Drugs In Elderly Patients Research Articles

Psychotropic medication in geriatric psychiatric patients: use and unreported use in relation to serum concentrations.

The aim of this observational study was to describe the type, number, and serum concentration levels of psychotropic drugs in elderly patients, on admission to a geriatric psychiatric inpatient unit. We further wanted to investigate the use and unreported use of psychotropic drugs by analyzing for a broad spectrum of drugs in the serum samples. A total of 236 patients were included. Drug use, patient characteristics, and diagnoses were recorded, and serum analysis was performed for a total of 56 psychotropic drugs in 233 of the patients. Nine out of ten patients (88%) used one or more psychotropic drugs on admission to hospital; the mean use was 2.8 (95% confidence interval (CI) 2.6-2.9) drugs. In 25 patients (11%), drugs reported used were not detected in serum. Unreported use of drugs (serum analysis revealing one or more drugs not reported) was found in 100 patients (43%). This was more common in younger patients. Psychotropic polypharmacy (use of three or more psychotropic drugs) was found in 109 patients (47%). Patients with a main diagnosis of affective disorder used the most psychotropic drugs. Psychotropic drugs are commonly used among geriatric psychiatric patients on admission to hospital. Psychotropic polypharmacy is a major concern among these patients. There was considerable unreported use of drugs within this population, and a low threshold for a broader serum analysis for psychotropic drugs appears indicated.

CP-028 Heart failure patients need heart failure teams

BackgroundAccording to current clinical guidelines developed from evidence-based medicine, heart failure with ventricular dysfunction needs to be treated with the combination of an ACE inhibitor and a beta blocker. An...

Utilization of antipsychotic drugs in elderly patients with Alzheimer’s disease seen in ambulatory practice in Japan

Utilization of antipsychotic drugs in elderly patients with Alzheimer’s disease seen in ambulatory practice in Japan

Changes in the prescribing pattern of antidepressant drugs in elderly patients: an Italian, nationwide, population-based study

Despite the high use of antidepressants (ADs) among the elderly, there is limited information about the prescribing pattern of these drugs in the Italian elderly population. The aim of this study was to analyze the trend in the use of ADs in the Italian elderly patients in the years 2003-2009, and specifically, to evaluate rates and predictors of AD treatment discontinuation in depressed older patients. The nationwide general practice Health Search Database (HSD) was used to identify AD users aged 65 years old and over from 2003 to 2009. ADs were categorized as (1) selective serotonin reuptake inhibitors (SSRIs); (2) serotonin-norepinephrine reuptake inhibitors (SNRIs); (3) tricyclic antidepressants (TCAs); (4) noradrenergic and specific serotonergic antidepressants (NaSSAs); and (5) other ADs. Incidence and prevalence of AD use per 1,000 inhabitants was calculated by drug class and single compound. We also measured rates and predictors of AD discontinuation (i.e., treatment gap ≥ 60 days) during the first year of therapy. Overall, 39,557 AD users ≥65 years (17 % of the total HSD elderly population) were included in the study. SSRIs were increasingly and most frequently prescribed ADs (102.7-195.3 per 1,000 over seven years). The most common indications for AD use were depression and anxiety. Overall, 14 % of AD users continued their AD medication without treatment gaps, 27 % were intermittent AD users and 58 % discontinued their ADs during the first year of follow-up. Specific AD classes such as TCAs and 'other ADs were found to be predictors of discontinuation. In depressed patients, the use of NaSSas, TCAs and 'other ADs as well the concomitant use of >5 drugs (other than ADs) and living in Southern Italy were more likely to predict discontinuation. ADs, especially SSRIs, are widely and increasingly prescribed in elderly Italian patients in recent years. The observed high AD discontinuation rates are likely to impact the achievement of a therapeutic endpoint in depressed patients. Patients who are at high risk of AD discontinuation such as those receiving multi-drug therapy or living in Southern Italy should be monitored more closely to improve benefits of AD treatments.

