Evaluation of psychotropic medications use among elderly with psychiatric disorders in Saudi Arabia

Abstract

Aims Potentially inappropriate psychotropic medications (PIPMs) prescribed to older adults with psychiatric disorders can inadvertently affect their health. The use of standards and guidelines can ensure prudent prescribing and minimize the risk of morbidities. This study assessed the pattern and prevalence of prescription of PIPMs to older individuals in outpatient psychiatric settings in Saudi Arabia, using the updated 2015 Beers criteria, as well as the probability of polypharmacy. Methods The study was conducted in the outpatient psychiatric clinics of the only psychiatric hospital in Jazan region of Saudi Arabia. A retrospective cross-sectional review of electronic medical records was undertaken during 2018 to assess PIPM use and psychotropic polypharmacy. Descriptive statistics were generated and associations between PIPM use and baseline characteristics were assessed using multivariable logistic regression. Results Overall, 68% of 1300 older adults received PIPMs, and 77.7% were on psychotropic polypharmacy. Amitriptyline, chlorpromazine, and trifluoperazine were extensively prescribed. Paroxetine (1.2%) and benzodiazepines were prescribed to a smaller proportion of the patients. Elderly with schizophrenia (AOR = 0.046, p < 0.001) and anxiety (AOR = 0.530, p = 0.036) were significantly less likely to have PIPMs than those with dementia. Likewise, elderly with depression and anxiety were less likely to have psychotropic polypharmacy as compared to those with dementia. Conclusion A substantial number of the elderly received PIPMs possibly based on implicit criteria. It is therefore important to provide mental health care providers in the region with educational programs to increase their awareness of PIPMs.

Potentially inappropriate medications use in a psychiatric elderly care hospital: A cross‐sectional study using Beers criteria

“…The majority of drugs classified as PIMs in the current study were antipsychotics accounting for 40.2% of overall PIMs. This outcome is consistent with previous studies involving older adults with psychiatric disorders 26,31,33 . Risperidone (11.2%) and haloperidol (10.3%) were precisely the most prevalent PIMs, similarly to another study of psychiatric outpatients 27 .…”

“…While some studies showed that these characteristics and PIM use were positively associated, other studies revealed no significant association or even a negative correlation. 33,43,44 None of these factors were found to be significantly associated with PIM use, after adjusting for all potential confounders, in the present study. These discrepancies may be caused by differences in prescribing patterns for frail older adults, physicians' awareness of PIMs, and the influence of other confounding factors.…”

“…The primary cause of this discrepancy could be the shortage of drugs that restricted the use of benzodiazepines while it was perceived as prudent prescribing in a study reporting also a low prevalence of benzodiazepines. 33 The present study tested the association between PIM use and different demographic and clinical characteristics of psychiatric older adults. In accordance with several studies, polypharmacy or the use of 5 or more drugs was identified as an independent risk factor for PIM use.…”

“…This outcome is consistent with previous studies involving older adults with psychiatric disorders. 26,31,33 Risperidone (11.2%) and haloperidol (10.3%)…”

“…In the current study, benzodiazepines represented 10% of PIMs to be avoided, due to increased risk of cognitive impairment, falls and fractures, with a predominance of Lorazepam, an intermediate‐acting benzodiazepine. The primary cause of this discrepancy could be the shortage of drugs that restricted the use of benzodiazepines while it was perceived as prudent prescribing in a study reporting also a low prevalence of benzodiazepines 33 …”