Changes in prevalence of psychotropic drug use and alcohol consumption among the elderly in Germany: results of two National Health Interview and Examination Surveys 1997-99 and 2008-11

Abstract

BackgroundPsychotropic drug use and alcohol consumption among older adults need to be monitored over time as their use or combined use bears risks of harms. Representative data on changes in prevalence, patterns and co-relates of substance use are lacking in Germany.MethodsParticipants were older adults (60–79 years) from two German National Health Surveys: 1997–99 (GNHIES98, N = 1,606) and 2008-11 (DEGS1, N = 2,501). Included were drugs acting on the nervous system used during the last 7 days. Alcohol consumption was measured by frequency (daily drinking) and quantity (risky drinking: ≥20/10 g/day alcohol for men/women). Changes in prevalence adjusted for potential socio-economic and health-related confounders were calculated by logistic regression models approximated by the SAS LSMEANS statement.ResultsThe prevalence of overall psychotropic drug use (20.5% vs. 21.4%) remained constant between the two surveys. Significant changes were observed in the use of some psychotropics (all GNHIES98 vs. DEGS1): Synthetic antidepressants (3.9% vs. 6.9%), St. John’s wort (2.9% vs. 1.1%), benzodiazepines (3.7% vs. 2.5%), benzodiazepine related drugs (0.2% vs. 0.8%), narcotic analgesics (3.0% vs. 4.1%), anti-dementia drugs (2.2% vs. 4.2%) and anti-epileptics (1.0% vs. 2.3%). Significant changes were also observed in long-term use of synthetic anti-depressants (3.2% vs. 5.9%), St. John’s wort (2.0% vs. 0.6%) and opioid analgesics (1.0% vs. 2.2%). Further, we found significant changes in benzodiazepines use (3.3% vs. 1.4%) among men, opioids use (2.9% vs. 7.3%) among people with a lower social status, and overall psychotropics (26.8% vs. 32.5%) as well as opioids use (4.4% vs. 8.1%) among those with a worse health status. Moderate alcohol consumption increased significantly (58.0% vs. 66.9%). Risky drinking remained unchanged (16.6% vs. 17.0%). In spite of significant increases in daily alcohol drinking (13.2% vs. 18.4%) psychotropic drug use combined with daily drinking remained unchanged (1.8% vs. 2.7%).ConclusionsAlthough prevalence of overall psychotropic drug use remained stable, changes in the use of some psychotropic drug groups and alcohol consumption patterns have been observed. Further studies are required to investigate resulting health consequences and public health relevance of those outcomes.

Association of psychotropic drug use with falls among older adults in Germany. Results of the German Health Interview and Examination Survey for Adults 2008 – 2011 (DEGS1)

“…This permitted automated recording of unique product identifiers and drug coding according to the WHO "Anatomical Therapeutic Chemical" (ATC) classification system [28]. Definition of psychotropic drugs has been published previously [25,29]. Briefly, we included drugs belonging to the nervous system class (ATC code N00) as well as opiates used as antitussives (ATC code R05DA) and aspirincaffeine combination preparations (ATC code N02BA71) [25,29] (Appendix Table 1a).…”

“…Briefly, we included drugs belonging to the nervous system class (ATC code N00) as well as opiates used as antitussives (ATC code R05DA) and aspirincaffeine combination preparations (ATC code N02BA71) [25,29] (Appendix Table 1a). We excluded other analgesics and antipyretics such as aspirin and paracetamol (ATC code N02B), local anesthetics (ATC code N01B), homeopathic drugs, and drugs with indistinct active Community size: Rural towns (<5,000 inhabitants), small cities (5,000-<20,000 inhabitants), middle-sized cities (20,000-<100,000 inhabitants) and large cities (100,000 inhabitants or more) Region of residence: Eastern Germany (Berlin, Brandenburg, Mecklenburg-Vorpommern, Sachsen, Sachsen-Anhalt and Thü ringen); Northern Germany ingredients under the ATC class N00 [25,29]. Psychotropic drugs with herbal active ingredients were considered and coded separately under specific subgroups (S1 Table).…”

Low‐Dose Trazodone, Benzodiazepines, and Fall‐Related Injuries in Nursing Homes: A Matched‐Cohort Study

“…Several studies have recently reported decreasing trends in benzodiazepine use in older adults in community and NH settings . It is unclear which factors are behind this pattern.…”

Verordnungshäufigkeit, Missbrauch und Abhängigkeit von Benzodiazepinen, Z-Substanzen und Opioidanalgetika

“…In Deutschland gehen laut Arzneiverordnungsreport (AVR) die BZD-Verordnungen deutlich zurück, auch die der Z-Drugs sinkt mittlerweile, allerdings langsamer [12]; diese Daten aus dem Bereich der Gesetzlichen Krankenversicherung sind allerdings mit Vorsicht zu interpretieren, weil die Verordnung von BZD und Z-Drugs häufig auf Privatrezept erfolgt, hier werden Anteile von 30-50 % berichtet [28,29]. Im Gegensatz zum AVR verzeichnen repräsentative Datenerhebungen im Rahmen der DEGS1 zwischen 1997 und 2011 eine Zunahme des Gebrauchs von Z-Drugs, wenn dieser auch geringer war als die Abnahme bei den BZD [30]. In diesen Erhebungen waren Heimbewohner nicht eingeschlossen.…”