Jano Elda, Johnson Michael, Chen Hua, Aparasu Rajender R
College of Pharmacy, University of Houston, Texas Medical Center, Houston, TX 77030, USA.
Curr Med Res Opin. 2008 Mar;24(3):709-16. doi: 10.1185/030079908X260989. Epub 2008 Jan 25.
This study examined the determinants of atypical antipsychotic use among antipsychotic users in community-dwelling elderly in the United States.
The study involved analysis of household and prescription files of the Medical Expenditure Panel Survey (MEPS) data from 1996 to 2004. The analysis focused on the use of six atypical antipsychotic agents namely, clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole among the elderly of 60 years or older. Multiple logistic regression analysis within the conceptual framework of Andersen's Behavioral Model was used to examine the determinants of atypical antipsychotic use among antipsychotic users in community-dwelling elderly.
An average of 0.62 million elderly received antipsychotic agents annually during the study period. A majority of the elderly using antipsychotic agents were female (70%), white (86%), non-Hispanic (95%), and living in metropolitan statistical areas (79%). Frequently reported diagnoses among the elderly taking antipsychotic agents were dementia (26.12%), anxiety (20.42%), and schizophrenia (6.62%). Of the elderly receiving antipsychotic agents, 50.39% received atypical agents and 51.88% received typical agents during the study period. The most frequently used atypical agents were risperidone, olanzapine, and quetiapine. Multivariate logistic regression analysis revealed that need (perceived mental health, p < 0.01) and enabling (time, p < 0.01) factors were significantly associated with atypical antipsychotic use after controlling for predisposing factors. The study found that elderly patients with relatively poor perception of mental health (need) and utilization of antipsychotic agents after 1998 (enabling) were more likely to involve the use of atypical agents.
This study was limited to the use of antipsychotic agents in community settings and cannot be extrapolated to other settings. Correlates examined in this study were limited to variables available from the data source and those used by previous researchers.
Need and enabling factors play a vital role in the use of atypical agents in the elderly. The findings have important implications in understanding the use and outcomes of atypical agents in the elderly. Future pharmacoepidemiological research can use these variables to control for confounding and selection bias when evaluating health care outcomes in observational studies.
本研究调查了美国社区居住老年人中使用抗精神病药物者非典型抗精神病药物使用的决定因素。
该研究对1996年至2004年医疗支出小组调查（MEPS）数据中的家庭和处方档案进行了分析。分析聚焦于60岁及以上老年人中六种非典型抗精神病药物的使用情况，这六种药物分别是氯氮平、奥氮平、利培酮、喹硫平、齐拉西酮和阿立哌唑。在安德森行为模型的概念框架内进行多元逻辑回归分析，以研究社区居住老年人中使用抗精神病药物者非典型抗精神病药物使用的决定因素。
在研究期间，平均每年有62万老年人使用抗精神病药物。使用抗精神病药物的老年人大多数为女性（70%）、白人（86%）、非西班牙裔（95%），且居住在大都市统计区（79%）。服用抗精神病药物的老年人中，常见的诊断包括痴呆（26.12%）、焦虑（20.42%）和精神分裂症（6.62%）。在研究期间，接受抗精神病药物治疗的老年人中，50.39%使用非典型药物，51.88%使用典型药物。最常使用的非典型药物是利培酮、奥氮平和喹硫平。多变量逻辑回归分析显示，在控制了 predisposing 因素后，需求（感知心理健康，p < 0.01）和促成因素（时间，p < 0.01）与非典型抗精神病药物的使用显著相关。研究发现，心理健康感知相对较差（需求）且在1998年后使用抗精神病药物（促成因素）较多的老年患者更有可能使用非典型药物。
本研究仅限于社区环境中抗精神病药物的使用，不能外推至其他环境。本研究中所考察的相关因素仅限于数据源中可得的变量以及先前研究人员所使用的变量。
需求和促成因素在老年人使用非典型药物方面起着至关重要的作用。这些发现对于理解老年人非典型药物的使用及结果具有重要意义。未来的药物流行病学研究在观察性研究中评估医疗保健结果时，可以使用这些变量来控制混杂和选择偏倚。
