Specialist prescribing of psychotropic drugs to older persons in Sweden - a register-based study of 188 024 older persons

BMC Psychiatry

Christina Lindholm¹  Lena Wiklund-Gustin⁴  Ingegerd Fagerberg³  Gunilla Martinsson² 

[1]Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

[2]School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden

[3]Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden

[4]Faculty of Health and Society, Narvik University College, Narvik, Norway

关键词: Register-based;    Psychotropic drugs;    Psychiatry;    Prescribing;    Physicians;    Older persons;    Mental disorders;    Geriatric;    Aged;   

Others  :  1124235
DOI  :  10.1186/1471-244X-12-197

 received in 2012-01-27, accepted in 2012-11-04,  发布年份 2012

【 摘 要 】

Background

The situation for older persons with mental disorders other than dementia disorders has scarcely been studied. The older population is increasing worldwide and along with this increase the prevalence of mental disorders will also rise. The treatment of older persons with mental disorders entails complex challenges, with drugs constituting the major medical treatment. Knowledge of geriatric psychiatry is essential for providing older persons with appropriate treatment and care. This study aimed to evaluate the prescription of drugs for mental disorders to older persons (≥65) in Sweden, focused on the medical specialties of the prescribing physicians.

Methods

Data concerning drug treatment for older persons from 2006 to 2008 was gathered from the Swedish Prescribed Drug Register. Mental disorders, defined as affective, psychotic and anxiety disorders (ICD-10 F20-42) were evaluated in order to identify associated drugs. Included was a total of 188 024 older individuals, who collectively filled 2 013 079 prescriptions for the treatment of mental disorders. Descriptive analyses were performed, including frequency distribution and 95% CI. The competence of the prescribers was analyzed by subdividing them into five groups: geriatricians, psychiatrists, general practitioners (GPs), other specialists, and physicians without specialist education.

Results

GPs represented the main prescribers, whereas geriatricians and psychiatrists rarely prescribed drugs to older persons. Benzodiazepines and tricyclic antidepressants were the most commonly prescribed drugs. Women were prescribed drugs from geriatricians and psychiatrists to a greater extent than men.

Conclusions

This study examined the prescription of psychotropic drugs to older persons. Physicians specialized in older persons’ disorders and mental health were rarely the prescribers of these drugs. Contrary to clinical guidelines, benzodiazepines and tricyclic antidepressants were commonly prescribed to older persons, emphasizing the need for continuous examination of pharmaceutical treatment for older persons. The results indicate a future need of more specialists in geriatrics and psychiatry.

