Psychotropics use in the Spanish elderly: predictors and evolution between years 1993 and 2003.
01 Apr 2007-Pharmacoepidemiology and Drug Safety (John Wiley & Sons, Ltd.)-Vol. 16, Iss: 4, pp 449-457
TL;DR: This study mainly aimed at describing the prevalence of psychotropic medication consumption in the Spanish elderly population between the years 1993 and 2003.
Abstract: Purpose
This study mainly aimed at describing the prevalence of psychotropic medication consumption in the Spanish elderly population between the years 1993 and 2003.
Methods
Descriptive, cross-sectional study covering the Spanish population aged 65 years and over, using data drawn from the 1993 and 2003 Spanish National Health Surveys (ENSS). A total of 9570 interviews were analysed (3436 from 1993 and 6134 from 2003). The independent variables were sociodemographic and health-related, and the dependent variable was total consumption of psychotropic medication. Using logistic multivariate regression models, we have analysed the temporal evolution of psychotropic medication consumption between 1993 and 2003.
Results
The prevalence of consumption was significantly higher in women (6.7% from 1993 and 26.4 % from 2003) versus men (2.4% from 1993 and 10.6% from 2003) (p < 0.001). Multivariate analysis, highlighted the association between increased psychoactive drug intake and sex, nervous, depressive, sleep disorders and negative perception of health, displayed a strong association with consumption of psychoactive drugs across the 2 years.
Conclusions
In Spain, the prevalence of psychoactive drug consumption is higher among elderly women than men, and increases with negative perception of health. The prevalence of consumption was significantly higher in the year 2003. Copyright © 2006 John Wiley & Sons, Ltd.
Citations
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TL;DR: The result was robust in pooled analyses across cohorts of new users of benzodiazepines throughout the study and in a complementary case-control study, and indiscriminate widespread use should be cautioned against.
Abstract: Objective To evaluate the association between use of benzodiazepines and incident dementia. Design Prospective, population based study. Setting PAQUID study, France. Participants 1063 men and women (mean age 78.2 years) who were free of dementia and did not start taking benzodiazepines until at least the third year of follow-up. Main outcome measures Incident dementia, confirmed by a neurologist. Results During a 15 year follow-up, 253 incident cases of dementia were confirmed. New use of benzodiazepines was associated with an increased risk of dementia (multivariable adjusted hazard ratio 1.60, 95% confidence interval 1.08 to 2.38). Sensitivity analysis considering the existence of depressive symptoms showed a similar association (hazard ratio 1.62, 1.08 to 2.43). A secondary analysis pooled cohorts of participants who started benzodiazepines during follow-up and evaluated the association with incident dementia. The pooled hazard ratio across the five cohorts of new benzodiazepine users was 1.46 (1.10 to 1.94). Results of a complementary nested case-control study showed that ever use of benzodiazepines was associated with an approximately 50% increase in the risk of dementia (adjusted odds ratio 1.55, 1.24 to 1.95) compared with never users. The results were similar in past users (odds ratio 1.56, 1.23 to 1.98) and recent users (1.48, 0.83 to 2.63) but reached significance only for past users. Conclusions In this prospective population based study, new use of benzodiazepines was associated with increased risk of dementia. The result was robust in pooled analyses across cohorts of new users of benzodiazepines throughout the study and in a complementary case-control study. Considering the extent to which benzodiazepines are prescribed and the number of potential adverse effects of this drug class in the general population, indiscriminate widespread use should
387 citations
TL;DR: The trends in the prescribing of subsidised anxiolytic, hypnotic and sedative medication use in the Australian population from 2002 to 2007 are examined.
Abstract: Purpose
New sedative drugs have been marketed in Australia in the last few years. We examined the trends in the prescribing of subsidised anxiolytic, hypnotic and sedative (AHS) medication use in the Australian population from 2002 to 2007.
Methods
We analysed the Medicare Australia and Drug Utilisation Sub-Committee databases for AHS script data from 2002 to 2007 by source, class of prescriber, gender and 5-year age groups. Scripts were converted to defined daily dose per 1000 population per day (DDD/1000 population/day) using Australian Bureau of Statistics population data.
