Results
In the study, table 1 describes the sociodemographic, clinical characteristic parameters for selecting predictors for PIP medication use in older adult patients (n=456). The demographic data reflects that the median age of 456 patients was found to be 65 years.
The most widely used psychotropic drugs in older adults are listed in Figure 1. LABZDs such as clonazepam, chlordiazepoxide were the most commonly used psychotropic medications (n= 290), followed by atypical antipsychotics (n= 229), and selective serotonin reuptake inhibitor (SSRI) such as escitalopram, paroxetine, fluoxetine used in 212 patients. The median number of psychotropic medications prescribed was 3 drugs (1-7 drugs). Out of 456 patients, a staggering number more than 73% (n= 336) were prescribed with three or more PIMs, and about one-fourth proportion of the patients (24.2%, n= 110) were prescribed with two drugs. The median number of visits was 5 times (1- 48 times).
In our study, Beers criteria 2019 yielded higher PIP medication use than the STOPP criteria 2015. According to Beers criteria 2019, the overall prevalence of PIP medication use was 91.2% (416/456). The median number of PIP medications prescribed in 416 older adult patients was 2 (1-5). The most frequently prescribed Psychotropic PIMs were found to be clonazepam, quetiapine, risperidone, Lorazepam, etc. whereas according to STOPP criteria 2015, the overall prevalence of PIP medication use was 73.3% (336/456). The median number of PIP medication prescribed in 336 older adult patients was 1 (1- 2). Clonazepam, Chlordiazepoxide, dothiepin, mirtazapine was the most frequently prescribed PIP medication identified by STOPP criteria. Table 2 describes the PIP medications use identified using Beers criteria and STOPP criteria.
Odds ratio reflects the association of exposure of patients to the outcome of a particular parameter and can suggest PIP medication predictors in a study. In the present study, Bivariate analysis, of data shows that the participants from rural background (OR 2.60, 95% CI 1.20-5.65; P=0.015), ≥4 medications (OR 12.25, 95% CI 1.78-84.0; P=0.011), TCA use (OR 0.30, 95% CI 0.120.75; P= 0.010), SNRI use (OR 0.20, 95% CI 0.06-0.63; P= 0.006), LABZD use (OR 33.72, 95% CI 11.27-100.85; P=<0.001), short-acting benzodiazepine use (OR 4.71, 95% CI 1.97-11.24; P= <0.001), Atypical Antipsychotic use (OR 22.35, 95% CI 5.31- 93.99; P= <0.001) were found to be important predictors for the PIP medication use as identified by Beers criteria.
Whereas Alcohol addiction (OR 13.13, 95% CI 1.77-97.14; P=0.012), rural background of participants (OR 1.64, 95% CI 1.07-2.53; P= 0.023), TCA use (OR 33, 95% CI 7.80-139.59; P= <0.001), SSRI use (OR 3.51, 95% CI 2.19-5.63; P= <0.001), LABZD use (OR 160.87, 95% CI 53.67-482.19; P= <0.001), Atypical Antipsychotic use (OR 0.43, 95% CI 0.28-0.67; P= <0.001) were found to be important predictors for the PIMs use as identified by STOPP criteria.
Out of a total of 456 patients, the Antianxiety agents were prescribed in nearly 82% (n=378) of the older adults. Out of 378 patients, potentially inappropriate antianxiety agents were prescribed in 97.3% (n=362) and 74.6% (n= 282) older adults as per Beers criteria and STOPP criteria. Our study also found that antidepressants were the second most frequently prescribed psychotropic drug, almost 68.8% of the older adults were prescribed with at least one antidepressant either TCA, SSRI, SNRI. Atypical Antipsychotics were the third most prescribed psychotropic drug in older adults. Beers criteria have given the list of conventional and atypical antipsychotic list, irrespective of diagnosis/conditions that should be avoided in older adults. Among Atypical antipsychotics medication class quetiapine, olanzapine, risperidone is the most common PIP medication prescribed in older adults.