Potentially inappropriate medication in older psychiatric patients
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CLINICAL TRIAL
Potentially inappropriate medication in older psychiatric patients Gudrun Hefner 1
2
3
4
2
& Martina Hahn & Sermin Toto & Christoph Hiemke & Sibylle C. Roll & Jan Wolff
5,6
& Ansgar Klimke
1,7
Received: 23 April 2020 / Accepted: 1 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Many psychotropic drugs are listed as potentially inappropriate medication (PIM) in the older population. Potentially inappropriate means that prescription of those drugs in older adults may cause significant harm. The objective of this study was to analyze the prevalence and sort of PIM prescribing in a naturalistic, real-world psychiatric setting. Methods The retrospective analysis gathered data from a large pharmacovigilance study, conducted at 10 psychiatric hospitals. Data from inpatients aged ≥ 65 years were included for the analysis. The number and sort of PIM, as defined by the German PRISCUS list, were controlled by analyzing the patients’ medication profile. Results In total, 4760 patient cases (59.2% female) with a mean (mean ± standard deviation (SD)) age of 77.33 ± 7.77 years were included into the study. Altogether, 1615 cases (33.9%) received at least 1 PRISCUS-PIM per day (regular and as-needed medication included). The most frequently prescribed PRISCUS-PIM (n = 2144) were zopiclone > 3.75 mg/day (n = 310), lorazepam > 2 mg/day (n = 269), haloperidol > 2 mg/day (n = 252), and diazepam (n = 182). Cases with PRISCUS-PIM were younger (75.7 vs. 78.2 years, p < 0.001) and had a longer (26 vs. 22 days, p < 0.001) hospital length of stay. Replacing benzodiazepines and z-substances, haloperidol > 2 mg, tricyclic antidepressants, first generation antihistaminergic drugs, and clonidine by non-PIM could reduce 69.9% of PRISCUS-PIM-prescribing. Conclusions The prevalence of PRISCUS-PIM is high in the hospitalized psychiatric setting. Rational deprescribing of inappropriate anticholinergics, benzodiazepines, and antipsychotics in the older population is a key component to reduce the risk of adverse drug reactions. More tolerable medications should be prescribed. Keywords Psychiatry . Potentially inappropriate medication . PRISCUS list . Psychopharmacology . Older patients
Introduction
* Gudrun Hefner [email protected] 1
Department of Psychiatry and Psychotherapy, Vitos Klinikum Hochtaunus, Emil-Sioli-Weg 1-3, 61081 Friedrichsdorf, Germany
2
Psychiatric Hospital, Vitos Klinik Eichberg, Eltville, Germany
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Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Mainz, Germany
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Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
6
Evangelical Foundation Neuerkerode, Braunschweig, Germany
7
Heinrich-Heine-University, Duesseldorf, Germany
Due to demographic change, the health care system will face a growing number of older, often mul
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