Results
Overall use of AHS increased from 23.76 to 24.11 DDD/1000 population/day between 2002 and 2007. Anxiolytic medication utilisation increased as hypnotic medication utilisation decreased. Diazepam was the most widely used anxiolytic followed by alprazolam and oxazepam. Temazepam was the most widely used hypnotic followed by nitrazepam. Medication use was concentrated in those aged ≥65 years with peak use in those aged 85–89 years. There was substantial use of anxiolytics in those aged 30–65 years. Age-adjusted utilization was higher in females than males.
Conclusions
The prescribing of AHS medications increased slightly over the last half decade. There is growing use of zolpidem on private prescription. The gender differences in use reflect the higher prevalence of anxiety and sleep disorders in women. The very high use of these drugs in elderly people warrants further exploration because of the concomitant increased risks of mortality and morbidity. Copyright © 2010 John Wiley & Sons, Ltd.
90 citations
TL;DR: The use of benzodiazepines is associated with increased risk of dementia, but it remains unclear whether the risk relates to short or long half‐life Benzodiazepine and whether it extends to other psychotropic drugs.
Abstract: Introduction Benzodiazepine use has been associated with increased risk of dementia. However, it remains unclear whether the risk relates to short or long half-life benzodiazepines and whether it extends to other psychotropic drugs. Methods Prospective cohort study among 8240 individuals ≥65, interviewed on medication use. Incident dementia confirmed by an end point committee after a multistep procedure. Results During a mean of 8 years of follow-up, 830 incident dementia cases were observed. Users of benzodiazepines at baseline had a 10% increased risk of dementia (adjusted hazard ratio [HR], 1.10; 95% confidence interval, 0.90–1.34). However, long half-life (>20 hours) benzodiazepine users had a marked increased risk of dementia (HR = 1.62; 1.11–2.37) compared with short half-life users (HR = 1.05; 0.85–1.30). Users of psychotropics had an increased risk of dementia (HR = 1.47; 1.16–1.86). Discussion Results of this large, prospective study show increased risk of dementia for long half-life benzodiazepine and psychotropic use.
73 citations
TL;DR: Available data, although limited, do not support the routine use of benzodiazepines for the treatment of BPSD, but these drugs may be used in certain circumstances where other psychotropic medications are unsafe for use in individuals with B PSD or when there are significant medication allergies or tolerability issues with certain classes of psychotropic medication.
Abstract: The objective of this review is to summarize the available data on the use of benzodiazepines for the treatment of behavioral and psychological symptoms of dementia (BPSD) from randomized controlled trials (RCTs). A systematic search of 5 major databases, PubMed, MEDLINE, PsychINFO, EMBASE, and Cochrane Collaboration, yielded a total of 5 RCTs. One study compared diazepam to thioridazine, 1 trial compared oxazepam to haloperidol and diphenhydramine, 1 trial compared alprazolam to lorazepam, 1 trial compared lorazepam to haloperidol, and 1 trial compared intramuscular (IM) lorazepam to IM olanzapine and placebo. The data indicates that in 4 of the 5 studies, there was no significant difference in efficacy between the active drugs to treat the symptoms of BPSD. One study indicated that thioridazine may have better efficacy than diazepam for treating symptoms of BPSD. In 1 study, the active drugs had greater efficacy in treating BPSD when compared to placebo. There was no significant difference between the active drugs in terms of tolerability. However, in 2 of the 5 studies, about a third of the patients were noted to have dropped out of the studies. Available data, although limited, do not support the routine use of benzodiazepines for the treatment of BPSD. But these drugs may be used in certain circumstances where other psychotropic medications are unsafe for use in individuals with BPSD or when there are significant medication allergies or tolerability issues with certain classes of psychotropic medications.
64 citations
TL;DR: Almost 84% of individuals displaying some mental disorder did not use psychotropic drugs, which indicates an important gap between demand and access to treatment in the health system for patients with mental disorders.
