Potentially inappropriate prescription of antidepressants in old people: characteristics, associated factors, and impact on mortality

Hiance-Delahaye, Anne; Schongor, Florence Muller de; Lechowski, L.; Teillet, Laurent; Arvieu, Jean-Jacques; Robine, Jean‐Marie; Ankri, Joël; Herr, Marie

doi:10.1017/s1041610217002290

Cited by 9 publications

(9 citation statements)

References 51 publications

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“…The three most commonly studied populations were patients with mental illness (59/79, 74.7%), followed by elderly with comorbidities (one being a mental illness) (10/79, 12.7%) [ 52 , 54 , 56 , 103 – 105 , 124 , 126 , 128 , 129 ] and then dementia with other comorbidities (5/79, 6.3%) [ 55 , 86 , 87 , 97 , 106 ]. Studies reported either one or more mental health diagnoses with 37 studies focusing on one and 42 reporting multiple diagnoses.…”

Section: Resultsmentioning

confidence: 99%

“…Parsons et al found a correlation between the number of medications prescribed and the occurrence of PIM (r = 0.335, p < 0.001) [ 86 ]. Hiance-Delahaye et al noted polypharmacy (adjusted OR 5–9 drugs 2.61 (95% CI 1.11– 6.16) and OR ≥ 10 drugs 2.69 (95% CI 1.06–6.87)) and longer symptom duration (adjusted OR 2.82 (95% CI 1.42–6.99)) was correlated with PIP of antidepressants in older patients [ 103 ]. A UK study found > 10 repeat prescriptions had a higher risk of PHP (adjusted OR 30.22) but a lower risk of inadequate monitoring (adjusted OR 0.35 (95% CI 0.29–0.41)), and female patients were more at risk of PHP (adjusted OR 1.43 (95% CI 1.41–1.45)) and inadequate monitoring (adjusted OR 1.12 (95% CI 1.05–1.20)) [ 26 ].…”

Section: Resultsmentioning

confidence: 99%

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Understanding the medication safety challenges for patients with mental illness in primary care: a scoping review

Ayre,

Lewis,

Keers

2023

BMC Psychiatry

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Background Mental illness and medication safety are key priorities for healthcare systems around the world. Despite most patients with mental illness being treated exclusively in primary care, our understanding of medication safety challenges in this setting is fragmented. Method Six electronic databases were searched between January 2000-January 2023. Google Scholar and reference lists of relevant/included studies were also screened for studies. Included studies reported data on epidemiology, aetiology, or interventions related to medication safety for patients with mental illness in primary care. Medication safety challenges were defined using the drug-related problems (DRPs) categorisation. Results Seventy-nine studies were included with 77 (97.5%) reporting on epidemiology, 25 (31.6%) on aetiology, and 18 (22.8%) evaluated an intervention. Studies most commonly (33/79, 41.8%) originated from the United States of America (USA) with the most investigated DRP being non-adherence (62/79, 78.5%). General practice was the most common study setting (31/79, 39.2%) and patients with depression were a common focus (48/79, 60.8%). Aetiological data was presented as either causal (15/25, 60.0%) or as risk factors (10/25, 40.0%). Prescriber-related risk factors/causes were reported in 8/25 (32.0%) studies and patient-related risk factors/causes in 23/25 (92.0%) studies. Interventions to improve adherence rates (11/18, 61.1%) were the most evaluated. Specialist pharmacists provided the majority of interventions (10/18, 55.6%) with eight of these studies involving a medication review/monitoring service. All 18 interventions reported positive improvements on some medication safety outcomes but 6/18 reported little difference between groups for certain medication safety measures. Conclusion Patients with mental illness are at risk of a variety of DRPs in primary care. However, to date, available research exploring DRPs has focused attention on non-adherence and potential prescribing safety issues in older patients with dementia. Our findings highlight the need for further research on the causes of preventable medication incidents and targeted interventions to improve medication safety for patients with mental illness in primary care.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Understanding the medication safety challenges for patients with mental illness in primary care: a scoping review

Ayre,

Lewis,

Keers

2023

BMC Psychiatry

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“…Anticholinergic medications such as paroxetine are often considered potentially inappropriate for elderly patients with dementia and cognitive impairment [ 47 ]. The use of paroxetine and other SSRIs has substantially increased during the last decades [ 48 ], but studies show that patients often receive suboptimal treatment because of the concomitant use of anticholinergic drugs, excessively high or low daily dosages, short-duration therapy, or inadequate follow-up [ 49 , 50 ]. Confirming our results, a cross-sectional study in France showed that anti-depressive drugs represented 28.4% of the potentially inappropriate use of psychotropic drugs according to the 2003 Beers criteria list [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

