Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
PLoS One. 2019 Jan 14;14(1):e0210695. doi: 10.1371/journal.pone.0210695. eCollection 2019.
Use of psychotropic drugs is common among older adults. Population-based studies on the associations of psychotropic drug use with mortality are sparse.
To investigate the associations between the use of specific psychotropic drug groups (opioids, antipsychotics, antidepressants and benzodiazepines) and all-cause mortality among community-dwelling older adults in Germany.
Participants of the German National Health Interview and Examination Survey 1998 were followed up for mortality from 1997 to 2011. Persons aged 60-79 years with complete data on psychotropic drug use at baseline and on mortality follow-up were considered as study population (N = 1,563). Associations between the use of opioids, antipsychotics, antidepressants and benzodiazepines and all-cause mortality were examined by Cox proportional hazards models adjusted for sociodemographics (sex, age, community size, region, socioeconomic status), life style (smoking, sports, risky alcohol drinking) and health conditions (obesity, disability, history of cardiovascular diseases, diabetes, hyperlipidemia, hypertension, any cancers, any mental disorders) at baseline.
After a median follow-up of 11.4 years, 21, 18, 23 and 26 deaths were documented among those who used at baseline opioids (n = 39), antipsychotics (n = 30), antidepressants (n = 53) and benzodiazepines (n = 54) with an unadjusted mortality rate (MR) of 57.7, 59.1, 44.6 and 53.7 per 1000 person-years, respectively. Meanwhile, 400 deaths were documented among 1,406 nonusers of any of the above mentioned psychotropic drugs with a MR of 26.7 per 1000 person-years. The age and sex adjusted mortality rate ratios in comparison with nonusers were 2.20 (95% confidence intervals 1.42-3.41), 1.66(1.03-2.70), 1.56(1.06-2.28), and 1.57(1.07-2.31) for the use of opioids, antipsychotics, antidepressants and benzodiazepines, respectively. In the fully adjusted Cox models, use of opioids (hazardous ratio 2.04, 95% confidence intervals 1.07-3.89), antipsychotics (2.15, 1.11-4.15) and benzodiazepines (1.76, 1.09-2.82), but not antidepressants, were significantly associated with an increased risk of mortality.
Use of opioids, antipsychotics, benzodiazepines is significantly associated with an increased risk of all-cause mortality among community-dwelling older adults in Germany. Clinicians should be careful in prescribing these psychotropic drugs to older adults while patients already under psychotropic therapy should well balance the risks and benefits of drug use. Further studies with a larger sample size and information on specific indications for psychotropic drug use and mental comorbidities are required to confirm the findings of the present study.
精神药物的使用在老年人中很常见。基于人群的研究表明，精神药物的使用与死亡率之间存在关联，但相关研究还很少。
调查在德国，社区居住的老年人使用特定精神药物组（阿片类药物、抗精神病药、抗抑郁药和苯二氮䓬类药物）与全因死亡率之间的关系。
德国国家健康访谈和检查调查 1998 年的参与者从 1997 年开始随访至 2011 年的死亡率。在基线时完整报告了精神药物使用情况且有完整的死亡率随访数据的 60-79 岁人群（N=1563）被视为研究人群。使用 Cox 比例风险模型调整人口统计学因素（性别、年龄、社区规模、地区、社会经济地位）、生活方式（吸烟、运动、危险饮酒）和健康状况（肥胖、残疾、心血管疾病史、糖尿病、高血脂、高血压、任何癌症、任何精神障碍）后，研究了使用阿片类药物、抗精神病药、抗抑郁药和苯二氮䓬类药物与全因死亡率之间的关系。
在中位随访 11.4 年后，基线时使用阿片类药物（n=39）、抗精神病药（n=30）、抗抑郁药（n=53）和苯二氮䓬类药物（n=54）的人群中分别有 21、18、23 和 26 人死亡，未调整的死亡率（MR）分别为 57.7、59.1、44.6 和 53.7/1000 人年。同时，在未使用上述任何一种精神药物的 1406 名非使用者中记录了 400 例死亡，MR 为 26.7/1000 人年。与非使用者相比，年龄和性别调整后的死亡率比值分别为 2.20（95%置信区间 1.42-3.41）、1.66（1.03-2.70）、1.56（1.06-2.28）和 1.57（1.07-2.31），分别用于使用阿片类药物、抗精神病药、抗抑郁药和苯二氮䓬类药物。在完全调整的 Cox 模型中，使用阿片类药物（危险比 2.04，95%置信区间 1.07-3.89）、抗精神病药（2.15，1.11-4.15）和苯二氮䓬类药物（1.76，1.09-2.82）与死亡率增加显著相关，但抗抑郁药无此相关性。
在德国，社区居住的老年人使用阿片类药物、抗精神病药、苯二氮䓬类药物与全因死亡率增加显著相关。临床医生在为老年人开具这些精神药物时应谨慎，而已经接受精神药物治疗的患者应权衡药物使用的风险和益处。需要进一步开展具有更大样本量的研究，并提供精神药物使用的具体适应证和精神合并症的信息，以验证本研究的结果。
