Abstract
BackgroundThe situation for older persons with mental disorders other than dementia disorders has scarcely been studied. The older population is increasing worldwide and along with this increase the prevalence of mental disorders will also rise. The treatment of older persons with mental disorders entails complex challenges, with drugs constituting the major medical treatment. Knowledge of geriatric psychiatry is essential for providing older persons with appropriate treatment and care. This study aimed to evaluate the prescription of drugs for mental disorders to older persons (≥65) in Sweden, focused on the medical specialties of the prescribing physicians.MethodsData concerning drug treatment for older persons from 2006 to 2008 was gathered from the Swedish Prescribed Drug Register. Mental disorders, defined as affective, psychotic and anxiety disorders (ICD-10 F20-42) were evaluated in order to identify associated drugs. Included was a total of 188 024 older individuals, who collectively filled 2 013 079 prescriptions for the treatment of mental disorders. Descriptive analyses were performed, including frequency distribution and 95% CI. The competence of the prescribers was analyzed by subdividing them into five groups: geriatricians, psychiatrists, general practitioners (GPs), other specialists, and physicians without specialist education.ResultsGPs represented the main prescribers, whereas geriatricians and psychiatrists rarely prescribed drugs to older persons. Benzodiazepines and tricyclic antidepressants were the most commonly prescribed drugs. Women were prescribed drugs from geriatricians and psychiatrists to a greater extent than men.ConclusionsThis study examined the prescription of psychotropic drugs to older persons. Physicians specialized in older persons’ disorders and mental health were rarely the prescribers of these drugs. Contrary to clinical guidelines, benzodiazepines and tricyclic antidepressants were commonly prescribed to older persons, emphasizing the need for continuous examination of pharmaceutical treatment for older persons. The results indicate a future need of more specialists in geriatrics and psychiatry.
Highlights
The situation for older persons with mental disorders other than dementia disorders has scarcely been studied
Aim This study aimed to evaluate the prescription of drugs for mental disorders to older persons (≥65 years) in Sweden during the three-year period from 2006 to 2008, focusing on the medical specialties among the prescribing physicians and the amount of drugs prescribed to older men and women
Drugs corresponding to 25 different Anatomical Therapeutic Chemical Classification (ATC) codes, level 5, were dispensed to older persons (≥65) in Sweden from 2006 to 2008, all of which were included in the analysis
Summary
The situation for older persons with mental disorders other than dementia disorders has scarcely been studied. The treatment of older persons with mental disorders entails complex challenges, with drugs constituting the major medical treatment. The treatment of mental disorders (i.e. affective, psychotic and anxiety disorders) in older persons is a complex task and can be affected by a variety of factors, including pharmacokinetic and pharmacodynamic changes related to age, influences of concurrent disorders and possible adverse drug reactions. The risk of adverse drug reactions increases with age, drug treatment is common among older persons, both nationally [6] and internationally [7]. As older persons are often treated for several conditions besides mental disorders, the possibility for unwanted drug interactions is increased in this age group. Several studies have reported that older persons are subjected to polypharmacy and inappropriate drug use [8,9,10], and that many hospitalizations occur due to drug related problems [11]
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