Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis

Abstract

Background: Both old age and institutionalization in aged care homes come with a significant risk of developing several long-term mental and neurological disorders, but there has been no definitive meta-analysis of data from studies to determine the pooled estimate of central nervous system (CNS) medicines use in aged care homes. We conducted this systematic review to summarize the use of CNS drugs among aged care home residents. Methods: MEDLINE, EMBASE, CINAHL, Scopus, and International Pharmaceutical Abstracts (IPA) databases were searched (between 1 January 2000 and 31 December 2018) to identify population-based studies that reported the use of CNS medicines in aged care homes. Pooled proportions (with 95% confidence interval), according to study location were calculated. Results: A total of 89 studies reported the use of CNS medicines use in aged care. The pooled estimate of CNS drug use varied according to country (from 20.3% in Ireland to 49.0% in Belgium) and region (from 31.7% in North America to 42.5% in Scandinavia). The overall pooled estimate of psychotropic medicines use was highest in Europe (72.2%, 95% CI, 67.1–77.1%) and lowest in the ANZ region (56.9%, 95% CI, 52.2–61.4%). The pooled estimate of benzodiazepines use varied widely, from 18.9% in North America to 44.8% in Europe. The pooled estimate of antidepressant use from 47 studies was 38.3% (95% CI 35.1% to 41.6%), with the highest proportion in North America (44.9%, 95% CI, 35.3–54.5%). Conclusion: The overall use of CNS drugs varied among countries, with studies from Australia New Zealand reporting the lowest use of CNS drugs. The criteria for prescribing CNS drugs in clinical practice should be evidence-based. The criteria should be used not to prohibit the use of the listed medications but to support the clinical judgement as well as patient safety.

Benzodiazepines and antidepressants: Effects on cognitive and functional decline in Alzheimer's disease and Lewy body dementia

“…44 It should be noted that in older adults, the risk of adverse effects increases with the addition of a new medication, and even more when both medications affect the same body system. 17,45 This may explain why BZD alone predicted fewer outcomes than BZD-ADep. Besides, the rate of BZD-ADep prescriptions was higher than BZD prescriptions alone, and it increased over time.…”

“…, 13 Psychotropic drugs are commonly prescribed to treat NPS, although with uncertain clinical potency and high risk of adverse effects in older adults with dementia 14–16 . Prescription of such medications is still high, a recent meta‐analysis in European nursing homes reported a frequency of use of 44.8% for benzodiazepines (BZD) and 38.3% for antidepressants (ADep) 17 . In older adults BZD prescription is associated with adverse events, such as dizziness, syncope, falls, fractures, hospitalizations, delirium, and increased mortality 18 …”

“…[14][15][16] Prescription of such medications is still high, a recent meta-analysis in European nursing homes reported a frequency of use of 44.8% for benzodiazepines (BZD) and 38.3% for antidepressants (ADep). 17 In older adults BZD prescription is associated with adverse events, such as dizziness, syncope, falls, fractures, hospitalizations, delirium, and increased mortality. 18,19 Thus, they should be carefully managed and preferably avoided particularly in individuals with high comorbidity, frailty, and dementia.…”

What Makes Deprescription of Psychotropic Drugs in Nursing Home Residents with Dementia so Challenging? A Qualitative Systematic Review of Barriers and Facilitators

“…The symptoms may include anxiety, agitation, hallucinations, depression, and apathy. Despite various guidelines recommending non-pharmacological interventions for the management of BPSD [3][4][5], psychotropic drugs are frequently prescribed in nursing homes, although usage can vary between countries [6]. As these drugs often are prescribed in an attempt to alleviate the various symptoms of BPSD, they include a range of both antipsychotics, antidepressants, hypnotics, and anxiolytics.…”

Drug Delivery Approaches for Managing Overactive Bladder (OAB): A Systematic Review

“…The data was extracted from all the eligible studies using a form ( Table S1 ) developed by the principal investigator, which was used and verified by the lead author. The extracted information was subsequently tabulated using Microsoft Word 2019 following an already published method [ 34 , 35 , 36 , 37 ]. The extracted information includes active pharmaceutical ingredient used, drug delivery route, in vitro/in vivo studies, excipients and study characteristics.…”