Older adults recently started on psychotropic medication: where are the symptoms?

Racial Disparities in Prescription of Antidepressants Among U.S. Veterans Referred to Behavioral Health Care

OBJECTIVE

Antidepressants are often prescribed in primary care to treat veterans who have depression. An evaluation of current racial disparities in integrated primary care is warranted. This study examined the association between race and prescription of antidepressants among veterans in primary care.

METHODS

Veterans in primary care (Black, N=4,120; White, N=4,372) who were referred from primary care to a collaborative care program completed an assessment of demographic characteristics and clinical symptoms, including of current antidepressant prescription before the referral, verified by chart review. Patient data were collected from January 1, 2015, to December 22, 2020. Logistic regression analyses were conducted to examine the relationships between patient race and both depression symptoms and antidepressant prescription. Analyses were also stratified by severity of depression symptoms to understand the results in the context of clinical guidelines.

RESULTS

White patients were almost two times (odds ratio=1.96, 95% confidence interval [CI]=1.75–2.19, p<0.001) more likely than Black patients to receive an antidepressant prescription, after the analysis was controlled for depression symptoms, demographic characteristics, and other clinical symptoms. Among patients with severe depression, for whom prescription of antidepressants is clinically indicated, White patients were 1.87 times more likely than Black patients to receive an antidepressant prescription (95% CI=1.40–2.50, p<0.001).

CONCLUSIONS

The findings reveal racial disparities in antidepressant prescription for veterans in primary care. Regular clinical review of antidepressant prescription is recommended to identify disparities in individual clinics. Future research should aim to identify drivers of racial disparities and provide recommendations for health care systems, providers, and patients.

Perceptions, clinical characteristics, and other factors associated with prolonged and high daily dose of benzodiazepine use among patients with anxiety or depressive disorders

BACKGROUND

Benzodiazepines (BZDs) have been widely used to treat anxiety; however, the risk of adverse health effects caused by their long-term use is high. This study examined the factors associated with the duration and higher daily dose of BZDs use among a population with anxiety or depressive disorders.

METHODS

A cross-sectional study design was used. Patients from a psychiatric outpatient department who had been prescribed BZDs were recruited. Data were collected from 250 patients.

RESULTS

Nearly 94% of patients were long-term BZDs users. The mean duration of BZDs use was 5.5 years; and mean defined daily dose (DDD) of BZDs use, converted to diazepam milligram equivalent (DDD), was 1.53 DME-DDD. Patients who knew more about alternative treatments were less prone to use BZD longer. Patients aged 65 years or older and those with difficulty falling asleep were more prone to use BZDs longer. Patients who were currently taking BZDs at higher daily dose were those who felt more depressed, prescribed second generation antipsychotics, suffered from disrupted sleep, less aware of alternative treatments, had comorbid chronic physical illness, and were current smokers.

LIMITATIONS

The cross-sectional study design limited its ability to confirm causal relationships.

CONCLUSIONS

Long-term and excessive daily dose of BZDs use in patients with depressive or anxiety disorders needs to be noted. Providing information or program of non-pharmacological treatment in reducing anxiety and improving specific sleep disturbance is suggested. Elderly, suffering from depressive mood, had comorbid chronic physical illness need to be targeted for further intervention.

Red Blood Cell Omega-3 Fatty Acid Composition and Psychotropic Drug Use in Older Adults: Results from the MAPT Study

Low docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) concentration has been associated with the development of some psychiatric disorders.

OBJECTIVES

to assess the association between red blood cell (RBC) DHA-EPA concentration and psychotropic drug use in older adults and between the 1-year change in RBC DHA-EPA and psychotropic drug use at 12 months.

DESIGN

secondary analysis of multicenter, randomized controlled trial testing multidomain intervention and/or n-3 PUFA supplement on cognitive function (MAPT study).

SETTING

France, 2008-2014.

PARTICIPANTS

1680 participants ≥70 years, community-dwelling were included.

MEASUREMENTS

Psychotropic drug use was self-reported during medical interviews and assessments. RBC n-3 PUFA concentration was defined by % of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) among total fatty acids. Logistic regressions models controlling for age, sex, education, depression risk and intervention group were used.

