Psychotropic prescribing in the oldest old attending a geriatric psychiatry service: a retrospective, cross-sectional study

2013 ◽  
Vol 30 (3) ◽  
pp. 187-196
Author(s):  
E. Kolshus ◽  
A. Freyne ◽  
I. Callanan ◽  
C. Cooney
Keyword(s):  
Nursing Home ◽  
Old Age ◽  
Oldest Old ◽  
Psychiatric Morbidity ◽  
Inappropriate Prescribing ◽  
Potentially Inappropriate Prescribing ◽  
Cross Sectional ◽  
Common Diagnosis ◽  
Old Age Psychiatry

ObjectiveMore people are living beyond their 90s, yet this group has not been much studied. This study aimed to describe a sample of non-agenarians and centerians attending an old age psychiatry service with a focus on pharmacotherapy.MethodsRetrospective, cross-sectional survey of patients aged >90 in contact with the Department of Old Age Psychiatry in a university hospital over a 1-year period. Results were compared with the Beers, the Canadian and Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria.ResultsA total of 65 nonagenarians or centerians were identified (mean age 93, 82% female). The majority (65%) resided in a nursing home; dementia was the most common diagnosis (77%), followed by depression (29%). The most commonly prescribed psychotropics were antidepressants (58%), followed by antipsychotics (45%), hypnotics (42%), anti-dementia agents (31%) and anxiolytics (26%). Overall, patients were on a mean of 2.1 (S.D. 1.3, range 0–5) psychotropics and 4.99 (S.D. 2.7, range 0–11) non-psychotropics. Mean Mini Mental State Examination (MMSE) score was 15 (S.D. 8.1). Increasing anticholinergic burden was negatively associated with MMSE scores (B = −1.72, p = 0.013). Residing in a nursing home was associated with a higher rate of antidepressant [OR 5.71 (95% CI 1.9–17.4)], anxiolytic [OR 13.5 (95% CI 1.7–110.4)] and antipsychotic [OR 3.4 (95% CI 1.1–10.4)] use. Potentially inappropriate prescribing included long-term benzodiazepine use (26%) and long-term antipsychotic use (25%).ConclusionsOur sample had a high psychiatric morbidity burden with high levels of psychotropic use. Ongoing review and audit of psychotropic use in elderly patients can identify potentially inappropriate prescribing in a group vulnerable to high levels of polypharmacy and extended psychotropic use.

scholarly journals Identification of inappropriate prescribing in a Brazilian nursing home using STOPP/START screening tools and the Beers' Criteria

2014 ◽  
Vol 50 (4) ◽  
pp. 911-918 ◽  
Author(s):  
Mariana Martins Gonzaga Nascimento ◽  
Andréia Queiroz Ribeiro ◽  
Mariana Linhares Pereira ◽  
Adriana Cristina Soares ◽  
Antônio Ignácio de Loyola Filho ◽  
...  
Keyword(s):  
Nursing Home ◽  
Medical Records ◽  
Inappropriate Medication ◽  
Inappropriate Prescribing ◽  
Cross Sectional Study ◽  
Screening Tools ◽  
Beers Criteria ◽  
Cross Sectional ◽  
The Past ◽  
Prescribing Omissions

The objective of this study was to determine the prevalence of Potentially Inappropriate Medication (PIM) use and associated factors, as well as the prevalence of Prescribing Omissions (PO). A cross-sectional study was conducted in a philanthropic Brazilian nursing home involving 46 individuals aged 60 years or older. The following information was collected from medical records and drug prescriptions: gender, age, health conditions and drugs used in the past thirty days. PIM and PO were identified according to the Beers' Criteria and the STOPP/START screening tools. Over one third (37%) of the population used at least one PIM according to the Beers' Criteria (n=17) and 60.9% according to the STOPP tool. A significant association was found between polypharmacy (use of five or more drugs) and use of PIM according to the Beers' Criteria, but not according to the STOPP. Eight residents (17.4%) were exposed to eight PO. This study allowed the diagnosis of a concerning drug utilization profile with use of a high number of PIMs. Thus, there is an evident need to implement strategies for improving geriatric prescription.

scholarly journals Potentially inappropriate prescribing in people with chronic kidney disease: cross-sectional analysis of a large population cohort

2020 ◽  
pp. BJGP.2020.0871
Author(s):  
Clare Elizabeth MacRae ◽  
Stewart Mercer ◽  
Bruce Guthrie
Keyword(s):  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Large Population ◽  
Inappropriate Prescribing ◽  
Prescribing Patterns ◽  
Potentially Inappropriate Prescribing ◽  
Cross Sectional ◽  
Stage 4 ◽  
Ckd Stage

Background: Many drugs should be avoided or require dose-adjustment in chronic kidney disease (CKD). Previous estimates of potentially inappropriate prescribing rates have been based on data on a limited number of drugs and mainly in secondary care settings. Aim: To determine the prevalence of contraindicated and potentially inappropriate primary care prescribing in a complete population of people with CKD. Method: Cross-sectional study of prescribing patterns in a complete geographical population of people with CKD defined using laboratory data. Drugs were organised by British National Formulary advice. Contraindicated (CI) drugs: “avoid”. Potentially high risk (PHR) drugs: “avoid if possible”. Dose inappropriate (DI) drugs: dose exceeded recommended maximums. Results: 28,489 people with CKD were included in analysis, of whom 70.0% had CKD 3a, 22.4% CKD 3b, 5.9% CKD 4, and 1.5% CKD 5. 3.9% (95%CI 3.7-4.1) of people with CKD stages 3a-5 were prescribed one or more CI drug, 24.3% (95%CI 23.8-24.8) PHR drug, and 15.2% (95% CI 14.8-15.62) DI drug. CI drugs differed in prevalence by CKD stage, and were most commonly prescribed in CKD stage 4 with a prevalence of 36.0% (95%CI 33.7–38.2). PHR drugs were commonly prescribed in all CKD stages ranging from 19.4% (95%CI 17.6-21.3) in stage 4 to 25.1% (95%CI 24.5–25.7) in stage 3b. DI drugs were most commonly prescribed in stage 4, 26.4% (95%CI 24.3-28.6). Conclusion: Potentially inappropriate prescribing is common at all stages of CKD. Development and evaluation of interventions to improve prescribing safety in this high-risk populations are needed.

