Potentially Inappropriate Use of Psychotropic Medications in Hospitalized Elderly Patients in France: Cross-Sectional Analysis of the Prospective, Multicentre SAFEs Cohort

• Published in: Drugs & aging 2008-01, Vol.25 (11), p.933-946
• Main Authors: Prudent, Max, Dramé, Moustapha, Jolly, Damien, Trenque, Thierry, Parjoie, Renaud, Mahmoudi, Rachid, Lang, Pierre-Olivier, Somme, Dominique, Boyer, François, Lanièce, Isabelle, Gauvain, Jean-Bernard, Blanchard, François, Novella, Jean-Luc
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Age Factors; Aged - statistics & numerical data; Aged patients; Aged, 80 and over; Biological and medical sciences; Cross-Sectional Studies; Data Collection; Delirium; Delirium - complications; Delirium - psychology; Dementia; Dementia - complications; Dementia - psychology; Dosage and administration; Drug Interactions; Drug therapy; Drug Utilization; Emergency medical care; Female; Frail Elderly - statistics & numerical data; Frailty; France - epidemiology; Geriatrics; Geriatrics/Gerontology; Health aspects; Hospital patients; Hospitalization; Hospitals; Humans; Internal Medicine; Logistic Models; Male; Medical sciences; Medicine; Medicine & Public Health; Multivariate analysis; Neuropharmacology; Older people; Original Research Article; Patients; Pharmacology. Drug treatments; Pharmacology/Toxicology; Pharmacotherapy; Polypharmacy; Prescription drugs; Prescriptions - standards; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Psychotropic drugs; Psychotropic Drugs - therapeutic use; Socioeconomic Factors
• ISSN: 1170-229X; 1179-1969
• DOI: 10.2165/0002512-200825110-00004

Background: In France, there is evidence to suggest that 50% of elderly individuals are prescribed psychotropic medications. However, it is known that use of these agents increases the risk of falls, fractures and delirium in older people. Objective: To study the consumption of ‘potentially inappropriate medication’ (PIM) among patients aged ≥75 years, paying particular attention to psychotropic drugs and the factors influencing the use of ‘potentially inappropriate psychotropics’ (PIPs). Method: This was a cross-sectional analysis of a prospective multicentre cohort of 1306 hospitalized French patients aged ≥75 years (the SAFEs [Sujet Âgé Fragile: Évaluation et suivi (Frail Elderly Subjects: Evaluation and follow-up)] cohort). The present analysis involved the 1176 patients for whom there was information on the usual treatments being taken in the 2 weeks before hospitalization. The drugs were coded according to the Anatomical Therapeutic Chemical classification; the Beers list as updated in 2003 defined which medications were considered PIPs. Standardized geriatric assessment variables were recorded on inclusion in the study. Logistic regression analysis was performed to identify factors linked to use of psychotropics and PIPs. Results: The mean number of drugs taken was 5.7 ± 2.9 per patient. Twenty-eight percent of patients took at least one PIM. The number of patients who had taken at least one psychotropic drug in the 2 weeks before hospitalization (mean 1.6 ± 0.9 psychotropics per patient) was 589 (50.1%). More than half of both the 510 patients with a depressive syndrome and the 543 patients affected by dementia were treated with psychotropics. Multivariate analysis showed that prescription of psychotropics was linked to the presence of a dementia syndrome (odds ratio [OR] = 1.4; 95% CI 1.1, 1.9; p = 0.03), the presence of a depressive syndrome (OR = 1.7; 95% CI 1.3, 2.1; p < 0.001), living in an institution (OR = 2.2; 95% CI 1.5, 3.4; p < 0.001), use of more than five drugs (OR = 3.2; 95% CI 2.5, 4.2; p < 0.001) and Charlson’s co-morbidity score >1 (OR = 0.6; 95% CI 0.5, 0.8; p = 0.001). Nineteen percent of all psychotropics prescribed were PIPs. Of these PIPs, 66.5% were anxiolytics, 28.4% were antidepressants and 5.1% were antipsychotics. Use of PIPs in the multivariate analysis was associated only with consumption of more than five drugs (OR = 1.7; 95% CI 1.1, 2.5; p = 0.01). Conclusion: PIM use is common among hospitalized older adults in Franc