Abstract: Objective
Estimate the prevalence of psychotropic drugs use in the city of Rio de Janeiro, Brazil, and establish its relationship with the presence of mental disorders.
Methods
A probabilistic sample of non-institutionalized individuals, from the general population of Rio de Janeiro (n = 1208;turn out:81%), 15 years or older, who were interviewed using the Composite International Diagnostic Interview 2.1 (depression, anxiety-phobia, OCD\PTSD, alcoholism sections), and asked about their psychotropic use during a 12 and one-month period before the interview. Data were collected between June/2007-February/2008.The prevalence was estimated with a confidence interval of 95%. The associations between psychotropics use and mental disorders were analyzed through a logistic regression model (Odds Ration – OR).
Results
The one-month prevalence of psychotropic drug use was 6.55%, 3.19% for men and 9.13% for women. Antidepressants were the most frequently used drug (2.78%), followed by anorectics (1.65%), tranquilizers (1.61%) and mood stabilizers (1.23%). General practitioners issued the highest number of prescriptions (46.3%), followed by psychiatrists (29.3%); 86.6% of the psychotropic drugs used were paid for by the patient himself. Individuals with increased likelihood of using psychotropic drugs were those that had received a psychiatric diagnosis during a one-month period before the study (OR:3.93), females (OR:1.82), separated/divorced (OR:2.23), of increased age (OR:1.03), with higher income (OR:2.96), and family history of mental disorder (OR:2.59); only 16% of the individuals with a current DSM IV diagnosis were using a psychotropic drug; 17% among individuals with a depression-related diagnosis and 8% with Phobic Anxiety Disorders-related diagnosis used psychotropics.
Conclusion
Approximately 84% of individuals displaying some mental disorder did not use psychotropic drugs, which indicates an important gap between demand and access to treatment. A significant failure is evident in the health system for patients with mental disorders; this could be due to health workers' inability to recognize mental disorders among individuals.
37 citations
References
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TL;DR: Depression is the fourth leading cause of disease burden, accounting for 4.4% of total DALYs in the year 2000, and it causes the largest amount of non-fatal burden, covering almost 12% of all total years lived with disability worldwide.
Abstract: Background The initial Global Burden of Disease study found that depression was the fourth leading cause of disease burden, accounting for 3.7% of total disability adjusted life years (DALYs) in the world in 1990.
Aims To presentthe new estimates of depression burden for the year 2000.
Method DALYs for depressive disorders in each world region were calculated, based on new estimates of mortality, prevalence, incidence, average age at onset, duration and disability severity.
Results Depression is the fourth leading cause of disease burden, accounting for 4.4% of total DALYs in the year 2000, and it causes the largest amount of non-fatal burden, accounting for almost 12% of all total years lived with disability worldwide.
Conclusions These data on the burden of depression worldwide represent a major public health problem that affects patients and society.
1,698 citations
TL;DR: Substantial differences in potentially inappropriate medication use exist between European countries and might be a consequence of different regulatory measures, clinical practices, or inequalities in socioeconomic background.
Abstract: ContextCriteria for potentially inappropriate medication use among elderly
patients have been used in the past decade in large US epidemiological surveys
to identify populations at risk and specifically target risk-management strategies.