The Incidence of Upper Gastrointestinal Complications of Non-Steroidal Anti-Inflammatory Drugs in Elderly Patients

The incidence of upper gastrointestinal (GI) complications of non-steroidal anti-inflammatory drugs remains the most common side effect. The objective of this study was to compare the incidence of upper gastrointestinal complications of Ibuprofen as non-selective non-steroidal anti-inflammatory drug (NSAID) to Celecoxib and Meloxicam as selective non-steroidal anti-inflammatory drugs. This study included 4 groups of subjects aging above 50 years old divided into control group including 10 healthy volunteers suffering from the symptom of dyspepsia and three test groups, each test group included 10 osteoarthritic or rheumatic patients receiving only one NSAIDs (Ibuprofen, Celecoxib or Meloxicam) from at least 1 month. There was a statistically highly significant difference between the studied groups regarding the incidence of dyspepsia (p-value=0.008) and regarding the incidence of gastritis (p-value=0.042). In group II, there was a statistically significant correlation between the duration of administration of Ibuprofen and the incidence of dyspepsia. Similarly, in group III, there was a statistically significant correlation between the duration of administration of Celecoxib and the incidence of dyspepsia. Controversial, in group IV, there was no statistically significant correlation between the duration of administration of Meloxicam and the incidence of dyspepsia or gastritis or ulcer. Incidence of gastrointestinal side effects was lower for Celecoxib than for Meloxicam than for Ibuprofen. The study concluded that Celecoxib was safer than Meloxicam than Ibuprofen on the upper gastrointestinal tract.

The primary goal of anticoagulation in atrial fibrillation to prevent stroke and not to offer the apparently cheapest treatment.

Patients with atrial fibrillation (AF) have a particular high risk of cardio-embolic stroke. Cardio-embolic strokes have a high mortality (20%) and >50% of patients remain permanently disabled. Oral anticoagulation with warfarin is highly effective in preventing strokes as long as warfarin is taken. Unfortunately many patients with atrial fibrillation refuse to take warfarin because they are afraid of major bleeding complications in particular intracranial bleeds. In addition long term compliance and adherence with warfarin is terrible due to the need of regular international normalized ratio (INR) monitoring and the many interactions with food and drugs in elderly patients with polypharmacy. Anticoagulation is most effective in old patients who have difficulties to get to a physicians' office or an anticoagulation clinic to get the INR monitored. Just imagine the 86 years old lady with unsteady gate and a walker needing to get to a doctor in winter with ice and freezing temperatures outside. Data from Canadian and German stroke units on admission of patients with AF and a new stroke display shocking facts.1,2 One third of patients with AF and without contraindications for anticoagulation are untreated at the time of stroke. Thirty percent are treated with aspirin which is not effective in secondary stroke prevention in AF.3 Another 30% are treated with warfarin but the INR was <2.0 at the time of stroke. Only 10% of patients were on warfarin and the INR was between 2.0 and 3.0. Reimbursement bodies, however, will consider only the last 10% of patients, namely patients with AF well controlled on warfarin. This does not reflect clinical reality. The most restrictions for the use of novel anticoagulants (NOACs) instead of warfarin prevent the patients in highest need of stroke prevention from a drug that is superior to warfarin and has fewer intracranial bleeds, namely the elderly. In this issue, Bang et al.4 summarized pieces of evidence that NOACs may be particularly helpful for Asian stroke patients. Indeed, Asians are at particular high risk of major bleeds on warfarin. This risk is much lower with novel anticoagulants. Therefore it is not rational to restrict the use of NOACs in Asian patients with AF. My policy would be to offer all patients who had a transient ischemic attack or ischemic stroke and AF a NOAC, because these patients have a particular high risk of a recurrent stroke. In primary prevention I would offer NOACs to untreated patients, patients on aspirin and patients poorly controlled on warfarin. I see no reason to switch well controlled patients on warfarin to NOACs. In summary putting high hurdles on the prescription of NOACs will lead to many strokes with severe disability and tremendous costs for a national health care system.