Potentially Inappropriate Prescribing among Elderly Outpatients: Evaluation of Temporal Trends 2012–2018 in Piedmont, Italy

Galimberti

Casula

Scotti

et al. 2022

IJERPH

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Pharmacological intervention is one of the cornerstones in the treatment and prevention of disease in modern healthcare. However, a large number of drugs are often prescribed and used inappropriately, especially in elderly patients. We aimed at investigating the annual prevalence of potentially inappropriate prescriptions (PIPs) among older outpatients using administrative healthcare databases of the Piedmont Region (Italy) over a seven-year period (2012–2018). We included all Piedmont outpatients aged 65 years or older with at least one drug prescription per year. Polypharmacy and the prevalence of PIPs according to the ERD list explicit tool were measured on an annual basis. A range between 976,398 (in 2012) and 1,066,389 (in 2018) elderly were evaluated. Among them, the number of subjects with at least one PIP decreased from 418,537 in 2012 to 339,764 in 2018; the prevalence significantly reduced by ~25% over the study period. The stratified analyses by age groups and sex also confirmed the downward trend and identified several differences in the most prevalent inappropriately prescribed drugs. Overall, despite a reduction in PIP prevalence, one out of three older outpatients was still exposed to inappropriateness, highlighting the extensive need for intervention to improve prescribing.

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“…The associations between independent variables and potential antidepressant overprescribing were investigated using univariate logistic regression, with stratification by general antidepressant indication (general medical diagnosis, specific psychiatric diagnosis, and non‐specific psychiatric symptoms). The independent variables for this study were selected based on prior knowledge of factors that may influence the risk of potential overprescribing of medications to elderly people across multiple treatment settings and to older adults with chronic diseases . Multivariable logistic regression models were adjusted for sex, age (six strata), calendar year (four strata), non‐white race (including Black, Asian, mixed race, Hispanic [non‐White], and other types based on self‐report), and education level (high school graduate and above vs less than high school graduate).…”

Section: Methodsmentioning

confidence: 99%

Frequency and predictors of the potential overprescribing of antidepressants in elderly residents of a geographically defined U.S. population

Bobo

Grossardt

Lapid

et al. 2019

Pharmacology Res & Perspec

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The purpose of this study was to estimate the extent of potential antidepressant overprescribing in a geographically defined U.S. population, and to determine the indications and factors that account for it. We conducted a cohort study of new antidepressant prescriptions for elderly residents of Olmsted County, Minnesota, 2005‐2012, using the Rochester Epidemiology Project medical records‐linkage system. Indications for antidepressants were abstracted from health records for all cohort members. Potential antidepressant overprescribing was defined based on regulatory approval, the level of evidence identified from a standardized drug information database, and multidisciplinary expert review. Predictors of potential antidepressant overprescribing were investigated using logistic regression models, stratified by general antidepressant indication (general medical indication, specific psychiatric diagnosis, and non‐specific psychiatric symptoms). Potential antidepressant overprescribing occurred in 24% of 3199 incident antidepressant prescriptions during the study period, and involved primarily newer antidepressants that were prescribed for non‐specific psychiatric symptoms and subthreshold diagnoses. Potential antidepressant overprescribing was associated with nursing home residence, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, having greater use of urgent or acute care services in the year preceding the index antidepressant prescription, and being prescribed antidepressants via telephone, e‐mail, or patient portal. In conclusion, potential antidepressant overprescribing occurred in elderly persons and involved mainly newer antidepressants used for non‐specific psychiatric symptoms and subthreshold diagnoses, and was associated with indicators of higher clinical complexity or severity and with prescribing without face‐to‐face patient contact.

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Potentially inappropriate prescription of antidepressants in old people: characteristics, associated factors, and impact on mortality

Cited by 9 publications

References 51 publications

Understanding the medication safety challenges for patients with mental illness in primary care: a scoping review

Understanding the medication safety challenges for patients with mental illness in primary care: a scoping review

Potentially Inappropriate Prescribing among Elderly Outpatients: Evaluation of Temporal Trends 2012–2018 in Piedmont, Italy

Frequency and predictors of the potential overprescribing of antidepressants in elderly residents of a geographically defined U.S. population

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