Introduction Insomnia is a frequent problem in acutely hospitalized older adults, particularly in those suffering from polymorbidity and treated by polypharmacy. The aim of our study was to describe the prevalence of insomna and patterns of inappropriately prescribed hypnosedatives in acutely hospitalized older patients in the Czech Republic. Methods 438 patients (≥65 yrs) acutely hospitalized at 3 geriatric clinics (Brno, Hradec Králové, Praha) in the Czech Republic underwent a comprehensive geriatric assessment (CGA) using the EUROAGEISM H2020 assessment protocols. Descriptive statistics was used to determine the prevalence of insomnia and use of hypnosedatives. Explicit criteria of potentially inappropriate medications (PIMs), mainly 2019 Beers criteria and 2015 EU(7)-PIM list were applied to determine inappropriate patterns of hypnosedatives use. Results 16.9% (N = 74) seniors had diagnosed insomnia in their medical records, but 34,6% used hypnosedatives in the evening or at night (e/n). 13.8% reported e/n use of drugs aggravating insomnias (particularly beta-blockers- 6.4%, diuretics-2.5% and theophylline- 2.1%). Most frequent hypnosedatives used were: antipsychotics e/n (18.5%), Z-drugs (16,2%) and benzodiazepines e/n (BZD, 14,2%). Non-geriatric doses were determined in users of Z-drugs (10.5%) and sedative antidepressants e/n (1,8%), longer than recommended geriatric duration of therapy has been described for Z-drugs (5.9%,>1 month), BZDs e/n (5,3%,>1 month) and sedative antidepressants e/n (3,3%, >6 months). In total, 1PIM was prescribed to 7.5% of seniors (N = 33), 2PIMs to 2.5% and 3PIMs to 1,1% of seniors. Combination of hypnotics and other sedative drugs was documented in 5.9% of cases. Conclusion Inappropriate patterns of hypnosedative use in acutely hospitalized seniors in the Czech Republic at geriatric clinics were found particularly in excessive indication of antipsychotics e/n, inappropriate dosing of Z-drugs and long-term use of BZDs e/n. Supported by: InoMed project (reg. No: CZ.02.1.01/0.0/0.0/18_069/0010046, 2019–2022), EUROAGEISM H2020-MCSF-ITN-764632 project, PROGRESS Q42 Faculty of Pharmacy, Charles University, SVV 260417.
Introduction Among psychotropic drugs, particularly hypnotics are often used by ambulatory seniors due to high prevalence of insomnia in higher age. This study focused on describing the prevalence of insomnia, prevalence of hypnosedative drug use and inappropriate patterns of their prescribing (nongeriatric doses, nongeriatric lenght of therapy) in ambulatory seniors in the Czech Republic. Methods There were 563 ambulatory geriatric patients (≥65 years) included in the study, from 4 geriatric ambulances (regionally different sites) in the Czech Republic. All patients have been assessed using comprehensive geriatric assessment (CGA) using the EUROAGEISM H2020 study protocols. Prevalences of insomnia, hypnosedative drug use and use of drugs that may exacerbate insomnias were documented by descriptive statistics, as well as the prevalence of potentially inappropriate medications in older patients (PIMs, selectively for hypnosedatives, defined by 2019 Beers criteria and 2015 EU(7)-PIM list). Results 30.6% (N = 172) of ambulatory seniors suffered from insomnias and the majority of patients were treated pharmacologically (24.0%), nonpharmacologic procedures were used rarely (0.5%). Hypnosedatives in the evening or at night (e/n) were mostly prescribed in the age group of patients 84–94 years (42.8%) and most often these were Z-drugs (8.2%), benzodiazepines (BZDs, 7.6%) and from „off-label “hypnotics antipsychotics (17.8%,!17% of users 6 months) and sedative antidepressants (9.2%). In nongeriatric doses and nongeriatric duration of therapy (>4 weeks) there were most often prescribed Z-drugs (6.0% and 2,7%, respectively) and BZDs (2,7% and 11%). Conclusion In ambulatory Czech seniors we documented that one third suffered from insomnias and minimally were applied nonpharmacological treatment strategies. From nongeriatric procedures in hypnosetive drug use were most often described long-term use of antipsychotics e/n, non-geriatric dosing of Z-drugs and long-term use of BZDs e/n. Supported by: InoMed project (reg. No: CZ.02.1.01/0.0/0.0/18_069/0010046, 2019–2022), EUROAGEISM H2020-MCSF-ITN-764632 project, PROGRESS Q42 Faculty of Pharmacy, Charles University, SVV 260417.
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