In contrast, in Europe little information is available about potentially inappropriate
medication use and is based on small studies with uncertain generalizability.ObjectiveTo estimate the prevalence and associated factors of potentially inappropriate
medication use among elderly home care patients in European countries.Design, Setting, and ParticipantsRetrospective cross-sectional study of 2707 elderly patients receiving
home care (mean [SD] age, 82.2 [ 7.2] years) representatively enrolled
in metropolitan areas of the Czech Republic, Denmark, Finland, Iceland, Italy,
the Netherlands, Norway, and the United Kingdom. Patients were prospectively
assessed between September 2001 and January 2002 using the Minimum Data Set
in Home Care instrument.Main Outcome MeasuresPrevalence of potentially inappropriate medication use was documented
using all expert panels criteria for community-living elderly persons (Beers
and McLeod). Patient-related characteristics independently associated with
inappropriate medication use were identified with a multiple logistic regression
model.ResultsCombining all 3 sets of criteria, we found that 19.8% of patients in
the total sample used at least 1 inappropriate medication; using older 1997
criteria it was 9.8% to 10.9%. Substantial differences were documented between
Eastern Europe (41.1% in the Czech Republic) and Western Europe (mean 15.8%,
ranging from 5.8% in Denmark to 26.5% in Italy). Potentially inappropriate
medication use was associated with patient’s poor economic situation
(adjusted relative risk [RR], 1.96; 95% confidence interval [CI], 1.58-2.36),
polypharmacy (RR, 1.91; 95% CI, 1.62- 2.22), anxiolytic drug use (RR, 1.82;
95% CI, 1.51-2.15), and depression (RR, 1.29; 95% CI, 1.06-1.55). Negatively
associated factors were age 85 years and older (RR, 0.78; 95% CI, 0.65-0.92)
and living alone (RR, 0.76; 95% CI, 0.64-0.89). The odds of potentially inappropriate
medication use significantly increased with the number of associated factors
(P<.001).ConclusionsSubstantial differences in potentially inappropriate medication use
exist between European countries and might be a consequence of different regulatory
measures, clinical practices, or inequalities in socioeconomic background.
Since financial resources and selected patient-related characteristics are
associated with such prescribing, specific educational strategies and regulations
should reflect these factors to improve prescribing quality in elderly individuals
in Europe.
682 citations
TL;DR: The major finding is the wide difference in the prevalence of depressive disorders found across the study sites, which is a highly prevalent condition in Europe.
Abstract: Background This is the first report on the epidemiology of depressive disorders from the European Outcome of Depression International Network (ODIN) study.
Aims To assess the prevalence of depressive disorders in randomly selected samples of the general population in five European countries.
Method The study was designed as a cross-sectional two-phase community study using the Beck Depression inventory during Phase 1, and the Schedule for Clinical Assessment in Neuropsychiatry during Phase 2.
Results An analysis of the combined sample ( n =8.764) gave an overall prevalence of depressive disorders of 8.56% (95% CI 7.05-10.37). The figures were 10.05% (95% CI 7.80-12.85) for women and 6.61% (95% CI 4.92-8.83) for men. The centres fall into three categories: high prevalence (urban Ireland and urban UK), low prevalence (urban Spain) and medium prevalence (the remaining sites).
Conclusions Depressive disorder is a highly prevalent condition in Europe. The major finding is the wide difference in the prevalence of depressive disorders found across the study sites.
567 citations
TL;DR: It is revealed that polypharmacy continues to be a significant issue and little research has been conducted regarding the methods primary care providers utilize to assess polyphARMacy.
Abstract: Purpose
To review the body of literature addressing polypharmacy in individuals aged 60 years and older to (a) determine primary care providers’ definition of polypharmacy, (b) explore how polypharmacy was assessed in primary care, and (c) seek tested interventions that address polypharmacy.
Data sources
A systematic review of electronic bibliographic databases (e.g. EBSCOHost, InfoTrac, OVID, FirstSearch, and FirstSearch Deluxe) utilizing the search terms “polypharmacy,”“polypharmacy and elderly,”“polypharmacy and research,” and “multiple medications” for the period January 1991 to October 2003 was completed. The search was supplemented with online site searches of relevant journals and review of reference lists of each article.
Conclusions
Results of the literature review revealed that polypharmacy continues to be a significant issue and little research has been conducted regarding the methods primary care providers utilize to assess polypharmacy. Also, there is a gap in the literature regarding the interventions implemented by primary care providers to address polypharmacy.
Implications for practice
The following definition of polypharmacy in clinical practice might be more practical: the use of medications that are not clinically indicated. Selecting appropriate limits for numbers of medications may be counterproductive in populations with multiple comorbidities.
529 citations
TL;DR: Significant changes in medicine use and polypharmacy were carried out among community-dwelling persons aged 64 years or over in 1990-91 and 1998-99 in the municipality of Lieto in southwestern Finland.
467 citations