Appropriateness of use of psychotropic drugs in elderly patients hospitalised in a short-stay ward

general practitioners (GP) in primary care. The aim of this study was then to measure the impact of STOPP criteria during primary care consultation on PIM. Methods.– Twenty GPs have been involved in the study and ask for using STOPP criteria for 10 consecutive elderly patients (> 75years) whowere takingat leastfivedifferentdrugs. The rateof PIMaccording to STOPP criteria was measured before and after consultation and the Medication Appropriateness Index (MAI) score assessing thequality of prescribingwasused for statistical comparisonbefore and after intervention. Results.– The number of PIM decreased according to STOPP criteria for nearly half of the patients (46.9%) and the mean MAI score decreased by 39.1% (P<0.001). The improvement in MAI according to STOPP is mainly related to the number of medication regardless the age (≥50years) of medical doctors. The use of STOPP also allowed an improvement of all prescriptions (globalMAI decreased by 14.3%, P<0.001). Conclusions.– This is the first study showing a reduction of PIMwith STOPP criteria in primary care. These results need to be confirmed by a randomized-control study; it should be then appropriate to promote the use of STOPP criteria in primary care, during an annual consultation dedicated to drug medication reviewing.

Use of psychotropic drugs in elderly patients admitted to a short-stay ward through the emergency department: The SAFES Cohort

general practitioners (GP) in primary care. The aim of this study was then to measure the impact of STOPP criteria during primary care consultation on PIM. Methods.– Twenty GPs have been involved in the study and ask for using STOPP criteria for 10 consecutive elderly patients (> 75years) whowere takingat leastfivedifferentdrugs. The rateof PIMaccording to STOPP criteria was measured before and after consultation and the Medication Appropriateness Index (MAI) score assessing thequality of prescribingwasused for statistical comparisonbefore and after intervention. Results.– The number of PIM decreased according to STOPP criteria for nearly half of the patients (46.9%) and the mean MAI score decreased by 39.1% (P<0.001). The improvement in MAI according to STOPP is mainly related to the number of medication regardless the age (≥50years) of medical doctors. The use of STOPP also allowed an improvement of all prescriptions (globalMAI decreased by 14.3%, P<0.001). Conclusions.– This is the first study showing a reduction of PIMwith STOPP criteria in primary care. These results need to be confirmed by a randomized-control study; it should be then appropriate to promote the use of STOPP criteria in primary care, during an annual consultation dedicated to drug medication reviewing.

1808 – The use of antipsychotic drugs in elderly patients with dementia

Introduction Delusions, hallucinations, aggression, and agitation affect more than half of patients with dementia. Antipsychotic drugs are used to treat these behaviors and symptoms. They are among the most frequently used psychotropic drugs in this disease, but their benefits are uncertain and concerns about safety have emerged. We assessed the current practice in use of antipsychotics medication in outpatients with dementia. Method We conducted a retrospective cohort study involving patients older than 65 years who began outpatient treatment with antipsychotic drugs following a dementia diagnosis. Results 22 patients were included (16 female, 6 male) with mean age of 78.6 years. All patients consulted for behavioral problems. Most received typical aantipsychotic drugs (72,8%), while 36,4% received atypical antipsychotic drugs. 13 patients (59,1%) were receiving haloperidol. Improvement was observed in 54,5% of patients. The comparisons of haloperidol with risperidone suggest no difference in efficacy for the treatment of global behaviour disturbance. On the other hand, use of haloperidol is, however, associated with a higher incidence of extrapyramidal and other side effects. Conclusion The treatment of elderly patients requires daily careful management and monitoring because of their polypathology, polymedication and of their greater sensitivity to the toxic effects of drugs. Overall, the study findings suggest that there is a need to monitor antipsychotic drug use by elderly patients in light of recent efficacy and safety data on atypical agents.

