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Potentially inappropriate medication in older psychiatric patients

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Abstract

Purpose

Many psychotropic drugs are listed as potentially inappropriate medication (PIM) in the older population. Potentially inappropriate means that prescription of those drugs in older adults may cause significant harm. The objective of this study was to analyze the prevalence and sort of PIM prescribing in a naturalistic, real-world psychiatric setting.

Methods

The retrospective analysis gathered data from a large pharmacovigilance study, conducted at 10 psychiatric hospitals. Data from inpatients aged ≥ 65 years were included for the analysis. The number and sort of PIM, as defined by the German PRISCUS list, were controlled by analyzing the patients’ medication profile.

Results

In total, 4760 patient cases (59.2% female) with a mean (mean ± standard deviation (SD)) age of 77.33 ± 7.77 years were included into the study. Altogether, 1615 cases (33.9%) received at least 1 PRISCUS-PIM per day (regular and as-needed medication included). The most frequently prescribed PRISCUS-PIM (n = 2144) were zopiclone > 3.75 mg/day (n = 310), lorazepam > 2 mg/day (n = 269), haloperidol > 2 mg/day (n = 252), and diazepam (n = 182). Cases with PRISCUS-PIM were younger (75.7 vs. 78.2 years, p < 0.001) and had a longer (26 vs. 22 days, p < 0.001) hospital length of stay. Replacing benzodiazepines and z-substances, haloperidol > 2 mg, tricyclic antidepressants, first generation antihistaminergic drugs, and clonidine by non-PIM could reduce 69.9% of PRISCUS-PIM-prescribing.

Conclusions

The prevalence of PRISCUS-PIM is high in the hospitalized psychiatric setting. Rational deprescribing of inappropriate anticholinergics, benzodiazepines, and antipsychotics in the older population is a key component to reduce the risk of adverse drug reactions. More tolerable medications should be prescribed.

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Acknowledgments

The authors are very grateful to all 10 participating hospitals for their voluntary collection of data.

Availability of data and material

Data transparency was given and controlled by external government in Hesse, Germany.

Funding

The Federal Joint Committee (G-BA, project executing organization, Deutsches Zentrum für Luft- und Raumfahrt, DLR) is funding health care research projects that aim to optimize quality of care for statutory insured persons in Germany. In this regard, the innovative study “Optimization of pharmacological treatment in hospitalized psychiatric patients” (OSA-PSY, study number 01VSF16009, ethical approval reference number FF 116/2017) is sponsored by the DLR.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, Vitos Klinikum Hochtaunus, Emil-Sioli-Weg 1-3, 61081, Friedrichsdorf, Germany

    Gudrun Hefner & Ansgar Klimke

  2. Psychiatric Hospital, Vitos Klinik Eichberg, Eltville, Germany

    Martina Hahn & Sibylle C. Roll

  3. Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany

    Sermin Toto

  4. Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Mainz, Germany

    Christoph Hiemke

  5. Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany

    Jan Wolff

  6. Evangelical Foundation Neuerkerode, Braunschweig, Germany

    Jan Wolff

  7. Heinrich-Heine-University, Duesseldorf, Germany

    Ansgar Klimke

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  1. Gudrun Hefner
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Contributions

G. Hefner did literature search, did analysis, pharmacological interpretation, and wrote the final manuscript. M. Hahn, S. C. Roll, S. Toto, and C. Hiemke did analysis and pharmacological interpretation of the manuscript. J. Wolff did statistical analysis of patient data. A. Klimke gave the idea and made data analysis and interpretation of study results.

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Correspondence to Gudrun Hefner.

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Conflict of interest

Gudrun Hefner, Martina Hahn, Sibylle C. Roll, Jan Wolff, and Ansgar Klimke declare no conflicts of interest/competing interests. Sermin Toto has been a member of an advisory board for Otsouka, and has received speaker’s honoraria from Janssen Cilag, Lundbeck, Otsouka, and Servier. Christoph Hiemke has received speaker’s and consultancy fees from Stada, Lohmann Transdermal Systems, and Otsuka during the last 2 years.

Ethics approval

Ethical approval in November 2017 in Hesse, Germany; reference number FF 116/2017.

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Hefner, G., Hahn, M., Toto, S. et al. Potentially inappropriate medication in older psychiatric patients. Eur J Clin Pharmacol 77, 331–339 (2021). https://doi.org/10.1007/s00228-020-03012-w

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