Results
In the study, table 1 describes the sociodemographic, clinical
characteristic parameters for selecting predictors for PIP medication
use in older adult patients (n=456). The demographic data reflects that
the median age of 456 patients was found to be 65 years.
The most widely used psychotropic drugs in older adults are listed in
Figure 1. LABZDs such as clonazepam, chlordiazepoxide were the most
commonly used psychotropic medications (n= 290), followed by atypical
antipsychotics (n= 229), and selective serotonin reuptake inhibitor
(SSRI) such as escitalopram, paroxetine, fluoxetine used in 212
patients. The median number of psychotropic medications prescribed was 3
drugs (1-7 drugs). Out of 456 patients, a staggering number more than
73% (n= 336) were prescribed with three or more PIMs, and about
one-fourth proportion of the patients (24.2%, n= 110) were prescribed
with two drugs. The median number of visits was 5 times (1- 48 times).
In our study, Beers criteria 2019 yielded higher PIP medication use than
the STOPP criteria 2015. According to Beers criteria 2019, the overall
prevalence of PIP medication use was 91.2% (416/456). The median number
of PIP medications prescribed in 416 older adult patients was 2 (1-5).
The most frequently prescribed Psychotropic PIMs were found to be
clonazepam, quetiapine, risperidone, Lorazepam, etc. whereas according
to STOPP criteria 2015, the overall prevalence of PIP medication use was
73.3% (336/456). The median number of PIP medication prescribed in 336
older adult patients was 1 (1- 2). Clonazepam, Chlordiazepoxide,
dothiepin, mirtazapine was the most frequently prescribed PIP medication
identified by STOPP criteria. Table 2 describes the PIP medications use
identified using Beers criteria and STOPP criteria.
Odds ratio reflects the association of exposure of patients to the
outcome of a particular parameter and can suggest PIP medication
predictors in a study. In the present study, Bivariate analysis, of data
shows that the participants from rural background (OR 2.60, 95% CI
1.20-5.65; P=0.015), ≥4 medications (OR 12.25, 95% CI 1.78-84.0;
P=0.011), TCA use (OR 0.30, 95% CI 0.120.75; P= 0.010), SNRI use (OR
0.20, 95% CI 0.06-0.63; P= 0.006), LABZD use (OR 33.72, 95% CI
11.27-100.85; P=<0.001), short-acting benzodiazepine use (OR
4.71, 95% CI 1.97-11.24; P= <0.001), Atypical Antipsychotic
use (OR 22.35, 95% CI 5.31- 93.99; P= <0.001) were found to
be important predictors for the PIP medication use as identified by
Beers criteria.
Whereas Alcohol addiction (OR 13.13, 95% CI 1.77-97.14; P=0.012), rural
background of participants (OR 1.64, 95% CI 1.07-2.53; P= 0.023), TCA
use (OR 33, 95% CI 7.80-139.59; P= <0.001), SSRI use (OR
3.51, 95% CI 2.19-5.63; P= <0.001), LABZD use (OR 160.87,
95% CI 53.67-482.19; P= <0.001), Atypical Antipsychotic use
(OR 0.43, 95% CI 0.28-0.67; P= <0.001) were found to be
important predictors for the PIMs use as identified by STOPP criteria.
Out of a total of 456 patients, the Antianxiety agents were prescribed
in nearly 82% (n=378) of the older adults. Out of 378 patients,
potentially inappropriate antianxiety agents were prescribed in 97.3%
(n=362) and 74.6% (n= 282) older adults as per Beers criteria and STOPP
criteria. Our study also found that antidepressants were the second most
frequently prescribed psychotropic drug, almost 68.8% of the older
adults were prescribed with at least one antidepressant either TCA,
SSRI, SNRI. Atypical Antipsychotics were the third most prescribed
psychotropic drug in older adults. Beers criteria have given the list of
conventional and atypical antipsychotic list, irrespective of
diagnosis/conditions that should be avoided in older adults. Among
Atypical antipsychotics medication class quetiapine, olanzapine,
risperidone is the most common PIP medication prescribed in older
adults.