Introduction
A number of psychiatric disorders follow the geriatric population without any invitation, hence psychotropic medications are most frequently used in older adults to treat various mental health conditions.1,2Still, the use of these agents has been associated with a deleterious outcome such as increased sedation, increased risk of stroke, and an increased chance of injuries and falls.3,4 Older adults are more prone to adverse events attributable to pharmacodynamic and pharmacokinetic age-related alterations.5Psychotropic medication whose adverse risk exceeds its health benefits, especially when safer or equally effective treatment available, is considered as potentially inappropriate medication (PIMs).6 It is imperative to use psychotropic medication judiciously to avoid the adverse effects of these medications in older adults. Various implicit and explicit measures have been developed to determine PIMs in the elderly population.7,8Psychotropic medication covers a higher proportion of PIMs in Beers criteria and STOPP criteria. Beers et al gave the first set of explicit criteria for determining PIMs use by the older adults in 1991.9 however, the American Geriatric Society gave official patronage to Beers criteria in 2012 and is now responsible for regularly updating the criteria at a steward cycle of 3 years.10,11Recently, Beers criteria 2019 recommends several psychotropic medications that should be avoided in older adults or limiting their dosage beyond the mentioned dose. It also recommends avoiding psychotropic medicines in older adults with a particular disease as well as the use of three or more Central Nervous System medications in conjunction with each other.12
Similarly, the British Geriatric Society recommends the use of STOPP criteria to identify PIMs use in older adults.13 Very few studies have examined the PIP medication use in the elderly population using Beers criteria 2003, 2012, 2015, and STOPP criteria (version 1& 2) reported PIP medication prevalence between 7% to 80%.14-16 No analysis using the Beers criteria 2019 and STOPP criteria 2015 has been carried out to determine the prevalence and predictors of PIP medication in older adults. Hence the present study was carried out to determine the prevalence and predictors of PIP medication in older adults attending the outpatient psychiatry department based on Beers criteria 2019 and STOPP criteria 2015.
Methods
Setting and Sample
A cross-sectional study was carried out at the psychiatry department/deaddiction center of tertiary care postgraduate teaching hospital on 456 patients of either sex, with a median age of 65 years attending the psychiatry outpatient department. All patients aged ≥65 years attending the outpatient psychiatry department and were prescribed at least one medication and who had given consent to participate in the study were included. Exclusion criteria were as follows: a) Without any psychotropic medication b) incomplete data c) did not provide consent for participation in the study.
Ethical Approval
The protocol for the present study was approved by the Institutional Ethics Committee vide letter No. ERB/UCER/2018/9/3 dated 17/09/2018. The study was carried out in compliance with the ethical standards for biomedical research on human participants.
Data Collection
Prevalidated data collection form was used to collect data on patients’ sociodemographic and clinical characteristics such as gender, age, urban/rural living background, educational qualification, smoking or alcohol addiction, number of visits to psychiatry outpatient department, prescribed psychotropic drugs along with their dosage and course of treatment. The authors used validated standardized scales to identify the differential diagnosis. The existence of mild, moderate, severe, very severe depression was assessed by the use of the Hamilton Depression Rating Scale (HAM-D).17,18 Cognitive impairment is one of the most significant changes observed in older adults as the aging process is associated with a decline in cognitive function. Cognitive impairment is most commonly caused by delirium and dementia in patients. Updated edition-98 of the Delirium Rating Scale was used to assess delirium.19 The Mini-Mental State Assessment was used to assess cognitive dysfunction and screen for dementia.20 Authors used the Up & Go test and One-Leg Stand- test to assess Walking difficulty and fall risk.21,22
Evaluation of PIMs
American Geriatric Society Beers criteria 2019 and British Geriatric Society STOPP criteria 2015 (version 2) were used to identify the prevalence of PIP medication in older adults. Two physicians and one pharmacist performed the assessment of PIMs use.
Statistical Analysis
Statistical analysis was carried out by using CorIP. IBM Statistical Package for Social Science Statistics for Windows, Ver. 24.0 and STATA.23 The Kolmogorov-Smirnov test was used to determine the normality distribution of data. The frequency with percentage is used to express categorical variables. A continuous variable is either defined as mean and standard deviation or median and minimum-maximum values as appropriate. Bivariate logistic regression was performed to identify the predictors for PIP medication prescribing in older adults. The results obtained are expressed in the form of an odds ratio (OR) with a 95% confidence interval (CI). A P- value of< 0.05 was considered statistically significant.