The burden of psychotropic and anticholinergic medicines use in care homes: population-based analysis in 147 care homes.
| Autor: | Grill, Paula, Marwick, Charis, Souza, Nicosha De, Burton, Jennifer Kirsty, Hughes, Carmel, Guthrie, Bruce |
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| Předmět: |
AGE distribution
ANTIDEPRESSANTS ANTIPSYCHOTIC agents CONFIDENCE intervals STATISTICAL correlation DEMENTIA patients DRUG prescribing MEDICAL quality control MEDICAL records NURSING care facilities PARASYMPATHOMIMETIC agents PATIENT safety PSYCHIATRIC drugs TRANQUILIZING drugs PHYSICIAN practice patterns LOGISTIC regression analysis GABAPENTIN INAPPROPRIATE prescribing (Medicine) ACQUISITION of data methodology ODDS ratio |
| Zdroj: | Age & Ageing; Jan2021, Vol. 50 Issue 1, p183-189, 7p, 3 Charts |
| Abstrakt: | Background older people living in care-homes are particularly vulnerable to adverse effects of psychotropic and anticholinergic drugs. Methods anonymised dispensed prescription data from all 4,478 residents aged ≥ 60 years in 147 care-homes in two Scottish health boards were analysed. Psychotropic medicines examined were antipsychotics, antidepressants, hypnotic/anxiolytics, opioids and gabapentinoids. Anticholinergic burden was measured using the modified anticholinergic risk scale (mARS). Variation between care-homes and associations with individual and care-home characteristics were examined using multilevel logistic regression. Results 63.5% of residents were prescribed at least one psychotropic drug, and 27.0% two or more, most commonly antidepressants (41.6%), opioids (20.3%), hypnotic/anxiolytics (16.9%) and antipsychotics (16.7%). 48.1% were prescribed an anticholinergic drug, and 12.1% had high anticholinergic burden (mARS ≥ 3). Variation between care-homes was high for antipsychotics (intra-cluster correlation coefficient [ICC] 8.2%) and hypnotics/anxiolytics (ICC = 7.3%), and moderate for antidepressants (ICC = 4.7%) and anticholinergics (ICC = 2.8%). Prescribing of all drugs was lower in the oldest old. People with dementia were more likely to be prescribed antipsychotics (adjusted OR = 1.45, 95%CI 1.23–1.71) but less likely to be prescribed anticholinergics (aOR = 0.61, 95%CI 0.51–0.74). Prescribing of antipsychotics was higher in Tayside (aOR = 1.52, 95%CI 1.20–1.92), whereas prescribing of antidepressants (particularly tricyclic-related) was lower (aOR = 0.66, 95%CI 0.56–0.79). There was no association with care-home regulator quality scores. Conclusion care-home residents have high psychotropic and anticholinergic burden, with considerable variation between care-homes that is not related to existing measures of quality of care. Research to better understand variation between care-homes and the interaction with local prescribing cultures is needed. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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