Abstract
BackgroundIn the many descriptive studies on prescribed psychotropic drug use by community-dwelling older persons, several sociodemographic and other factors associated with drug use receive inconsistent support.MethodEmpirical reports with data on at least benzodiazepine or antidepressant drug use in samples of older persons published between 1990 and 2001 (n = 32) were identified from major databases and analyzed to determine which factors are most frequently associated with psychotropic drug use in multivariate analyses. Methodological aspects were also examined.ResultsMost reports used probability samples of users and non-users and employed cross-sectional designs. Among variables considered in 5 or more reports, race, proximity to health centers, medical consultations, sleep complaints, and health perception were virtually always associated to drug use. Gender, mental health, and physical health status were associated in about two-thirds of reports. Associations with age, marital status, medication coverage, socioeconomic status, and social support were usually not observed.ConclusionsThe large variety of methods to operationalize drug use, mental health status, and social support probably affected the magnitude of observed relationships. Employing longitudinal designs and distinguishing short-term from long-term use, focusing on samples of drug users exclusively, defining drug use and drug classes more uniformly, and utilizing measures of psychological well-being rather than only of distress, might clarify the nature of observed associations and the direction of causality. Few studies tested specific hypotheses. Most studies focused on individual characteristics of respondents, neglecting the potential contribution of health care professionals to the phenomenon of psychotropic drug use among seniors.
Highlights
In the many descriptive studies on prescribed psychotropic drug use by communitydwelling older persons, several sociodemographic and other factors associated with drug use receive inconsistent support
Authors estimate that one-fifth to one-half of psychotropic drug prescriptions to the elderly are "inappropriate" [4,16,31,32]. These findings suggest that older persons' psychological well-being is not the principal determinant of their psychotropic drug use
We review recent empirical studies in order to identify other factors that may account for psychotropic drug use among older persons
Summary
In the many descriptive studies on prescribed psychotropic drug use by communitydwelling older persons, several sociodemographic and other factors associated with drug use receive inconsistent support. The use of prescribed psychotropic drugs by older persons has been a subject of interest for several decades [1,2]. BMC Nursing 2004, 3:3 http://www.biomedcentral.com/1472-6955/3/3 researchers' attention for several reasons, including (1) the high prevalence of older users (especially of benzodiazepines) and their typically long-term consumption, (2) their special vulnerability to drug induced iatrogenesis, (3) the discrepancy between rates of mental disorder and rates of drug use among older people, and (4) inappropriate prescribing. The prevalence of psychotropic drug use among community-dwelling older persons (usually defined as those 65 years and older) varies from about 20% to 48% [3,4,5]. Longterm use is contraindicated because benzodiazepines lack effectiveness beyond a few weeks or months of sustained use for their principal indications, the relief of insomnia and anxiety [8,9,10,11,12,13,14,15,16,17]
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