Inappropriate Drugs in Elderly Patients with Severe Cognitive Impairment: Results from the Shelter Study

BackgroundIt has been estimated that Nursing Home (NH) residents with impaired cognitive status receive an average of seven to eight drugs daily. The aim of this study was to determine prevalence and factors associated with use of inappropriate drugs in elderly patients with severe cognitive impairment living in NH in Europe.MethodsCross-sectional data from a sample of 1449 NH residents with severe cognitive impairment, participating in the Services and Health for Elderly in Long TERm care (SHELTER) study were analysed. Inappropriate drug use was defined as the use of drugs classified as rarely or never appropriate in patients with severe cognitive impairment based on the Holmes criteria published in 2008.ResultsMean age of participating residents was 84.2±8.9 years, 1087 (75.0%) were women. Inappropriate drug use was observed in 643 (44.9%) residents. Most commonly used inappropriate drugs were lipid-lowering agents (9.9%), antiplatelet agents (excluding Acetylsalicylic Acid – ASA –) (9.9%), acetylcholinesterase, inhibitors (7.2%) and antispasmodics (6.9%). Inappropriate drug use was directly associated with specific diseases including diabetes (OR 1.64; 95% CI 1.21–2.24), heart failure (OR 1.48; 95% CI 1.04–2.09), stroke (OR 1.43; 95% CI 1.06–1.93), and recent hospitalization (OR 1.69; 95% CI 1.20–2.39). An inverse relation was shown between inappropriate drug use and presence of a geriatrician in the facility (OR 0.55; 95% CI 0.39–0.77).ConclusionUse of inappropriate drugs is common among older EU NH residents. Determinants of inappropriate drug use include comorbidities and recent hospitalization. Presence of a geriatrician in the facility staff is associated with a reduced rate of use of these medications.

Drug Interactions

Drug interactions can have desired, reduced or unwanted effects. The probability of interactions increases with the number of drugs taken. The high rate of prescribed drugs in elderly patients (65-year-old patients take an average of 5 drugs) increases the likelihood of drug interactions and thus the risk that drugs themselves can be the cause of hospitalization. According to meta-analyses, up to 7% of hospitalizations are drug-related. Selective literature review. Drug interactions occur on pharmacodynamic and pharmacokinetic levels. Examples of pharmacodynamic interactions are simultaneous administration of a NSAID and phenprocoumon (additive interaction), or of aspirin and ibuprofen (antagonistic interaction). Pharmacokinetic interactions occur at the levels of absorption (e.g., levothyroxine and neutralizing antacids), elimination (e.g., digoxin and macrolides), and metabolism, as in the competition for cytochrome P450 enzymes (e.g., SSRIs and certain beta-blockers). The systematic knowledge of drug interaction, in particular on the level of absorption, elimination, transport and drug metabolism may help to prevent adverse effects. Predicting pharmacodynamic interactions often demands a deeper understanding of the mechanisms of effect. Electronic prescribing systems are helpful.

Adverse Drug Reactions in Elderly Hospitalized Patients: A 12-Year Population-Based Retrospective Cohort Study

