Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, IRELAND.
School of Allied Health, University of Limerick, Limerick, IRELAND.
Int J Geriatr Psychiatry. 2021 Aug;36(8):1241-1251. doi: 10.1002/gps.5518. Epub 2021 Feb 26.
Depression is the most common mental health problem in older adults and untreated is associated with significant burden of illness for patients. This study aimed to examine longitudinal patterns of antidepressant use in older adults and determine which factors were associated with changes in use.
Adults aged 50 and over, from The Irish Longitudinal Study on Ageing (TILDA), who participated at any one of the four TILDA waves (n = 8175) were included in the analysis. Repeated measures latent class analysis (RMLCA) is the model-based approach we used to identify underlying subgroups in a population.
We found antidepressant use ranged from 6% to 10%, over a 6-year period. RMLCA identified three distinct classes of antidepressant use. Notably, 6% of older adults were categorised in a 'long-term antidepressant use' class, with consistent use across all four waves, and 6% were categorised in an 'Intermittent/Developing Use' class. We found long-term antidepressant use to be a characteristic of older adults with chronic conditions at baseline of study and striking low uptake of psychological and psychiatric services.
These findings provide evidence of the complex presentations of depression with comorbidities in long-term antidepressant users. While prolonged use of antidepressants in an older cohort is often rationalised due to recurrent depression and comorbidities, this study suggests little deprescribing of antidepressants and a need for greater access and provision of psychological services tailored to later life seem necessary improve management of this condition.
抑郁症是老年人最常见的心理健康问题，未得到治疗会给患者带来严重的疾病负担。本研究旨在探讨老年患者抗抑郁药使用的纵向模式，并确定哪些因素与使用变化相关。
纳入来自爱尔兰老龄化纵向研究（TILDA）的年龄在 50 岁及以上的成年人，他们参加了 TILDA 的任意一波（n=8175）。我们使用基于模型的重复测量潜在类别分析（RMLCA）来识别人群中的潜在亚组。
我们发现，在 6 年的时间里，抗抑郁药的使用比例从 6%到 10%不等。RMLCA 确定了三种不同的抗抑郁药使用类别。值得注意的是，6%的老年人被归类为“长期使用抗抑郁药”类别，在所有四波研究中都持续使用，6%被归类为“间歇性/发展性使用”类别。我们发现，长期使用抗抑郁药是研究基线时患有慢性疾病的老年患者的特征，同时他们对心理和精神科服务的使用率极低。
这些发现提供了证据表明，患有共病的老年人的抑郁症表现复杂，长期使用抗抑郁药。虽然在老年患者中，由于反复发作的抑郁症和共病，延长使用抗抑郁药是合理的，但这项研究表明，抗抑郁药的减药幅度较小，需要增加获得和提供专门针对晚年生活的心理服务的机会，以改善这种疾病的管理。
