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Potentially inappropriate prescription of antidepressants in old people: characteristics, associated factors, and impact on mortality

Published online by Cambridge University Press:  17 November 2017

Anne Hiance-Delahaye ,
Florence Muller de Schongor ,
Laurent Lechowski ,
Laurent Teillet ,
Jean-Jacques Arvieu ,
Jean-Marie Robine ,
Joël Ankri  and
Marie Herr
Anne Hiance-Delahaye*
Affiliation:
Service de Gériatrie, Hôpital Sainte Périne, HUPIFO, AP-HP, Paris, France INSERM, U1168, VIMA: Aging and Chronic diseases. Epidemiological and Public Health approaches, Villejuif, France Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France Univ Versailles St-Quentin-en-Yvelines, Gérontologie, Montigny le Bretonneux, France
Florence Muller de Schongor
Affiliation:
Service de Gériatrie, Hôpital Sainte Périne, HUPIFO, AP-HP, Paris, France
Laurent Lechowski
Affiliation:
Service de Gériatrie, Hôpital Sainte Périne, HUPIFO, AP-HP, Paris, France Univ Versailles St-Quentin-en-Yvelines, Gérontologie, Montigny le Bretonneux, France
Laurent Teillet
Affiliation:
Service de Gériatrie, Hôpital Sainte Périne, HUPIFO, AP-HP, Paris, France Univ Versailles St-Quentin-en-Yvelines, Gérontologie, Montigny le Bretonneux, France
Jean-Jacques Arvieu
Affiliation:
AG2R La Mondiale, Direction des Etudes, Prévoyance Individuelle et IARD, Paris, France
Jean-Marie Robine
Affiliation:
INSERM U988 et U1198, EPHE, Paris & Montpellier, France
Joël Ankri
Affiliation:
INSERM, U1168, VIMA: Aging and Chronic diseases. Epidemiological and Public Health approaches, Villejuif, France Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France Département Hospitalier d'Epidémiologie et de Santé Publique, Hôpital Sainte Périne, HUPIFO, AP-HP, Paris, France
Marie Herr
Affiliation:
INSERM, U1168, VIMA: Aging and Chronic diseases. Epidemiological and Public Health approaches, Villejuif, France Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France Département Hospitalier d'Epidémiologie et de Santé Publique, Hôpital Sainte Périne, HUPIFO, AP-HP, Paris, France
*
Correspondence should be addressed to: Anne Hiance-Delahaye, Service de Gériatrie, 11 rue Chardon Lagache, Paris 75016, France. Phone: +33 (0) 144 96 31 31. Email: anne.delahaye@aphp.spr.fr.
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Abstract

Background:

The increasing use of antidepressants (ADs) has raised concerns about their inappropriate use in old people.

Objective:

To examine the prevalence of potentially inappropriate prescribing (PIP) of ADs, their associated factors, and their impact on mortality in a sample of old people in France.

Methods:

The analysis used data from the SIPAF study, a cross-sectional study consisting of 2,350 people aged ≥ 70 years. Trained nurses interviewed participants at home between 2008 and 2010. Information was collected concerning socio-demographic and health characteristics, including medication use. The study population consisted of the 318 AD users from the SIPAF study (13.5%). PIP of ADs was defined according to national and international criteria. Factors associated with PIP of ADs were assessed using a multivariate logistic regression model. The influence of PIP of ADs on mortality was assessed using a Cox model (median follow-up 2.8 years).

Results:

Among the SIPAF study, 71% of AD users were female and the mean age was 84 ± 7 years. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed ADs (19.8%). We found PIP of ADs in 36.8% of the study population, mainly the co-prescription of diuretics with SSRIs (17.6%) and the prescription of tricyclics (12.9%). PIP of ADs was associated with polypharmacy (aOR5-9 drugs 2. 61, 95% CI 1.11–6.16 and aOR≥10 drugs 2.69, 95% CI 1.06–6.87) and comorbidity (aOR3-4 chronic diseases 2.59, 95%CI 1.04–6.44 and aOR≥5 chronic diseases 2.33, 95%CI 0.94–5.79), and increased the risk of mortality during follow-up (aHR 2.30, 95%CI 1.28–4.12).

Conclusions:

This study shows that more than one third of AD prescriptions may be inappropriate in old people. PIP of ADs was related to polypharmacy and comorbidity and increased mortality among AD users.

Keywords

antidepressantsadverse eventscommunity careepidemiology
Type
Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 5: Issue Theme: Brain Imaging , May 2018 , pp. 715 - 726
Copyright
Copyright © International Psychogeriatric Association 2017 

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