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

Abstract

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.

Trends in the use of psychotropics in older people with dementia: interrupted time series of Finnish clinical guidelines of behavioural and psychological symptoms of dementia

“…This could partly be explained by physicians replacing hypnotics with antidepressants [ 39 ]. Psychotropics have other acknowledged indications than BPSD [ 40 ], and this is a challenge when using the SII Prescription Register with no information concerning the patient’s diagnosis.…”

“…Changes in reimbursements and medication prices may have an impact on medication use and prescribing practice in long term [ 32 , 43 ]. There are many factors influencing the treatment of BPSD, such as coping with BPSD of carers, care staff and patients with dementia [ 40 ]. Physicians may recommend non-pharmacological treatments, but their implementation is the responsibility of the whole staff and there can be a lack of resources or knowledge [ 44 ].…”

Benzodiazepines and Z-hypnotics consumption in long-COVID-19 patients: Gender differences and associated factors

“…These active drugs can generate tolerance and dependence, making it necessary to prolong treatment by using increasingly higher doses, despite the risks of long-term use. This circumstance is particularly relevant in view of the high consumption of medications in the elderly population, among whom hypnotics and anxiolytics are regularly used at a very high intake prevalence, often for long periods of time, and not always properly prescribed ( 14 ). These studies obtained different use rate values but had a common denominator: women show a higher use of these medications than men ( 15 – 17 ).…”