The Use of Antidepressants in Belgian Nursing Homes

Bourgeois, Jolyce; Elseviers, Monique; Bortel, Luc Van; Petrovic, Mirko; Stichele, Robert Vander

doi:10.1007/s40266-012-0003-6

Cited by 29 publications

(14 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Antidepressant drug use is more prevalent in older adults than in the general population, with the highest rates seen in institutionalized older people [98,99]. Antidepressant use is more common in persons with AD compared with those without dementia [100].…”

Section: Antidepressantsmentioning

confidence: 99%

Psychotropic Drug-Associated Pneumonia in Older Adults

2020

View full text Add to dashboard Cite

The use of psychotropic drugs (antipsychotics, benzodiazepines and benzodiazepine-related drugs, and antidepressants) is common, with a prevalence estimates range of 19-29% among community dwelling older adults. These drugs are often prescribed for off-label use, including neuropsychiatric symptoms. The older adult population also has high rates of pneumonia and some of these cases may be associated with adverse drug events. In this narrative review, we summarize the findings from current observational studies on the association between psychotropic drug use and pneumonia in older adults. In addition to studies assessing the use of psychotropics, we included antiepileptic drugs, as they are also central nervous system-acting drugs, whose use is becoming more common in the aging population. The use of antipsychotics, benzodiazepine, and benzodiazepine-related drugs are associated with increased risk of pneumonia in older adults (≥ 65 years of age), and these findings are not limited to this age group. Minimal and conflicting evidence has been reported on the association between antidepressant drug use and pneumonia, but differences between study populations make it difficult to compare findings. Studies regarding antiepileptic drug use and risk of pneumonia in older persons are lacking, although an increased risk of pneumonia in antiepileptic drug users compared with non-users in persons with Alzheimer's disease has been reported. Tools such as the American Geriatric Society Beers Criteria and the STOPP/START criteria for potentially inappropriate medications aids prescribers to avoid these drugs in order to reduce the risk of adverse drug events. However, risk of pneumonia is not mentioned in the current criteria and more research on this topic is needed, especially in vulnerable populations, such as persons with dementia.

show abstract

Section: Antidepressantsmentioning

confidence: 99%

Psychotropic Drug-Associated Pneumonia in Older Adults

2020

View full text Add to dashboard Cite

show abstract

“…Entre as classes farmacológicas inapropriadas, sobressaem os psicofármacos; justificado pela elevada prevalência de demência, [57][58][59] perturbação do sono [57][58][59] e delírio, identificados nos processos clínicos dos residentes das ERPIs em análise.…”

Section: Discussionunclassified

“…Como opção, seria útil testar a efetividade das intervenções psicoterapêuticas, desprovidas dos riscos adversos associados aos antidepressivos. 1,48,58,60 O consumo de benzodiazepinas é semelhante ao de outros estudos, 5,7,8,[12][13][14] sendo de destacar o alprazolam, em grande medida, pela sua prescrição constar 'conforme necessária' em 13 processos, ficando, por isso, a sua administração ao critério dos profissionais. Em geral, os ansiolíticos reduzem o nível de consciência e aumentam o risco de sonolência diurna e noctúria, pelo que, baixos níveis de alerta determinam um risco aumentado para quedas (e fraturas), reduzem a mobilidade e a força muscular, e podem diminuir a ingestão de líquidos e dieta, agravando a fragilidade no idoso.…”

Section: Discussionunclassified

Aplicação dos Critérios de Beers de 2015 Operacionalizados para Portugal em Pessoas Idosas Institucionalizadas: Um Estudo Transversal

