Concordance for psychotropic drug use in older married couples.

Abstract

To the Editor: As part of the Epidemiology of Vascular Aging (EVA) Study, a large study of cognitive decline in older adults, we examined cognitive performance similarities in married couples, taking into account the potential confound-ers that might be shared by spouses. This led us to investigate concordance among couples for psychotropic drug use, a major risk factor for cognitive impairment in older adults.1 The EVA study is a longitudinal study of vascular aging and cognitive decline conducted in a community sample of 1389 subjects, born between 1922 and 1932, recruited from the electoral rolls of the city of Nantes (Western France). An extensive questionnaire was administered by a research assistant at study entry. Data regarding education, self-reported sleep disorders, and treatments were used for this analysis. Medication use during the month before the interview was recorded from both subject interview and original medical prescriptions. Drugs were classified according to the French National Prescription Dictionary (1991). Psychotropic drugs included anxiolytic, hypnotic, sedative, antidepressant, normothimic, and neuroleptic drugs. The name of the subject's general practitioner was also recorded. The study also included an assessment of depressive symptoms using the Center for Epidemiologic Study-Depression (CES-D) scale; high depressive symptomatology was defined as a CES-D score higher than 16 in men or 22 in women.2 There were 318 married couples in the EVA study. Husbands were slightly older than wives (mean ages: 65.7 years (Standard Deviation (SD) = 2.8) vs 64.2 years (SD = 2.8), P < .001). The prevalence of psychotropic drug use was 13.8% among husbands and 25.8% among wives (P < .001); these rates were similar to those found in the whole EVA population (13.9% in men and 27.0% in women). The frequency of spouses having the same general practitioner was 77.7%. Multivariate logistic regression models showed that independent of depression and sleep disorders, men whose wives take psychotropic drugs had a 3.5 times increased risk of psychotropic drug use compared with men whose wives did not. Similarly, the odds ratio associated with husbands' psychotropics drug use was equal to 2.9 in women (Table 1). All analyses were adjusted for age, education level, and concordance for general practitioner. Numbers were too small to perform separate analysis by psychotropic drug category. The effect of a spouse's use was similar in magnitude (even greater in women) than personal determinants of psychotropic use such as depressive symptoms or sleep complaints. No similarity among spouses was found for other categories of drugs (odds ratio = 1.2, P = .5 in men; odds ratio = 1.3, P = .4 in women). Psychotropic drug use may have various negative consequences in older adults, including cognitive impairment,1 falls,3 or motor vehicle accidents.4 The risk of adverse reactions as a result of pharmacological interactions between psychotropic and other drugs is particularly high in older people who take medications for treating a variety of age-related disorders.5 Thus, the rationale for prescribing psychotropic drugs to older people must be critically analyzed. Our study showed high concordance for psychotropic drug use among married couples that was not explained by potential shared confounders such as sleep disorders, depressive symptoms, or same general practitioner. Concordance might result from either common attitude toward psychotropic drugs in married couples or self-prescription of the psychotropic drug used by his/her spouse. The public health importance of psychotropic drug use in older persons suggests the need for investigating this finding further in order to define appropriate information to be given both to prescribers and to older users.