Although research has identified some risk factors for first-time adverse drug reactions (ADRs), little is known about the risks associated with the number of ADRs. Modeling ADR counts is relatively complex because of the rarity of the events, requiring careful consideration of appropriate models that best present the observed data. To determine the incidence of ADRs among elderly hospitalized patients, assess patient-related risk factors for the number of ADRs, and review drug classes commonly responsible for ADRs. This retrospective cohort study used a population-based large administrative database on hospital separations from all acute care hospitals in the Canadian province of Newfoundland and Labrador. Patients aged 65 years or older with at least 1 hospital admission from April 1, 1995, to March 31, 2007, were included. Comorbidities, Charlson Comorbidity Index (CCI), and sociodemographic factors were assessed as predictors of ADR counts. A zero-inflated negative binomial regression model was used for analysis. The study cohort contained 64,446 patients. The incidence of ADRs was 15.2 per 1000 person-years (95% CI 14.8 to 15.7). Of those having an ADR, 15.4% had recurrent ADRs. The most common drug category implicated in ADRs was cardiovascular agents (17.7%). A dose-response relationship was found between CCI and ADR counts (rate ratio [RR] 1.67, 95% CI 1.41 to 1.98 for CCI 2-3; RR 2.38, 95% CI 1.98 to 2.87 for CCI 4-5; and RR 3.83, 95% CI 3.21-4.57 for CCI ≥6). Comorbid conditions including congestive heart failure (RR 1.58, 95% CI 1.33 to 1.89), diabetes (RR 2.42, 95% CI 1.64 to 3.56), and cancer (RR 3.12, 95% CI 2.58 to 3.76) were strong predictors. Rural areas (RR 1.22, 95% CI 1.01 to 1.46) were associated with increased risk for ADRs, whereas age and sex had no effect. Comorbidity from chronic diseases and severity of illness, rather than individual characteristics (advancing age and sex), increased the likelihood of ADRs. Changes in the delivery of care focusing on the monitoring of prescribed drugs in elderly patients with comorbidities could mitigate ADRs.

Population Pharmacokinetics of Carbamazepine in Elderly Patients

Carbamazepine is a commonly used antiepileptic drug in elderly patients. This study analyzed prospective data collected as part of a randomized, double-blinded trial of newly diagnosed epilepsy patients. The aims of this study were to determine the pharmacokinetic parameters and their variability of carbamazepine in elderly patients and to quantify the effect of covariates on these parameters. Prospectively collected carbamazepine concentrations from 121 patients aged 60 years or older were used to develop a population pharmacokinetic model. Data were analyzed by a nonlinear mixed effects model (NONMEM). A 1-compartment model with first-order absorption and elimination was used to characterize the time course of carbamazepine concentration. Model evaluation and the predictive performance of the final model were assessed using the nonparametric bootstrap approach. The apparent clearance (CL/F) of carbamazepine in this community-dwelling elderly population was estimated to be 3.59 L/h with an interindividual variability of 18.1%. The CL/F increases 23% in patients comedicated with phenytoin. The volume of distribution (V/F) was estimated to be 102 L with an interindividual variability of 74.7%. Carbamazepine clearance was not associated with body weight or any parameterization of body size nor was age or race or any marker of hepatic or renal function in community dwelling elderly patients. Elderly patients on concurrent phenytoin therapy may require a smaller 23% higher dose on average, about half that reported for younger patients.

Year in review 2011: Asthma, chronic obstructive pulmonary disease and airway biology

1UBC James Hogg Research Centre, Institute for Heart + Lung Health, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada, 2The Prince Charles Hospital and The University of Queensland, Brisbane, Queensland, Australia, 3Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, and 4Department of Medicine, National University Hospital, Singapore, Singapore

Prolonged-release formulation of melatonin (Circadin) for the treatment of insomnia

Introduction: Insomnia is common among the elderly. The use of hypnotic drugs in elderly patients is frequently criticized owing to dependency, cognitive impairments, falls and withdrawal effects. The production of melatonin, a physiological sleep and circadian rhythm regulator, declines with age. Prolonged-release melatonin (Circadin®), designed to mimic the endogenous pattern of melatonin production, is licensed for insomnia in patients aged ≥ 55 years.Areas covered: This review summarizes published studies on Circadin's efficacy and safety (Summary of Product Characteristics and Medline search on ‘Circadin' and ‘insomnia').Expert opinion: The main significant and clinically relevant benefits are improvements in sleep quality and latency, next-day morning alertness and quality of life. The responses may develop over several days. An oral 2-mg dose once daily, for 3 months, has generally been well tolerated with no rebound, withdrawal or ‘hangover' effects and no safety concerns on concomitant therapy with antihypertensive, antidiabetic, lipid-lowering or anti-inflammatory drugs. Untoward effects of hypnotics on cognition, memory, postural stability and sleep structure are not seen with Circadin. Given as a first-line prescription, with 13 weeks' posology and the lack of rebound effects, Circadin has the potential to improve quality of life in insomnia patients aged 55 years and older and avoid long-term use of hypnotics.

