Introduction
A number of psychiatric disorders follow the geriatric population
without any invitation, hence psychotropic medications are most
frequently used in older adults to treat various mental health
conditions.1,2Still, the use of these agents has been associated with a deleterious
outcome such as increased sedation, increased risk of stroke, and an
increased chance of injuries and
falls.3,4 Older
adults are more prone to adverse events attributable to pharmacodynamic
and pharmacokinetic age-related
alterations.5Psychotropic medication whose adverse risk exceeds its health benefits,
especially when safer or equally effective treatment available, is
considered as potentially inappropriate medication
(PIMs).6 It is
imperative to use psychotropic medication judiciously to avoid the
adverse effects of these medications in older adults. Various implicit
and explicit measures have been developed to determine PIMs in the
elderly
population.7,8Psychotropic medication covers a higher proportion of PIMs in Beers
criteria and STOPP criteria. Beers et al gave the first set of explicit
criteria for determining PIMs use by the older adults in
1991.9 however,
the American Geriatric Society gave official patronage to Beers criteria
in 2012 and is now responsible for regularly updating the criteria at a
steward cycle of 3
years.10,11Recently, Beers criteria 2019 recommends several psychotropic
medications that should be avoided in older adults or limiting their
dosage beyond the mentioned dose. It also recommends avoiding
psychotropic medicines in older adults with a particular disease as well
as the use of three or more Central Nervous System medications in
conjunction with each other.12
Similarly, the British Geriatric Society recommends the use of STOPP
criteria to identify PIMs use in
older adults.13 Very few studies have examined the PIP
medication use in the elderly population using Beers criteria 2003,
2012, 2015, and STOPP criteria (version 1& 2) reported PIP medication
prevalence between 7% to
80%.14-16 No
analysis using the Beers criteria 2019 and STOPP criteria 2015 has been
carried out to determine the prevalence and predictors of PIP medication
in older adults. Hence the present study was carried out to determine
the prevalence and predictors of PIP medication in older adults
attending the outpatient psychiatry department based on Beers criteria
2019 and STOPP criteria 2015.
Methods
Setting and Sample
A cross-sectional study was carried out at the psychiatry
department/deaddiction center of tertiary care postgraduate teaching
hospital on 456 patients of either sex, with a median age of 65 years
attending the psychiatry outpatient department. All patients aged ≥65
years attending the outpatient psychiatry department and were prescribed
at least one medication and who had given consent to participate in the
study were included. Exclusion criteria were as follows: a) Without any
psychotropic medication b) incomplete data c) did not provide consent
for participation in the study.
Ethical Approval
The protocol for the present study was approved by the Institutional
Ethics Committee vide letter No. ERB/UCER/2018/9/3 dated 17/09/2018. The
study was carried out in compliance with the ethical standards for
biomedical research on human participants.
Data Collection
Prevalidated data collection form was used to collect data on patients’
sociodemographic and clinical characteristics such as gender, age,
urban/rural living background, educational qualification, smoking or
alcohol addiction, number of visits to psychiatry outpatient department,
prescribed psychotropic drugs along with their dosage and course of
treatment. The authors used validated standardized scales to identify
the differential diagnosis. The existence of mild, moderate, severe,
very severe depression was assessed by the use of the Hamilton
Depression Rating Scale (HAM-D).17,18 Cognitive
impairment is one of the most significant changes observed in older
adults as the aging process is associated with a decline in cognitive
function. Cognitive impairment is most commonly caused by delirium and
dementia in patients. Updated edition-98 of the Delirium Rating Scale
was used to assess delirium.19 The Mini-Mental State
Assessment was used to assess cognitive dysfunction and screen for
dementia.20 Authors used the Up & Go test and One-Leg
Stand- test to assess Walking difficulty and fall
risk.21,22
Evaluation of PIMs
American Geriatric Society Beers criteria 2019 and British Geriatric
Society STOPP criteria 2015 (version 2) were used to identify the
prevalence of PIP medication in older adults. Two physicians and one
pharmacist performed the assessment of PIMs use.
Statistical Analysis
Statistical analysis was carried out by using CorIP. IBM Statistical
Package for Social Science Statistics for Windows, Ver. 24.0 and
STATA.23 The Kolmogorov-Smirnov test was used to
determine the normality distribution of data. The frequency with
percentage is used to express categorical variables. A continuous
variable is either defined as mean and standard deviation or median and
minimum-maximum values as appropriate. Bivariate logistic regression was
performed to identify the predictors for PIP medication prescribing in
older adults. The results obtained are expressed in the form of an odds
ratio (OR) with a 95% confidence interval (CI). A P- value of< 0.05 was considered statistically significant.