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Potentially inappropriate psychotropic prescription at discharge is associated with lower functioning in the elderly psychiatric inpatients. A cross-sectional study

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Abstract

Objective

The objectives are to determine the rate of potentially inappropriate psychotropic (PIP) prescription at discharge in the elderly psychiatric inpatients and to determine whether PIP is associated with lowered functioning outcomes.

Methods

Sociodemographic, clinical, and treatment data for all inpatients aged ≥ 65 years consecutively hospitalized during 1 year in 13 psychiatry departments was analyzed. PIP+/PIP− groups were defined according to the French-updated Beers criteria. Daily functioning was evaluated by the daily living (ADL) scale. Logistic regression analysis was used to estimate odds ratios for the association between PIP administration at discharge and respectively functioning and potential confounding factors.

Results

Data was obtained for 327 patients. Overall, 124 (37.9 %) patients were males, and the mean age was 73.9 years (SD = 5.6); 163 (49.8 %) patients were diagnosed with affective disorders and 89 (27.2 %) with schizophrenia/schizotypal/delusional disorders. Overall, 249 (76.1 %) had one or more PIP medications, mainly anxiolytics (69.9 %) and hypnotics (17.2 %). In a multivariate analysis, PIP prescription at discharge has been associated with patient lowered personal care functioning, independently of age, gender, and psychiatric or somatic diagnoses (OR = 0.88 (0.79–0.97, p = 0.01).

Conclusion

In the current increasingly fragmented health care systems, special attention must be given to PIP prescription in older population suffering from psychiatric disorders. Using the Beers criteria, the present study demonstrates the high prevalence of PIP prescription, which concerns a large panel of drugs but mostly anxiolytics and hypnotics independently of psychiatric or somatic diagnoses and sociodemographic characteristics. Our study has demonstrated for the first time an association between PIP prescription and lowered patient functioning. Further longitudinal studies should confirm a potential causal relation.

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Acknowledgments

This work was supported by AP-HM (Assistance Publique des Hôpitaux de Marseille) and AP-HP (Assistance Publique des Hôpitaux de Paris), Fondation FondaMental (RTRS Santé Mentale), and by INSERM (Institut National de la Santé et de la Recherche Médicale). We express all our thanks to the nurses and to the patients who were included in the present study.

Contributors

GF, CF, LB, DD, and CL wrote the manuscript.

All authors except GF designed the study and wrote the protocol.

GF, CF, DD, and LB conducted the literature searches and analyses.

LB conducted the statistical analyses.

All authors contributed to and approved the final manuscript.

Author information

Authors and Affiliations

  1. Fondation FondaMental, Créteil, France

    Guillaume Fond, Lore Brunel & Christophe Lançon

  2. INSERM U955, Translational Psychiatry team, Créteil, France

    Guillaume Fond

  3. DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Paris Est University, Créteil, France

    Guillaume Fond

  4. Pole de Psychiatrie, Hôpital A. Chenevier, 40 rue de Mesly, Créteil, France, 94010

    Guillaume Fond & Lore Brunel

  5. Department of Psychiatry, Assistance Publique—Hôpitaux de Marseille, Sainte-Marguerite University Hospital, 13009, Marseille, France

    Claire Fajula

  6. Department of Psychiatry, Assistance Publique—Hôpitaux de Marseille, La Conception University Hospital, 13005, Marseille, France

    Daniel Dassa

  7. Department of Public Health, EA 3279 Research Unit, University Hospital, Assistance Publique—Hôpitaux de Marseille, 13005, Marseille, France

    Christophe Lançon & Laurent Boyer

Authors
  1. Guillaume Fond
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  2. Claire Fajula
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  3. Daniel Dassa
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  4. Lore Brunel
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  5. Christophe Lançon
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  6. Laurent Boyer
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Corresponding author

Correspondence to Guillaume Fond.

Ethics declarations

The French National Commission for Data Protection (CNIL) approved this study. Because the project involved the retrospective analysis of anonymous administrative data sets—patient names were replaced by a unique identification number—informed consent was not necessary. Principles outlined in the Declaration of Helsinki were followed (World Medical Association (WMA), general assembly, Seoul (2008)).

Conflict of interest

The authors declared that they have no conflicts of interest.

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None.

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Key points

• In the current increasingly fragmented health care systems, special attention must be given to potentially inappropriate psychotropic (PIP) prescription in older population suffering from psychiatric disorders and consuming a large range of medicines.

• Using the Beers criteria, the present study demonstrates the high prevalence of PIP prescription, which concerns a large panel of drugs but mostly anxiolytics and hypnotics independently of the psychiatric or somatic diagnoses and sociodemographic characteristics.

• Our study have demonstrated for the first time an association between PIP prescription and lowered functioning. Further longitudinal studies should confirm a causal relation.

• Our study raises the need of a greater health literacy concerning geriatric conditions in non-geriatrician practitioners who care elderly in hospital.

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Fond, G., Fajula, C., Dassa, D. et al. Potentially inappropriate psychotropic prescription at discharge is associated with lower functioning in the elderly psychiatric inpatients. A cross-sectional study. Psychopharmacology 233, 2549–2558 (2016). https://doi.org/10.1007/s00213-016-4312-z

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  • DOI: https://doi.org/10.1007/s00213-016-4312-z

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