Advertisement

Prevalence of use and appropriateness of antidepressants prescription in acutely hospitalized elderly patients

Published:August 09, 2019DOI:https://doi.org/10.1016/j.ejim.2019.07.025
      Depression is often under-recognized in older patients, even if antidepressants (AD) are commonly prescribed, with a prevalence of use that increase with ageing [
      • Parabiaghi A.
      • Franchi C.
      • Tettamanti M.
      • Barbato A.
      • D'Avanzo B.
      • Fortino I.
      • et al.
      Antidepressants utilization among elderly in Lombardy from 2000 to 2007: dispensing trends and appropriateness.
      ]. Nevertheless, even if a diagnosis of depression is established, inappropriate treatment can occur [
      • Boehlen F.H.
      • Freigofas J.
      • Herzog W.
      • Meid A.D.
      • Saum K.U.
      • Schoettker B.
      • et al.
      Evidence for underuse and overuse of antidepressants in older adults: results of a large population-based study.
      ]. Beers criteria are the most widely screening tools used to detect inappropriate prescription of drugs in people aged 65 years or more [
      • American Geriatrics Society 2015 Beers Criteria Update Expert Panel
      American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults.
      ]. Since 2010, attempts to adapt the Beers' criteria have been made in Europe [
      • Holt S.
      • Schmiedl S.
      • Thürmann P.A.
      Potentially inappropriate medications in the elderly: the PRISCUS list.
      ,
      • Renom-Guiteras A.
      • Meyer G.
      • Thürmann P.A.
      The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries.
      ]. Tricyclic drugs are the ADs to be always avoided in the elderly, owing to their anticholinergic side effects, such as cognitive impairment, delirium, urinary retention and falls [
      • American Geriatrics Society 2015 Beers Criteria Update Expert Panel
      American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults.
      ]. Selective serotonin reuptake inhibitors (SSRIs) should be used with caution because they can cause or exacerbate hyponatraemia [
      • American Geriatrics Society 2015 Beers Criteria Update Expert Panel
      American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults.
      ]. To our knowledge no studies have been conducted on recent data collected in hospitalized older patients in order to assess the appropriateness of prescription of ADs. With this background, the objectives of this study were to investigate the prevalence of AD use and prescription appropriateness, according to the above-cited criteria, in a large cohort of older patients hospitalized in Italian internal medicine and geriatric wards from 2010 to 2017.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Parabiaghi A.
        • Franchi C.
        • Tettamanti M.
        • Barbato A.
        • D'Avanzo B.
        • Fortino I.
        • et al.
        Antidepressants utilization among elderly in Lombardy from 2000 to 2007: dispensing trends and appropriateness.
        Eur J Clin Pharmacol. 2011 Oct; 67: 1077-1083
        • Boehlen F.H.
        • Freigofas J.
        • Herzog W.
        • Meid A.D.
        • Saum K.U.
        • Schoettker B.
        • et al.
        Evidence for underuse and overuse of antidepressants in older adults: results of a large population-based study.
        Int J Geriatr Psychiatry. 2019 Apr; 34: 539-547
        • American Geriatrics Society 2015 Beers Criteria Update Expert Panel
        American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults.
        J Am Geriatr Soc. 2015 Nov; 63: 2227-2246https://doi.org/10.1111/jgs.13702
        • Holt S.
        • Schmiedl S.
        • Thürmann P.A.
        Potentially inappropriate medications in the elderly: the PRISCUS list.
        Dtsch Arztebl Int. 2010; 107: 543-551
        • Renom-Guiteras A.
        • Meyer G.
        • Thürmann P.A.
        The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries.
        Eur J Clin Pharmacol. 2015 Jul; 71: 861-875
        • Marcucci M.
        • Franchi C.
        • Nobili A.
        • Mannucci P.M.
        • Ardoino I.
        • REPOSI Investigators
        Defining aging phenotypes and related outcomes: clues to recognize frailty in hospitalized older patients.
        J Gerontol A Biol Sci Med Sci. 2017 Mar 1; 72: 395-402
        • Ardoino I.
        • Rossio R.
        • Di Blanca D.
        • Nobili A.
        • Pasina L.
        • Mannucci P.M.
        • et al.
        Appropriateness of antiplatelet therapy for primary and secondary cardio- and cerebrovascular prevention in acutely hospitalized older people.
        Br J Clin Pharmacol. 2017 Nov; 83: 2528-2540https://doi.org/10.1111/bcp.13355
        • Franchi C.
        • Antoniazzi S.
        • Proietti M.
        • Nobili A.
        • Mannucci P.M.
        • SIM-AF Collaborators
        Appropriateness of oral anticoagulant therapy prescription and its associated factors in hospitalized older people with atrial fibrillation.
        Br J Clin Pharmacol. 2018 Sep; 84: 2010-2019
        • Franchi C.
        • Tettamanti M.
        • Djade C.D.
        • Pasina L.
        • Mannucci P.M.
        • Onder G.
        • et al.
        E-learning in order to improve drug prescription for hospitalized older patients: a cluster-randomized controlled study.
        Br J Clin Pharmacol. 2016 Jul; 82: 53-63
        • Franchi C.
        • Rossio R.
        • Ardoino I.
        • Mannucci P.M.
        • Nobili A.
        • REPOSI Collaborators
        Inappropriate prescription of benzodiazepines in acutely hospitalized older patients.
        Eur Neuropsychopharmacol. 2019 Jul; 29: 871-879https://doi.org/10.1016/j.euroneuro.2019.05.004