Older adults recently started on psychotropic medication: where are the symptoms?

Maust, Donovan T.; Chen, Shirley H.; Benson, Amy; Mavandadi, Shahrzad; Streim, Joel E.; DiFilippo, Suzanne; Snedden, Thomas M.; Oslin, David W.

doi:10.1002/gps.4187

Cited by 6 publications

(4 citation statements)

References 39 publications

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“…In addition to treatment of mental health problems, such as depression, anxiety, and insomnia, psychotopic drugs are also prescribed to older patients for behavioural and psychological symptoms of dementia (BPSD) (Gustafsson et al, 2013). Thus, psychotropic drugs are used extensively among older people (Johnell and Fastbom 2012) and there is a risk that these drugs are used long-term and off-label (Maust et al, 2015a).…”

Section: Introductionmentioning

confidence: 99%

Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults

Johnell

Bergman

Fastbom

et al. 2016

Int J Geriat Psychiatry

118

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ObjectiveTo investigate whether psychotropics are associated with an increased risk of fall injuries, hospitalizations, and mortality in a large general population of older adults.MethodsWe performed a nationwide matched (age, sex, and case event day) case–control study between 1 January and 31 December 2011 based on several Swedish registers (n = 1,288,875 persons aged ≥65 years). We used multivariate conditional logistic regression adjusted for education, number of inpatient days, Charlson co‐morbidity index, dementia and number of other drugs.ResultsAntidepressants were the psychotropic most strongly related to fall injuries (ORadjusted: 1.42; 95% CI: 1.38–1.45) and antipsychotics to hospitalizations (ORadjusted: 1.22; 95% CI: 1.19–1.24) and death (ORadjusted: 2.10; 95% CI: 2.02–2.17). Number of psychotropics was associated with increased the risk of fall injuries, (4 psychotropics vs 0: ORadjusted: 1.53; 95% CI: 1.39–1.68), hospitalization (4 psychotropics vs 0: ORadjusted: 1.27; 95% CI: 1.22–1.33) and death (4 psychotropics vs 0: ORadjusted: 2.50; 95% CI: 2.33–2.69) in a dose–response manner. Among persons with dementia (n = 58,984), a dose–response relationship was found between number of psychotropics and mortality risk (4 psychotropics vs 0: ORadjusted: 1.99; 95% CI: 1.76–2.25).ConclusionsOur findings support a cautious prescribing of multiple psychotropic drugs to older patients. © 2016 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons, Ltd.

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Section: Introductionmentioning

confidence: 99%

Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults

Johnell

Bergman

Fastbom

et al. 2016

Int J Geriat Psychiatry

118

View full text Add to dashboard Cite

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“…Although the use of evidence‐based psychotherapy options is preferred in older adults, it is more common for clinicians to select medication strategies with this population. In fact, it has been common practice for clinicians to initiate pharmacotherapy in the near‐absence of symptoms on clinical assessment (Maust, Chen, Benson, Mavandadi, Streim, DiFilippo, Snedden, & Oslin, ). Clinically inappropriate medications continue to be prescribed and preferred by many clinicians over nonpharmacological strategies despite continued evidence demonstrating poor outcomes in older adults (AGS, ).…”

Section: Resultsmentioning

confidence: 99%

“…Not only are larger numbers of psychotropics, particularly benzodiazepines, being prescribed to older adults, Maust, Oslin, and Marcus () noted that often these patients do not have a psychiatric diagnosis. In the case of depression and anxiety, benzodiazepines were often initiated with few symptoms of the disease (Maust, Mavandadi, et al., ; Maust, Chen, et al., ). Of concern, this lends to the possibility of inappropriate uses of benzodiazepine medications in the elderly, placing them at increased risk for memory impairment, hypersomnolence, falls, fractures, motor vehicle accidents, and addiction.…”

Section: Introductionmentioning

confidence: 99%

Benzodiazepines and Geriatrics: What Clinical Practice Strategies Can Be Used to Reduce the Inappropriate Prescribing?

