olsson

Carlsten

et al. 2007

Scandinavian Journal of Primary Health Care

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Lesén

Petzold

Andersson

et al. 2009

Eur J Clin Pharmacol

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Purpose The indicator "concurrent use of three or more psychotropic drugs" has been used as a measure of quality in drug use among the elderly. The aim of our study was to assess to what extent the indicator captures the use of specific psychotropics associated with an increased risk of adverse events among the elderly, i.e., potentially inappropriate psychotropic drugs (PIP). Methods All individuals aged 75 years and older in Sweden purchasing prescribed psychotropic drugs in 2006 constituted the study population (n=384,904). Data on purchased psychotropic drugs from the Swedish Prescribed Drug Register were used. The overlap between individuals with the indicator and individuals using PIP was assessed with sensitivity, specificity, positive and negative predictive values and likelihood ratio as outcome measures. Results Among the psychotropic drug users, 15% had the indicator and 39% used PIP. The proportion of individuals with the indicator among all individuals using PIP was 27% (sensitivity). The proportion of individuals without the indicator among all individuals not using PIP was 93% (specificity). The positive predictive value was 72%, and the negative predictive value was 67%. Differences in outcome measures were observed between different categories of PIP. Conclusions The indicator "concurrent use of three or more psychotropics" can be technically easy to use, but PIP is more specific. Three quarters of all individuals who used PIP in this study were not captured by the indicator.However, two thirds of all individuals with the indicator used PIP. When selecting instruments to assess appropriateness in drug therapy in the elderly, clinical relevance should be balanced against convenience of use.

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“…1 In nursing homes, psychotropic agents are given to up to twothirds of dementia patients. [2][3][4][5] The safety of antipsychotic medications in older adults has been called into question. The United States Food and Drug Administration and Health Canada have issued advisories stating that certain atypical antipsychotics (risperidone, olanzapine and aripiprazole) have been associated with an increased risk of stroke and transient ischemic events, and both atypical and conventional antipsychotics have been associated with an increased risk of death.…”

mentioning

confidence: 99%

“…1 We aimed to examine the association between various classes of psychotropic medications and a range of unintended health outcomes among older adults admitted to nursing homes. We focused on patients in nursing homes because use of psychotropic medication is known to be extensive in this setting, [2][3][4][5] and medication safety is of particular concern given the complex array of medical illnesses among these patients.…”

mentioning

confidence: 99%

Risk of death and hospital admission for major medical events after initiation of psychotropic medications in older adults admitted to nursing homes

Huybrechts¹,

Rothman²,

Silliman³

et al. 2011

Canadian Medical Association Journal

109

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Research CMAJBackground: Despite safety-related concerns, psychotropic medications are frequently prescribed to manage behavioural symptoms in older adults, particularly those with dementia. We assessed the comparative safety of different classes of psychotropic medications used in nursing home residents. Methods:We identified a cohort of patients who were aged 65 years or older and had initiated treatment with psychotropics after admission to a nursing home in British Columbia between 1996 and 2006. We used proportional hazards models to compare rates of death and rates of hospital admissions for medical events within 180 days after treatment initiation. We used propensity-score adjustments to control for confounders. CI 0.86-1.94 for antidepressants). Users of benzodiazepines had a higher risk of death (RR 1.28, 95% CI 1.04-1.58) compared with users of atypical antipsychotics. The RR for heart failure was 1.54 (95% CI 0.89-2.67), and for pneumonia it was 0.85 (95% CI 0.56-1.31). ResultsInterpretation: Among older patients admitted to nursing homes, the risks of death and femur fracture associated with conventional antipsychotics, antidepressants and benzodiazepines are comparable to or greater than the risks associated with atypical antipsychotics. Clinicians should weigh these risks against the potential benefits when making prescribing decisions. Abstract

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Psychotropic drug use in elderly people with and without dementia

Abstract: This study confirms the high rate of psychotropic drug use in the very old, particularly in persons with dementia. Psychotropic drug use was high among subjects living in institutions.

Cited by 69 publications

References 28 publications

Evaluation of the quality of drug therapy among elderly patients in nursing homes

Evaluation of the quality of drug therapy among elderly patients in nursing homes

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

Risk of death and hospital admission for major medical events after initiation of psychotropic medications in older adults admitted to nursing homes

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