scholarly journals The Interplay Between Infection Risk Factors of SARS-CoV-2 and Prognosis: A Cross-Sectional Study from a Cohort of Long-Term Care Nursing Home Residents

2021 ◽  
Author(s):  
Laura Soldevila ◽  
Núria Prat ◽  
Miquel À. Mas ◽  
Mireia Massot ◽  
Ramon Miralles ◽  
...  
Keyword(s):  
Nursing Home ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Risk Of Infection ◽  
Cross Sectional ◽  
Term Care ◽  
Facility Size ◽  
Care Nursing ◽  
Pcr Test

Abstract Background: Covid-19 pandemic has particularly affected older people living in Long-term Care settings. Methods: We carried out a cross-sectional analysis of a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at last one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered.Results: A total of 8021 participants were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = 0.03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < .001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). Conclusions: Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.

A Cross-Sectional Comparative Study of Mental Health among Geriatric Population Living in Care Homes and Those Living with Family in Hadoti Region, Rajasthan

2021 ◽  
Vol 8 (28) ◽  
pp. 2472-2477
Author(s):  
Swapnil Agrawal ◽  
Aftab Ahmed Khan
Keyword(s):  
Mental Health ◽  
Comparative Study ◽  
Psychiatric Disorders ◽  
Elderly People ◽  
Old Age ◽  
Elderly Population ◽  
Psychiatric Morbidity ◽  
Care Homes ◽  
Cross Sectional ◽  
Significant Difference

BACKGROUND With recent advancement in health facility, both in urban and rural population, ratio of elderly people has increased and due to this apart from physical illness, mental health is also emerged as an important public health challenge. Psychiatric disorders such as depression, anxiety, cognitive disorders and substance use disorders were commonly found in elderly specially living alone and in care homes. The primary purpose of this study was to compare mental health of elderly people living in care homes with those living with family in Kota (Hadoti region, Rajasthan). METHODS This is a cross-sectional comparative study that was carried out in 50 elderly people living in care homes and 50 elderly people living with family. Both groups were screened for psychiatric disorders using general health questionnaire (GHQ – 12). Comparison was made under various headings between these groups including severity. Obtained data were analysed by using proportion, mean, standard deviation, chi-square, and Pearson correlation. RESULTS No statistically significant difference was found in having psychiatric disorders on screening with GHQ - 12. Difference in these groups for prevalence and severity was not statistically significant for depression and anxiety although significant higher mean of total geriatric depression score (GDS) score in control (10.74 ± 2.56) than in cases (9.38 ± 2.36) and total Hamilton’s anxiety rating scale (HAM – A) score was seen in case group (24.53 ± 3.50) than in controls (23.15 ± 2.34). CONCLUSIONS In this study, it was found out that psychiatry morbidity was higher among elderly population living in old age home when compared to elders living with family in community. Possible reason for higher psychiatric morbidity in old age home group in our study appears to be because of lack of family support, pain of being separated from their children whom they cared and nurtured for their whole life. In psychiatric morbidity we found that depression was the most common disorder in elderly population in both groups. KEYWORDS Old Age Home, Mental Disorders, Depression, Anxiety

scholarly journals Who should take care of me? Preferences of old age individuals for characteristics of professional long-term caregivers: an observational cross-sectional study

2017 ◽  
Vol 10 (1) ◽  
Author(s):  
André Hajek ◽  
Thomas Lehnert ◽  
Annemarie Wegener ◽  
Steffi G. Riedel-Heller ◽  
Hans-Helmut König
Keyword(s):  
Old Age ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional

Reduced in vivo binding to the serotonin transporter in the cerebral cortex of MDMA (‘ecstasy’) users

1999 ◽  
Vol 175 (1) ◽  
pp. 63-69 ◽  
Author(s):  
David M. Semple ◽  
Klaus P. Ebmeier ◽  
Michael F. Glabus ◽  
Ronan E. O'Carroll ◽  
Eve C. Johnstone
Keyword(s):  
Dopamine Transporter ◽  
Serotonin Transporter ◽  
Single Photon ◽  
Psychiatric Morbidity ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Cross Sectional ◽  
Lenticular Nuclei

BackgroundThe use of MDMA (‘ecstasy’) is common among young people in Western countries. Animal models of MDMA toxicity suggest a loss of serotonergic neurons, and potentially implicate it in the development of significant psychiatric morbidity in humans.AimsTo test whether long-term use of MDMA can produce abnormalities in cerebral serotonin, but not dopamine, transporter binding measured by single photon emission computed tomography (SPECT)MethodTen male regular ecstasy users and 10 well-matched controls recruited from the same community sources participated in SPECT with the serotonin transporter (SEPT) ligand [123I]-CIT. Dopamine transporter binding was determined from scans acquired 23 hours after injection of the tracer.ResultsEcstasy users showed a cortical reduction of SERT binding, particularly prominent in primary sensory-motor cortex, with normal dopamine transporter binding in lenticular nuclei.ConclusionsThis cross-sectional association study provides suggestive evidence for specific, at least temporary, serotonergic neurotoxicity of MDMA in humans.

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