2016

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In the elderly, Potentially Inappropriate Prescriptions (PIPs) are quite common and connected with adverse drug events (ADEs), hospital stays, increased medical acuities, and inefficacious healthcare. Benzodiazepines as a class have been identified as an independent risk factor for ADE's and shown to be associated with sedation and impairments in cognition, memory, and balance, lending to an increased risk for falls. Clinically inappropriate medications continue to be prescribed and preferred by many clinicians over non-pharmacological strategies despite continued evidence demonstrating poor outcomes in older adults. Due to the increasing evidence in positive elderly outcomes through the reduction in use of inappropriate drugs, medication reduction strategies are now required policy components in the Centers for Medicare and Medicaid Services regulations along with Medicare Part D. Quality measures now focus on extensive drug reviews with reduction strategies that incorporate use of: the Beers Criteria; multidisciplinary approaches; involving patients and caregivers; and de-prescribing strategies. Case StudyEdna Smith is a 68-year-old female who presents to clinic for poststroke rehabilitation follow-up. She initially received physiotherapy treatments including activities focused on strengthening motor skills, mobility training, constraint-induced therapy, and range of motion therapy three times weekly for 4 months. Due to improvements in physical functioning, her treatment frequency was reduced to twice weekly 12 weeks ago and once weekly 1 month ago. At her last visit, she was ambulating without assistance or noticeable deficits.At this visit, Ms. Smith and her husband report new concerns. In recent weeks Ms. Smith has experienced intermittent and increasing occurrences of disorientation, poor balance, and several falls. She reports her Primary Care Provider (PCP) initiated lorazepam therapy approximately 6 weeks ago for complaint of insomnia.

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“…SF–36, SF–12, and SF–8 have been amply used in elderly populations (i.e., Gregorio et al, 2014; Maust et al, 2015; Naseer & Fagerström, 2015; Neubauer et al, 2012; Orive et al, 2015). But, whereas there is plentiful evidence on SF–36 and SF–12’s psychometric properties, research on SF–8 behavior is scarce, and it only includes four studies: the one by the developers of the reduced version (Ware et al, 2001); one that took place in Uganda (Roberts, Browne, Ocaka, Oyok, & Sondorp, 2008); another one carried out in Japan (Tokuda et al, 2009), and a fourth one developed in Spain (Vallès et al, 2010).…”

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confidence: 99%

The SF–8 Spanish Version for Health-Related Quality of Life Assessment: Psychometric Study with IRT and CFA Models

2018

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The aim of current research is to analyze the psychometric properties of the Spanish version of the SF-8, overcoming previous shortcomings. A double line of analyses was used: competitive structural equations models to establish factorial validity, and Item Response theory to analyze item psychometric characteristics and information. 593 people aged 60 years or older, attending long life learning programs at the University were surveyed. Their age ranged from 60 to 92 years old. 67.6% were women. The survey included scales on personality dimensions, attitudes, perceptions, and behaviors related to aging. Competitive confirmatory models pointed out two-factors (physical and mental health) as the best representation of the data: χ2(13) = 72.37 (p < .01); CFI = .99; TLI = .98; RMSEA = .08 (.06, .10). Item 5 was removed because of unreliability and cross-loading. Graded response models showed appropriate fit for two-parameter logistic model both the physical and the mental dimensions. Item Information Curves and Test Information Functions pointed out that the SF-8 was more informative for low levels of health. The Spanish SF-8 has adequate psychometric properties, being better represented by two dimensions, once Item 5 is removed. Gathering evidence on patient-reported outcome measures is of crucial importance, as this type of measurement instruments are increasingly used in clinical arena.

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Older adults recently started on psychotropic medication: where are the symptoms?

Cited by 6 publications

References 39 publications

Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults

Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults

Benzodiazepines and Geriatrics: What Clinical Practice Strategies Can Be Used to Reduce the Inappropriate Prescribing?

The SF–8 Spanish Version for Health-Related Quality of Life Assessment: Psychometric Study with IRT and CFA Models

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