Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, (8200 Aarhus N), Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, (8200 Aarhus, N), Denmark.
Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, (8200 Aarhus N), Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, (8200 Aarhus, N), Denmark.
Gen Hosp Psychiatry. 2023 May-Jun;82:66-74. doi: 10.1016/j.genhosppsych.2023.03.009. Epub 2023 Mar 22.
Concurrent polypharmacy and potentially-inappropriate-medication (PIMs) use with antidepressants in older adults is understudied. We investigated the prevalence and associated user characteristics of concurrent polypharmacy (≥5 drugs) and PIMs with antidepressants in all older adults (≥65 years) in Denmark based on prescriptions filled at community pharmacies during 2015-2019.
We applied a cross-sectional and cohort study design using socio-demographic and clinical data from Danish registers.
A total of 261,479 older adults (mean age 76 years, females 63%) redeemed at least one prescription of antidepressants during 2015-2019. The prevalence of polypharmacy was 73%, and PIMs was 56%, with over 80% using at least one other nervous system drug or cardiovascular system drug concomitantly with antidepressants. Characteristics associated with higher concurrent use of polypharmacy and PIM with antidepressants were older age, marital status as widow/widower/separated/single, place of residence predominantly in the rural regions, non-western origin, and having somatic diagnoses. Some characteristics showed opposite directions of the associations with the two outcomes, including previous antidepressant use and psychiatric diagnoses being associated with higher use of polypharmacy but lower use of PIM.
High polypharmacy and PIM use with antidepressants underline the importance of regularly reviewing pharmacological treatments in older adults with depression.
在老年人中，同时使用抗抑郁药和潜在不适当药物（PIMs）的现象以及同时使用多种药物的情况研究较少。我们基于 2015 年至 2019 年期间社区药房的处方，调查了丹麦所有老年人（≥65 岁）中同时使用多种药物（≥5 种药物）和 PIMs 与抗抑郁药的情况，并分析了其流行情况和相关使用者特征。
我们使用丹麦登记处的社会人口统计学和临床数据，采用横断面和队列研究设计。
共有 261479 名老年人（平均年龄为 76 岁，女性占 63%）在 2015 年至 2019 年期间至少使用了一种抗抑郁药处方。同时使用多种药物的比例为 73%，同时使用 PIMs 的比例为 56%，其中超过 80%的人同时使用至少一种其他神经系统药物或心血管系统药物。与同时使用多种药物和 PIMs 与抗抑郁药相关的特征包括年龄较大、丧偶/离异/分居/单身的婚姻状况、居住地主要在农村地区、非西方血统和患有躯体疾病。一些特征与这两种结果的关联方向相反，包括以前使用过抗抑郁药和患有精神科诊断与同时使用多种药物的可能性较高但与使用 PIMs 的可能性较低相关。
老年人在使用抗抑郁药时同时使用高剂量药物和 PIMs 的情况突出表明，定期审查抑郁症老年患者的药物治疗方案非常重要。
