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Abstract
Antidepressants, sedatives and antipsychotics are used to treat various behavioral, psychiatric and neurological disorders. However, the risk of adverse events challenges prescribing for older adults. The use of most antidepressants, all sedatives in older adults and the use of antipsychotics in elderly with dementia are considered potentially inappropriate by Beers 2012 criteria. This study aims to: (i) describe the prevalence of potentially inappropriate psychotropic (antidepressant, sedative, antipsychotic) prescribing for older community-dwelling Americans; (ii) assess the influence of sociological factors on potentially inappropriate psychotropic choices; and (iii) assess the relationship between potentially inappropriate psychotropic choices and emergency outcomes. Visits by older adults (>65 years) to office-based physicians across the US were extracted from the National Ambulatory Medical Care Survey 2010. Orders for antidepressants, sedatives and antipsychotics were classified based on Beers criteria. Multivariate logistic regression models were used to assess the influence of the various determinants on the choice of antidepressants, sedatives and the use of antipsychotics in dementia. Bivariate logistic regressions measured the risk of emergency referrals or hospitalizations following the visit. Although office-based physicians in the US rarely prescribe potentially inappropriate psychotropic medications to be avoided in older adults, many patients are exposed to classes that should be avoided in selected conditions due to drug-disease interactions. The use of electronic medical records is significantly associated with improved quality of antidepressant and sedative prescribing, through selection of more appropriate choices. Patient age, race, asthma, hypertension, obesity, and practice ownership are also associated with improved quality of psychotropic prescribing. Conversely, depression, income, and specialty are associated with higher risks of inappropriate psychotropic choices. Although increased consultation time was associated with less inappropriate antidepressant prescribing, this was reversed for antipsychotic prescribing in dementia. Patients receiving tertiary tricyclic antidepressants and patients with dementia receiving antipsychotics are at risk of emergency referrals or hospitalization. The determinants identified by this study may be used to develop quality indicators, and interventions to improve the quality of prescribing of antidepressants, sedatives and antipsychotics for older adults.