Drug prescribing pattern in elderly patients in a teaching hospital

Objective: The present study was undertaken to study prescribing pattern of various drugs in elderly patients & also to evaluate inappropriate prescribing with the help of Beers criteria. Material & methods: The study was conducted in Dr.B.R.Ambedkar Medical College & Hospital from June 2012 to August 2012. A total of 106 case records of inpatients >/65years in medicine wards were reviewed. Relevant information was recorded in a structured proforma & data was evaluated. Results: Most of the cases were from respiratory system (35.84%), followed by cardiovascular system (14.15%). The most commonly prescribed drugs were antimicrobials (16.94%). Polypharmacy was observed in 94(88.67%) patients. According to Beers criteria, 23(21.69%) patients were prescribed inappropriately & all these were drugs to be generally avoided in older adults. Conclusion: This study has shown the patterns of diseases prevalent in geriatric patients, drug use among them and also suggests that drugs to be avoided in elderly are among the most frequently inappropriately prescribed drugs. Prevalence of polypharmacy was high which is usually unavoidable in the elderly.

Concerns about studies investigating new anticoagulant drugs for stroke prevention in atrial fibrillation

Dear Sirs, Vitamin K-antagonists are highly effective in preventing stroke in patients with atrial fibrillation (AF) but have limitations like drug and food interactions; therefore, better drugs for stroke prevention are warranted. In the last 2 years, three studies, RE-LY, ROCKET-AF and ARISTOTLE, have been published which evaluated the new anticoagulant drugs dabigatran, rivaroxaban and apixaban in AF-patients [1‐3]. Dabigatran has been approved in several countries for stroke prevention in AF. The American Heart Association recommended dabigatran as class I, level of evidence B, as an alternative to warfarin for prevention of stroke and systemic thromboembolism in patients with paroxysmal or permanent AF who do not have severe renal failure (creatinine clearance \ 15 mL/min) or advanced liver disease [4]. Since new anticoagulants are mainly eliminated by the kidneys, and patients with a creatinine clearance\ 30 mL/min were excluded from the trials [1‐3], doubts arise if endorsement of class I status is justified [5]. Further concerns refer to the use of new anticoagulant drugs in elderly patients, which are the majority of AF patients, because of low body weight and renal dysfunction, drug and food interactions that cannot be detected with a routine coagulation test, and absence of an antagonist [6, 7]. In fact, a subgroup analysis of the RE-LY trial showed that in patients C 75 years, major bleeding was more frequent in dabigatran than in warfarin-treated patients [8]. Furthermore, we have concerns regarding data analysis of the three trials. The outcome-events were analyzed only according to the intention-to-treat principle. Since the discontinuation rates were up to 25%, and higher in the groups of patients treated with the new anticoagulants than with warfarin, it is important also to analyse the data on a per-protocol principle and to assess if the new anticoagulants were indeed associated with less embolic and bleeding events and a lower mortality compared with warfarin.