【 授权许可】

   
2012 Martinsson et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Bunting BP, Murphy SD, O’Neill SM, Ferry FR: Lifetime prevalence of mental health disorders and delay in treatment following initial onset: evidence from the Northern Ireland Study of Health and Stress. Psychol Med 2011, 42(8):1-13.
• [2]Jongenelis K, Pot AM, Eisses AM, Beekman AT, Kluiter H, Ribbe MW: Prevalence and risk indicators of depression in elderly nursing home patients: the AGED study. J Affect Disord 2004, 83(2–3):135-142.
• [3]Olivera J, Benabarre S, Lorente T, Rodríguez M, Pelegrín C, Calvo JM, Leris JM, Idáñez D, Arnal S: Prevalence of psychiatric symptoms and mental disorders detected in primary care in an elderly Spanish population. The PSICOTARD Study: preliminary findings. Int J Geriatr Psychiatry 2008, 23(9):915-921.
• [4]Martinsson G, Wiklund-Gustin L, Fagerberg I, Lindholm C: Mental disorders affect older persons in Sweden–a register-based study. Int J Geriatr Psychiatry 2011, 26(3):277-283.
• [5]Sigstrom R, Skoog I, Sacuiu S, Karlsson B, Klenfeldt IF, Waern M, Gustafson D, Ostling S: The prevalence of psychotic symptoms and paranoid ideation in non-demented population samples aged 70–82 years. Int J Geriatr Psychiatry 2009, 24(12):1413-1419.
• [6]National Board of Health and Welfare: Öppna jämförelser 2011- Vård och omsorg om äldre [The care of older persons 2011]. Stockholm with reference number 2011-12-5: National Board of Health and Welfare; 2011.
• [7]Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, de Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lepine JP, Ormel J, Polidori G, Russo LJ, Vilagut G: Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 2004, 109(420):55-64.
• [8]Johnell K, Fastbom J, Rosen M, Leimanis A: Inappropriate drug use in the elderly: a nationwide register-based study. Ann Pharmacother 2007, 41(7):1243-1248.
• [9]Johnell K, Fastbom J: Multi-dose drug dispensing and inappropriate drug use: A nationwide register-based study of over 700,000 elderly. Scand J Prim Health Care 2008, 26(2):86-91.
• [10]Hosia-Randell HM, Muurinen SM, Pitkala KH: Exposure to potentially inappropriate drugs and drug-drug interactions in elderly nursing home residents in Helsinki, Finland: a cross-sectional study. Drugs Aging 2008, 25(8):683-692.
• [11]Mjorndal T, Boman MD, Hagg S, Backstrom M, Wiholm BE, Wahlin A, Dahlqvist R: Adverse drug reactions as a cause for admissions to a department of internal medicine. PDS 2002, 11(1):65-72.
• [12]Tai-Seale M, McGuire T, Colenda C, Rosen D, Cook MA: Two-minute mental health care for elderly patients: inside primary care visits. JAGS 2007, 55(12):1903-1911.
• [13]Bergman A, Olsson J, Carlsten A, Waern M, Fastbom J: Evaluation of the quality of drug therapy among elderly patients in nursing homes. Scand J Prim Health Care 2007, 25(1):9-14.
• [14]National Board of Health and Welfare: Ökad kompetens inom geriatrik och gerontologi [Increased competence within geriatrics and gerontology] (In Swedish). Stockholm 2011-3-34: National Board of Health and Welfare; 2011.
• [15]National Board of Health and Welfare: Statistik om hälso- och sjukvårdspersonal - Officiell statistik om antal legitimerade (2010) och arbetsmarknadsstatus (2009) [Statistics- Health and Medical Care - Statistics on Health Care Personnel - Official Statistics on the Number of Licensed Practitioners (2010) and their Labour Market Situation (2009)]. Stockholm 2011-11-13: National Board of Health and Welfare; 2011.
• [16]Rahmner PB, Gustafsson LL, Holmstrom I, Rosenqvist U, Tomson G: Whose job is it anyway? Swedish general practitioners’ perception of their responsibility for the patient’s drug list. Ann Fam Med 2010, 8(1):40-46.
• [17]Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ: Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993, 342(8878):1032-1036.
• [18]Saltvedt I, Mo ES, Fayers P, Kaasa S, Sletvold O: Reduced mortality in treating acutely sick, frail older patients in a geriatric evaluation and management unit. A prospective randomized trial. JAGS 2002, 50(5):792-798.
• [19]Ellis G, Whitehead MA, Robinson D, O’Neill D, Langhorne P: Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 2011, 343:d6553.
• [20]Baztan JJ, Suarez-Garcia FM, Lopez-Arrieta J, Rodriguez-Manas L, Rodriguez-Artalejo F: Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis. BMJ 2009, 338:b50.
• [21]Fried TR, Tinetti ME, Iannone L: Primary care clinicians’ experiences with treatment decision making for older persons with multiple conditions. Arch Intern Med 2011, 171(1):75-80.
• [22]Stuijt CC, Franssen EJ, Egberts AC, Hudson SA: Appropriateness of prescribing among elderly patients in a Dutch residential home: observational study of outcomes after a pharmacist-led medication review. Drugs Aging 2008, 25(11):947-954.