RESULTS

1594 participants had baseline DHA-EPA concentration available (mean age=75.5±4.5 years, 65% females). At baseline, participants with DHA-EPA ≤4.82% (lowest quartile) reported higher prevalence of use of overall psychotropic drugs (34.0% vs 24.4%; aOR=1.33, 95%CI=[1.03-1.72]), anxiolytic/hypnotic drugs (25.0% vs 18.2%; aOR=1.42, 95%CI=[1.07-1.89]), and antidepressants (18.3% vs 13.5%; aOR=1.25, 95%CI=[0.93-1.72]) than participants with higher DHA-EPA. Participants who experienced an increase in DHA-EPA from baseline were less likely to use a psychotropic drug at 12 months than participants with no change or a decrease (aOR=0.72, 95%CI=[0.55-0.96]).

CONCLUSION

Low RBC DHA-EPA concentration was independently associated with psychotropic drug use. Future studies are needed to assess whether low RBC DHA-EPA is a risk marker for psychotropic drug use in older adults and to better understand underlying pathophysiological mechanisms. Registration number: ClinicalTrials.gov database (NCT00672685).

The SF-8 Spanish Version for Health-Related Quality of Life Assessment: Psychometric Study with IRT and CFA Models

The aim of current research is to analyze the psychometric properties of the Spanish version of the SF-8, overcoming previous shortcomings. A double line of analyses was used: competitive structural equations models to establish factorial validity, and Item Response theory to analyze item psychometric characteristics and information. 593 people aged 60 years or older, attending long life learning programs at the University were surveyed. Their age ranged from 60 to 92 years old. 67.6% were women. The survey included scales on personality dimensions, attitudes, perceptions, and behaviors related to aging. Competitive confirmatory models pointed out two-factors (physical and mental health) as the best representation of the data: χ2(13) = 72.37 (p < .01); CFI = .99; TLI = .98; RMSEA = .08 (.06, .10). Item 5 was removed because of unreliability and cross-loading. Graded response models showed appropriate fit for two-parameter logistic model both the physical and the mental dimensions. Item Information Curves and Test Information Functions pointed out that the SF-8 was more informative for low levels of health. The Spanish SF-8 has adequate psychometric properties, being better represented by two dimensions, once Item 5 is removed. Gathering evidence on patient-reported outcome measures is of crucial importance, as this type of measurement instruments are increasingly used in clinical arena.

Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults

OBJECTIVE

To investigate whether psychotropics are associated with an increased risk of fall injuries, hospitalizations, and mortality in a large general population of older adults.

METHODS

We performed a nationwide matched (age, sex, and case event day) case-control study between 1 January and 31 December 2011 based on several Swedish registers (n = 1,288,875 persons aged ≥65 years). We used multivariate conditional logistic regression adjusted for education, number of inpatient days, Charlson co-morbidity index, dementia and number of other drugs.

RESULTS

Antidepressants were the psychotropic most strongly related to fall injuries (OR_adjusted : 1.42; 95% CI: 1.38-1.45) and antipsychotics to hospitalizations (OR_adjusted : 1.22; 95% CI: 1.19-1.24) and death (OR_adjusted : 2.10; 95% CI: 2.02-2.17). Number of psychotropics was associated with increased the risk of fall injuries, (4 psychotropics vs 0: OR_adjusted : 1.53; 95% CI: 1.39-1.68), hospitalization (4 psychotropics vs 0: OR_adjusted : 1.27; 95% CI: 1.22-1.33) and death (4 psychotropics vs 0: OR_adjusted : 2.50; 95% CI: 2.33-2.69) in a dose-response manner. Among persons with dementia (n = 58,984), a dose-response relationship was found between number of psychotropics and mortality risk (4 psychotropics vs 0: OR_adjusted : 1.99; 95% CI: 1.76-2.25).

CONCLUSIONS

Our findings support a cautious prescribing of multiple psychotropic drugs to older patients. © 2016 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons, Ltd.