Peixoto¹,

Almeida

Rego

et al. 2021

Acta Med Port

View full text Add to dashboard Cite

Introduction: The consumption of potentially inappropriate medicines is high among institutionalized elderly, predisposing to potential drug interactions, adverse drug events, risk of iatrogenic cascade, increased morbidity and mortality and health costs. Medication review is a promising strategy for therapeutic optimization, although scarcely documented in Portugal. The aim of this study was to characterize, using explicit criteria, the existence of potentially inappropriate medicines, among institutionalized elderly, and to calculate the eventual cost savings, with their discontinuation.Material and Methods: Descriptive and cross-sectional study conducted in three residential homes for the elderly, from different geographic regions, based on a random sample of 33 health records. In order to characterize the existence of potentially inappropriate medicines, we used the 2015 Beers criteria, revised by the American Geriatrics Society and in the Portuguese version.Results: On average, 11 drugs are prescribed to elderly residents of three residential structures for the elderly. All health records contain potentially inappropriate medicines (mean 4.8 ± 2.0 per resident), with anxiolytics (17.7%), antidepressants (17.7%) and antipsychotics (15.8%) being the most prevalent. Its reduction would result in an average monthly savings of €9.6 per resident.Discussion: The consumption of potentially inappropriate medicines is higher than the literature describes, and the cost of medicines is high. The involvement of nurses in the process of drug management and reconciliation, in coordination with the physician, could be an effective strategy. This is the first study using the latest Portuguese version of the Beers criteria, which makes the comparability of the results difficult.Conclusion: The consumption of potentially inappropriate medicines is high, which suggest the need for adoption of improvement measures.

show abstract

“…Additionally, our IC 50 values for a number of the drugs in combination also approach human clinical concentrations (as described above), for example dicycloverine plus cyclobenzaprine (IC 50 10 nM; Table 3 ) or dicycloverine plus amitriptyline (22 nM). This is of great relevance as up to 40% of the elderly in care homes are being treated with anti-depressants [ 53 ] and other anticholinergic medications [ 54 ] concurrently.…”

Section: Discussionmentioning

confidence: 99%

A Predictive In Vitro Model of the Impact of Drugs with Anticholinergic Properties on Human Neuronal and Astrocytic Systems

et al. 2015

View full text Add to dashboard Cite

The link between off-target anticholinergic effects of medications and acute cognitive impairment in older adults requires urgent investigation. We aimed to determine whether a relevant in vitro model may aid the identification of anticholinergic responses to drugs and the prediction of anticholinergic risk during polypharmacy. In this preliminary study we employed a co-culture of human-derived neurons and astrocytes (NT2.N/A) derived from the NT2 cell line. NT2.N/A cells possess much of the functionality of mature neurons and astrocytes, key cholinergic phenotypic markers and muscarinic acetylcholine receptors (mAChRs). The cholinergic response of NT2 astrocytes to the mAChR agonist oxotremorine was examined using the fluorescent dye fluo-4 to quantitate increases in intracellular calcium [Ca2+]i. Inhibition of this response by drugs classified as severe (dicycloverine, amitriptyline), moderate (cyclobenzaprine) and possible (cimetidine) on the Anticholinergic Cognitive Burden (ACB) scale, was examined after exposure to individual and pairs of compounds. Individually, dicycloverine had the most significant effect regarding inhibition of the astrocytic cholinergic response to oxotremorine, followed by amitriptyline then cyclobenzaprine and cimetidine, in agreement with the ACB scale. In combination, dicycloverine with cyclobenzaprine had the most significant effect, followed by dicycloverine with amitriptyline. The order of potency of the drugs in combination frequently disagreed with predicted ACB scores derived from summation of the individual drug scores, suggesting current scales may underestimate the effect of polypharmacy. Overall, this NT2.N/A model may be appropriate for further investigation of adverse anticholinergic effects of multiple medications, in order to inform clinical choices of suitable drug use in the elderly.

show abstract

The Use of Antidepressants in Belgian Nursing Homes

Cited by 29 publications

References 56 publications

Psychotropic Drug-Associated Pneumonia in Older Adults

Psychotropic Drug-Associated Pneumonia in Older Adults

Aplicação dos Critérios de Beers de 2015 Operacionalizados para Portugal em Pessoas Idosas Institucionalizadas: Um Estudo Transversal

A Predictive In Vitro Model of the Impact of Drugs with Anticholinergic Properties on Human Neuronal and Astrocytic Systems

Contact Info

Product

Resources

About