• [23]Hori H, Richards M, Kawamoto Y, Kunugi H: Attitudes toward schizophrenia in the general population, psychiatric staff, physicians, and psychiatrists: a web-based survey in Japan. Psychiatry Res 2011, 186(2–3):183-189.
• [24]World Health Organization: The International Statistical Classification of Disease and Related Health Problems, Tenth Revision (ICD-10), Swedish version. World Health Organization; 2009. Retrieved in 2009 from http://www.who.int/classifications/icd/ webcite
• [25]LIF: The Swedish Medicines Information portal. Stockholm: LIF; 2009. [The Research-based Pharmaceutical Industry, LIF] http://www.FASS.se webcite
• [26]FASS: FASS (Farmacevtiska specialiteter i Sverige) 2006, (In Swedish) [Pharmaceutical specialities in Sweden]. Stockholm, Sweden: The Swedish Association of the Pharmaceutical Industry. LIF; 2006.
• [27]FASS: FASS (Farmacevtiska specialiteter i Sverige) 2007, (In Swedish) [Pharmaceutical specialities in Sweden]. Stockholm, Sweden: The Swedish Association of the Pharmaceutical Industry. LIF; 2007.
• [28]FASS: FASS (Farmacevtiska specialiteter i Sverige) 2008, (In Swedish) [Pharmaceutical specialities in Sweden]. Stockholm, Sweden: The Swedish Association of the Pharmaceutical Industry. LIF; 2008.
• [29]World Medical Association: WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. 2008. http://www.wma.net/en/30publications/10policies/b3/ webcite
• [30]Laroche ML, Charmes JP, Merle L: Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol 2007, 63(8):725-731.
• [31]Madhusoodanan S, Bogunovic OJ: Safety of benzodiazepines in the geriatric population. Expert Opin Drug Saf 2004, 3(5):485-493.
• [32]Coupland CA, Dhiman P, Barton G, Morriss R, Arthur A, Sach T, Hippisley-Cox J: A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database. Health Tech Ass 2011, 15(28):1-202. iii-iv
• [33]Moen J, Antonov K, Larsson CA, Lindblad U, Nilsson JL, Rastam L, Ring L: Factors associated with multiple medication use in different age groups. Ann Pharmacother 2009, 43(12):1978-1985.
• [34]Puustinen J, Nurminen J, Kukola M, Vahlberg T, Laine K, Kivela SL: Associations between use of benzodiazepines or related drugs and health, physical abilities and cognitive function: a non-randomised clinical study in the elderly. Drugs Aging 2007, 24(12):1045-1059.
• [35]Arai H, Ouchi Y, Yokode M, Ito H, Uematsu H, Eto F, Oshima S, Ota K, Saito Y, Sasaki H, Tsubota K, Fukuyama H, Honda Y, Iguchi A, Toba K, Hosoi T, Kita T: Toward the realization of a better aged society: Messages from gerontology and geriatrics. Geriatr Gerontol Int 2012, 12(1):16-22.
• [36]Moak GS: Treatment of late-life mental disorders in primary care: we can do a better job. J Aging Social policy 2011, 23(3):274-285.
• [37]George J, Adamson J, Woodford H: Joint geriatric and psychiatric wards: a review of the literature. Age Ageing 2011, 40(5):543-548.
• [38]Fredheim T, Danbolt LJ, Haavet OR, Kjonsberg K, Lien L: Collaboration between general practitioners and mental health care professionals: a qualitative study. Int J Ment Health Sys 2011, 5(1):13. BioMed Central Full Text
• [39]Lasserre A, Younes N, Blanchon T, Cantegreil-Kallen I, Passerieux C, Thomas G, Chan-Chee C, Hanslik T: Psychotropic drug use among older people in general practice: discrepancies between opinion and practice. Br J Gen Pract 2010, 60(573):e156-162.
• [40]Yamada K, Hosoda M, Nakashima S, Furuta K, Awata S: Psychiatric diagnosis in the elderly referred to a consultation-liaison psychiatry service in a general geriatric hospital in Japan. Geriatr Gerontol Int 2012, 12(2):304-309.
• [41]Ell K: Depression care for the elderly: reducing barriers to evidence-based practice. Home Health Care Serv Q 2006, 25(1–2):115-148.
• [42]Schuurmans J, van Balkom A: Late-life anxiety disorders: a review. Curr Psychiatry Rep 2011, 13(4):267-273.
• [43]Ribeiro O, Fernandes L, Firmino H, Simoes MR, Paul C: Geropsychology and psychogeriatrics in Portugal: research, education and clinical training. Int Psychoger 2010, 22(6):854-863.
• [44]Olafsdottir M, Marcusson J, Skoog I: Mental disorders among elderly people in primary care: the Linkoping study. Acta Psychiatr Scand 2001, 104(1):12-18.
• [45]Han B, Gfroerer JC, Colpe LJ, Barker PR, Colliver JD: Serious psychological distress and mental health service use among community-dwelling older U.S. adults. Psych Services 2011, 62(3):291-298.
• [46]Moen J, Norrgard S, Antonov K, Nilsson JL, Ring L: GPs’ perceptions of multiple-medicine use in older patients. JECP 2010, 16(1):69-75.
• [47]Jones SM, Vahia IV, Cohen CI, Hindi A, Nurhussein M: A pilot study to assess attitudes, behaviors, and inter-office communication by psychiatrists and primary care providers in the care of older adults with schizophrenia. Int J Geriatr Psych 2009, 24(3):254-260.
• [48]Anthony JS, Baik SY, Bowers BJ, Tidjani B, Jacobson CJ, Susman J: Conditions that influence a primary care clinician’s decision to refer patients for depression care. Rehabil Nurs 2010, 35(3):113-122.