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The use of central nervous system drugs and analgesics among very old people with and without dementia
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
2008 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 17, no 9, 912-918 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Old people in general, and particularly those with dementia, are more sensitive to adverse drug effects than younger people. Despite this, the use of central nervous system (CNS) drugs among old people is common. The aim of the present study was to compare the use of central nervous system drugs and analgesics among people aged 85 years or older, with and without dementia. METHODS: One half of all people aged 85 years old and all those aged 90, 95 and above in Umeå, Sweden and Vaasa and Mustasaari, Finland, were asked to participate in this part of the GERDA/Umeå 85+ study. Both those living in their own homes and those in institutions were included. Trained investigators performed structured interviews and assessments. Medication data were obtained from the participants and medical records. Dementia disorders were diagnosed according to DSM-IV. RESULTS: Dementia was diagnosed in 247/546 participants (45.2%). A higher proportion of the participants with dementia used paracetamol (50.6% compared to 21.4%, p < 0.001), antipsychotics (22.3% and 2.7%, p < 0.001), antidepressants (33.6% and 11.4%, p < 0.001) and anxiolytics (19.0% and 8.0%, p < 0.001). There were no differences in the use of opioid analgesics, anticonvulsants and hypnotics. CONCLUSIONS: The use of CNS drugs and analgesics was common among this population of very old people. Furthermore, the prescription of CNS drugs was more common among people with dementia. The use of antipsychotics in people with dementia should arouse particular concern, because of the high risk of severe adverse events and the limited evidence of positive effects.

Place, publisher, year, edition, pages
2008. Vol. 17, no 9, 912-918 p.
Keyword [en]
very old, dementia, Alzheimer's diseased, drug use, antipsychotics, antidepressants, benzodiazepines, pain, CNS drugs, analgesics
National Category
Pharmacology and Toxicology
Identifiers
URN: urn:nbn:se:umu:diva-22325DOI: 10.1002/pds.1600ISI: 000259217700009PubMedID: 18398935OAI: oai:DiVA.org:umu-22325DiVA: diva2:214463
Available from: 2009-05-05 Created: 2009-05-05 Last updated: 2013-10-22Bibliographically approved
In thesis
1. Psychotropic and analgesic drug use among old people: with special focus on people living in institutional geriatric care
Open this publication in new window or tab >>Psychotropic and analgesic drug use among old people: with special focus on people living in institutional geriatric care
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Old people in general, and those affected by dementia disorders in particular, are more sensitive to drug side effects than younger people. Despite this, the use of nervous system drugs and analgesics among old people is common, and has increased in recent years.

Institutional geriatric care accommodates people who need round-the-clock supervision and care, due to somatic, psychiatric, cognitive or behavioral symptomatology. A majority of those living in institutional geriatric care suffers from dementia disorders.

This thesis is based on three different data collections. Two large cross-sectional studies, the AC1982 and AC2000 data collections, including all those living in institutional geriatric care in the county of Västerbotten in May 1982 and 2000 respectively (n=3195 and n=3669) and one study, the GERDA/Umeå 85+ data collection, including a sample of very old people, living at home and in institutions (n=546), in the municipalities of Umeå, Sweden and Vaasa and Mustasaari, Finland, in 2005-2006.

The use of psychotropic drugs and analgesics was common among old people living in geriatric care and among very old people in general. A higher proportion of people with dementia received certain nervous system drugs, such as antipsychotic drugs. The use of antipsychotic drugs among people with cognitive impairment living in geriatric care was found to be correlated to several behaviors and symptoms that are not proper indications for antipsychotic drug use, and also factors related more to the staff and the caring situation.

Over the course of eighteen years, from 1982 to 2000, there has been a manifold increase in the use of antidepressants, anxiolytics and hypnotics in geriatric care, but the use of antipsychotics had decreased slightly. During the same time, the prevalence of several depressive symptoms decreased significantly, correcting for demographical changes. One analysis of calculated numbers needed to treat, however, indicated poor remission rates, suggesting that even better results might be achievable. The prevalence of depressive symptoms among people with moderate cognitive impairment remained unchanged between 1982 and 2000, despite the fact that about 50% were receiving treatment with antidepressants in 2000. One possible explanation might be that depressive symptoms have different etiologies in different stages of a dementia disorder.

Approximately a quarter of the people experiencing pain in geriatric care were not receiving any regular analgesic treatment. One possible reason might be misconceptions among the caring staff regarding whether or not the residents were receiving analgesic treatment. Such misconceptions were found to be common.

In conclusion, psychotropic and analgesic drug use among old people in geriatric care, and very old people in general, was found to be common and in many cases possibly inappropriate. The use of antipsychotics among people with dementia deserves particular concern, because of the high risk of severe adverse events and the limited evidence for positive effects. The use of antidepressants, on the other hand, might have contributed to a lower prevalence of depressive symptoms among old people.

Place, publisher, year, edition, pages
Umeå: Samhällsmedicin och rehabilitering, 2008. 109 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1157
Keyword
dementia, depression, pain, nursing Home, old, analgesics, antidepressants, anti-psychotics, behavioral and psychological symptoms of dementia, inappropriate drugs
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-1608 (URN)978-91-7264-504-2 (ISBN)
Public defence
2008-04-25, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2008-04-08 Created: 2008-04-08 Last updated: 2014-01-16Bibliographically approved

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Lövheim, HugoGustafson, Yngve

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