Use of antiarrhythmic drugs in elderly patients

Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability. Cardiac arrhythmias, including atrial fibrillation, sudden cardiac death, and bradycardia requiring pacemaker placement, all increase exponentially after the age of 60. It is important to distinguish between the normal, physiological consequences of aging on cardiac electrophysiology and the abnormal, pathological alterations. The age-related cardiac changes include ventricular hypertrophy, senile amyloidosis, cardiac valvular degenerative changes and annular calcification, fibrous infiltration of the conduction system, and loss of natural pacemaker cells and these changes could have a profound effect on the development of arrhythmias. The age-related cardiac electrophysiological changes include up- and down-regulation of specific ion channel expression and intracellular Ca2+ overload which promote the development of cardiac arrhythmias. As ion channels are the substrates of antiarrhythmic drugs, it follows that the pharmacokinetics and pharmacodynamics of these drugs will also change with age. Aging alters the absorption, distribution, metabolism, and elimination of antiarrhythmic drugs, so liver and kidney function must be monitored to avoid potential adverse drug effects, and antiarrhythmic dosing may need to be adjusted for age. Elderly patients are also more susceptible to the side effects of many antiarrhythmics, including bradycardia, orthostatic hypotension, urinary retention, and falls. Moreover, the choice of antiarrhythmic drugs in the elderly patient is frequently complicated by the presence of co-morbid conditions and by polypharmacy, and the astute physician must pay careful attention to potential drug-drug interactions. Finally, it is important to remember that the use of antiarrhythmic drugs in elderly patients must be individualized and tailored to each patient's physiology, disease processes, and medication regimen.

Age-related Changes in Pharmacodynamics: Focus on Drugs Acting on Central Nervous and Cardiovascular Systems

Aging is characterized by progressive impairment of functional capacities of all system organs, reduction in homeostatic mechanisms, and altered response to receptor stimulation. These age-related physiologic changes influence both pharmacokinetics and pharmacodynamics of drugs in elderly patients. Pharmacokinetic and pharmacodynamics changes as well as polypharmacy and comorbidities may alter significantly the effect of pharmacological treatment with advancing age. With the same drug concentration at the site of action, significant differences in the response to several drugs have been observed in older patients as compared to younger patients. Elderly patients are particularly suceptibles to the effects of frequently prescribed drugs acting on central nervous system, such as benzodiazepines, antidepressants, antipsychotics and lithium, with high potential for adverse drug reactions. Moreover, in older patients increased sensitivity to warfarin resulting in increased risk of bleeding has been previously documented. On the other hand, reduced effectiveness of conventional doses of cardiovascular drugs, such as diuretics and β-blockers, has been observed. Due to pharmacodynamic changes, therefore, dose adjustment of the above mentioned cardiovascular and psychotropic drugs is recommended in elderly. Clinicians should be aware of the age-related physiologic changes affecting several organ systems and their implications on the effect of drugs that are commonly prescribed to elderly patients.

Health management of older persons with chronically medicated psychotic disorders: the results of a survey in France

The medical care of elderly patients with psychotic disorders is a matter of major concern. The aim of the study was to investigate health conditions and treatment of elderly patients with psychotic disorders in France. The SAGE (Schizophrenia AGEd) study (observational, cross-sectional) was a survey conducted among 123 physicians in France, regarding prescriptions of antipsychotic drugs in elderly patients (≥60 years) suffering from psychotic disorders. The survey was based on a questionnaire addressing the mental and somatic health management of the patients. Data from 930 patients (mean age: 70.4 years) were collected. Most patients (58.5%) suffered from schizophrenia, 20.8% had delusional disorder and 20.6% hallucinatory chronic psychosis (very-late-onset schizophrenia-like psychosis). 70.8% of them were outpatients, while 29.2% were inpatients. The severity of psychotic symptoms was assessed in 97.8% of patients, but cognitive function was only evaluated in 41.6%. Some 46.5% of patients were treated with atypical antipsychotics alone, 36.2% with classical antipsychotics alone and 17.3% received a combination of both, atypical and classical antipsychotics; 36.3% patients were given antiparkinsonian medication, of whom only 17.8% as preventive treatment; 51.1% of patients had somatic comorbidities, particularly cardiovascular disorders (34.0%). Evaluation of renal and/or liver function to adjust the dose of treatment was done in only 32.1% of patients. Over the previous 12 months, almost half of the patients had had no ECG, glycemia or creatininemia investigated and HDL-cholesterol and triglycerides were available for less than one-third of them. Antipsychotic and antiparkinsonian drug prescriptions in French aged psychotic patients follow only partially the clinical guidelines and recommendations of consensus conferences. Moreover, cognitive, cardiac and metabolic aspects are not fully managed as expected.