High prevalence of prescription of psychotropic drugs for older patients in a general hospital

Abstract

BackgroundMany elderly patients receive psychotropic drugs. Treatment with psychotropic agents is associated with serious side effects including an increased risk of falls and fractures. Several psychotropic drugs are considered potentially inappropriate for treatment of the elderly.MethodsA retrospective chart review was conducted covering all patients aged ≥ 65 years who were admitted to Evangelisches Krankenhaus Göttingen-Weende between 01/01/2013 and 03/31/2013. Psychotropic drugs reviewed for included benzodiazepines, Z-drugs, antidepressants and neuroleptics, but not drugs for sedation during artificial ventilation or pre-medication before surgery. Potentially inappropriate drugs were identified according to the PRISCUS list. To assess which factors were associated with the administration of psychotropic drugs, univariate and multivariable logistic regression analyses were performed.ResultsThe charts of 2130 patients (1231 women) were analyzed. 53.9% of all patients received at least one psychotropic medication (29.5% benzodiazepines, 12.6% Z-drugs, 22.2% antidepressants, 11.9% neuroleptics). The mean number of psychotropic drugs prescribed per patient with at least one prescription was 1.6. Patients treated in the geriatric department most often received antidepressants (45.0%), neuroleptics (20.6%) and Z-drugs (27.5%). Benzodiazepines and Z-drugs were prescribed mostly as medication on demand (77.7% of benzodiazepines, 73.9% of Z-drugs). Surgical patients most frequently received benzodiazepines (37.1%). Nearly one-third of all patients ≥ 65 years was treated with at least one potentially inappropriate psychotropic medication. The mean number of potentially inappropriate psychotropic medications per patient with at least one psychotropic prescription was 0.69. The percentage of patients with potentially inappropriate psychotropic medication was highest in the surgical departments (74.1%). Female gender (adjusted OR 1.36; 95% CI 1.14 to 1.63), stay in the Department of Geriatrics (2.69; 2.01 to 3.60) or the interdisciplinary intensive care unit (1.87; 1.33 to 2.64) and age ≥ 85 years (1.33; 1.10 to 1.60) were associated with psychotropic drug treatment.ConclusionsA high percentage of patients aged ≥ 65 years received psychotropic drugs. The chance that a potentially inappropriate psychotropic drug would be administered was highest in the surgical departments. Antidepressants, neuroleptics and Z-drugs were used surprisingly often in geriatric medicine. Educational strategies could reduce the use of psychotropic drugs and the prescription of potentially inappropriate medications.

Patient‐reported factors associated with the desire to continue taking sleep‐inducing drugs after hospital discharge: A survey of older adults

“…Relevant comorbidities such as anxiety, chronic insomnia, and/or depression could have been the reason for the use of psychoactive drugs. However, we know from a chart review of all older patients treated in this hospital that the prevalence of such comorbidities was so low—for example, depression below 6%—that it cannot account for the use of these drugs in 45% of patients . A review of admission medication would have allowed us to identify “current users,” ie, those patients who were regularly taking sleep‐inducing drugs at the time of hospital admission.…”

“…A total sample of 2 × 91 patients would be necessary to detect a significant difference of 20% between both groups, with a power of 80% and a confidence level of 95%. A chart review performed at this hospital showed that 27% of hospitalized patients received one or more psychotropic drugs before hospital admission. Of course, not all psychotropic drugs are prescribed for sleep induction and related problems.…”

“…Reasons for poorer sleep in the hospital include noise of other patients, medical devices, pain, and toilet visits . Interventions to address such sleep problems during a hospital stay often include the prescription of hypnotic and sedative drugs, especially benzodiazepines and Z‐drugs …”

“…1 Interventions to address such sleep problems during a hospital stay often include the prescription of hypnotic and sedative drugs, especially benzodiazepines and Z-drugs. 2,3 These drugs have been shown to improve sleep quality, increase sleep time, and decrease the number of nighttime awakenings. However, there are several potential risks, especially for older patients, such as falls, cognitive impairment, depressive symptoms, and addiction.…”

The interplay of context factors in hypnotic and sedative prescription in primary and secondary care—a qualitative study

“…They are still frequently prescribed in both primary and secondary care, often as a “quick fix solution” for “nervousness,” “sleep problems,” and other life problems, especially in old age [2–4]. A recent European study [5] found that more than 36% of elderly patients received at least one benzodiazepine during hospitalization.…”