Patterns of Psychoactive Medication Use in Community-Dwelling Older Adults in the US in 2016: A Descriptive Cross-Sectional Study

Bajracharya, Rashmita; Qato, Dima M.

doi:10.1177/0898264320959293

Cited by 2 publications

(3 citation statements)

References 56 publications

(68 reference statements)

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“…[1][2][3][4] One-fourth of community-dwelling older adults take 1 or more CNS-active medications. [5][6][7] Although practice guidelines recommend that clinicians conduct periodic medication reviews to reduce use of these high-risk medications, 8 many barriers preclude adherence to this recommendation. [9][10][11] Promising approaches to curb medication use have engaged pharmacists and delivered directto-patient education on risks of CNS-active medications and safer alternatives and demonstrated medication reduction.…”

Section: Introductionmentioning

confidence: 99%

“…Medications that act on the central nervous system (CNS) are associated with cognitive impairment and falls among older people . One-fourth of community-dwelling older adults take 1 or more CNS-active medications . Although practice guidelines recommend that clinicians conduct periodic medication reviews to reduce use of these high-risk medications, many barriers preclude adherence to this recommendation …”

Section: Introductionmentioning

confidence: 99%

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Reducing Central Nervous System–Active Medications to Prevent Falls and Injuries Among Older Adults

Phelan,

Williamson,

Balderson

et al. 2024

JAMA Netw Open

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ImportanceHigh-risk medications that contribute to adverse health outcomes are frequently prescribed to older adults. Deprescribing interventions reduce their use, but studies are often not designed to examine effects on patient-relevant health outcomes.ObjectiveTo test the effect of a health system–embedded deprescribing intervention targeting older adults and their primary care clinicians for reducing the use of central nervous system–active drugs and preventing medically treated falls.Design, Setting, and ParticipantsIn this cluster randomized, parallel-group, clinical trial, 18 primary care practices from an integrated health care delivery system in Washington state were recruited from April 1, 2021, to June 16, 2022, to participate, along with their eligible patients. Randomization occurred at the clinic level. Patients were community-dwelling adults aged 60 years or older, prescribed at least 1 medication from any of 5 targeted medication classes (opioids, sedative-hypnotics, skeletal muscle relaxants, tricyclic antidepressants, and first-generation antihistamines) for at least 3 consecutive months.InterventionPatient education and clinician decision support. Control arm participants received usual care.Main Outcomes and MeasuresThe primary outcome was medically treated falls. Secondary outcomes included medication discontinuation, sustained medication discontinuation, and dose reduction of any and each target medication. Serious adverse drug withdrawal events involving opioids or sedative-hypnotics were the main safety outcome. Analyses were conducted using intent-to-treat analysis.ResultsAmong 2367 patient participants (mean [SD] age, 70.6 [7.6] years; 1488 women [63%]), the adjusted cumulative incidence rate of a first medically treated fall at 18 months was 0.33 (95% CI, 0.29-0.37) in the intervention group and 0.30 (95% CI, 0.27-0.34) in the usual care group (estimated adjusted hazard ratio, 1.11 (95% CI, 0.94-1.31) (P = .11). There were significant differences favoring the intervention group in discontinuation, sustained discontinuation, and dose reduction of tricyclic antidepressants at 6 months (discontinuation adjusted rate: intervention group, 0.23 [95% CI, 0.18-0.28] vs usual care group, 0.13 [95% CI, 0.09-0.17]; adjusted relative risk, 1.79 [95% CI, 1.29-2.50]; P = .001) and secondary time points (9, 12, and 15 months).Conclusions and RelevanceIn this randomized clinical trial of a health system–embedded deprescribing intervention targeting community-dwelling older adults prescribed central nervous system–active medications and their primary care clinicians, the intervention was no more effective than usual care in reducing medically treated falls. For health systems that attend to deprescribing as part of routine clinical practice, additional interventions may confer modest benefits on prescribing without a measurable effect on clinical outcomes.Trial RegistrationClinicalTrials.gov Identifier: NCT05689554

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reducing Central Nervous System–Active Medications to Prevent Falls and Injuries Among Older Adults

Phelan,

Williamson,

Balderson

et al. 2024

JAMA Netw Open

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“…Rates of prescribing are particularly high across care homes, where studies in the Western Europe have shown that up to 63% of residents are prescribed at least one psychotropic drug [ 5–8 ]. However, high psychotropic usage has also been noted with older adults in the community [ 9 , 10 ]. Older adults show greater sensitivity to drugs acting upon the central nervous system and their side effects [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Stakeholders’ views on the use of psychotropic medication in older people: a systematic review

et al. 2022

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Background psychotropic medication use has been shown to increase with age and has been associated with increased risk of falls, strokes and mortality. Various guidelines, regulations and tools have been developed to reduce inappropriate prescribing, but this remains high. In order to understand the reasons for this, we aimed to systematically review healthcare professionals’, patients’ and family caregivers’ attitudes towards the use of psychotropic medication in older people. Methods a systematic literature search was carried out from inception to September 2020 using PUBMED, EMBASE, PsycINFO and CINAHL and hand-searching of reference lists. Included studies investigated stakeholder views on psychotropic in adults over the age of 65. Findings were thematically synthesised. Results overall, there was an acceptance of long-term psychotropic medication for older people both living in the community and in residential care. While healthcare professionals were aware of guidelines for the use of benzodiazepines and psychotropic medicines, they identified barriers to following them on individual, team and organisational levels. Alternative non-pharmacological approaches were not always available or accepted by patients. Conclusion psychotropic medicine use in older adults remains a complex issue, which needs to be addressed on a broad level. Attitudes of older people and healthcare professionals encourage long-term use. Meanwhile, various internal and external factors act as barriers to the use of non-drug alternatives in this population. In order to reduce overprescribing of psychotropics, there is a need to increase the acceptability and accessibility of alternative interventions in both care homes and the community.

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Patterns of Psychoactive Medication Use in Community-Dwelling Older Adults in the US in 2016: A Descriptive Cross-Sectional Study

Cited by 2 publications

References 56 publications

Reducing Central Nervous System–Active Medications to Prevent Falls and Injuries Among Older Adults

Reducing Central Nervous System–Active Medications to Prevent Falls and Injuries Among Older Adults

Stakeholders’ views on the use of psychotropic medication in older people: a systematic review

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