Extent and Predictors of Potentially Inappropriate Antidepressant Use Among Older Adults With Dementia and Major Depressive Disorder

Sandipan Bhattacharjee, Jeannie K Lee, Asad E Patanwala, Nina Vadiei, Daniel C Malone, Shannon M. Knapp, Wei Hsuan Lo-Ciganic, William J. Burke

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Abstract

Objective: To quantify the extent and identify predictors of potentially inappropriate antidepressant use among older adults with dementia and newly diagnosed major depressive disorders (MDD). Methods: This retrospective cohort study included older adults (aged ≥65 years) with dementia and newly diagnosed MDD using Medicare 5% sample claims data (2012–2013). Based on Healthcare Effectiveness Data and Information Set guidelines, intake period for new antidepressant medication use was from May 1, 2012, through April 30, 2013. Index prescription start date was the first date of antidepressant prescription claim during the intake period. Dependent variable of this study was potentially inappropriate antidepressant use as defined by the Beers Criteria and the Screening Tool of Older Persons’ potentially inappropriate Prescriptions criteria. The authors conducted multiple logistic regression analysis to identify individual-level predictors of potentially inappropriate antidepressant use. Results: The authors’ final study sample consisted of 7,625 older adults with dementia and newly diagnosed MDD, among which 7.59% (N = 579) initiated treatment with a potentially inappropriate antidepressant. Paroxetine (N = 394) was the most commonly initiated potentially inappropriate antidepressant followed by amitriptyline (N = 104), nortriptyline (N = 35), and doxepin (N = 32). Initiation of a potentially inappropriate antidepressant was associated with age and baseline use of anxiolytic medications. Conclusion: More than 7% of older adults in the study sample initiated a potentially inappropriate antidepressant, and the authors identified a few individual-level factors significantly associated with it. Appropriately tailored interventions to address modifiable and nonmodifiable factors significantly associated with potentially inappropriate antidepressant prescribing are required to minimize risks in this vulnerable population.

Original languageEnglish (US)
JournalAmerican Journal of Geriatric Psychiatry
DOIs
StatePublished - Jan 1 2019

Fingerprint

Major Depressive Disorder
Antidepressive Agents
Dementia
Prescriptions
Doxepin
Inappropriate Prescribing
Nortriptyline
Paroxetine
Amitriptyline
Anti-Anxiety Agents
Vulnerable Populations
Medicare
Cohort Studies
Retrospective Studies
Logistic Models
Regression Analysis
Guidelines
Delivery of Health Care

Keywords

  • antidepressants
  • Beers Criteria
  • Dementia
  • depression
  • psychotherapy
  • Screening Tool of Older Persons’ potentially inappropriate Prescriptions criteria

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health

Cite this

@article{8de63e4474254f9c92cc7588da195028,
title = "Extent and Predictors of Potentially Inappropriate Antidepressant Use Among Older Adults With Dementia and Major Depressive Disorder",
abstract = "Objective: To quantify the extent and identify predictors of potentially inappropriate antidepressant use among older adults with dementia and newly diagnosed major depressive disorders (MDD). Methods: This retrospective cohort study included older adults (aged ≥65 years) with dementia and newly diagnosed MDD using Medicare 5{\%} sample claims data (2012–2013). Based on Healthcare Effectiveness Data and Information Set guidelines, intake period for new antidepressant medication use was from May 1, 2012, through April 30, 2013. Index prescription start date was the first date of antidepressant prescription claim during the intake period. Dependent variable of this study was potentially inappropriate antidepressant use as defined by the Beers Criteria and the Screening Tool of Older Persons’ potentially inappropriate Prescriptions criteria. The authors conducted multiple logistic regression analysis to identify individual-level predictors of potentially inappropriate antidepressant use. Results: The authors’ final study sample consisted of 7,625 older adults with dementia and newly diagnosed MDD, among which 7.59{\%} (N = 579) initiated treatment with a potentially inappropriate antidepressant. Paroxetine (N = 394) was the most commonly initiated potentially inappropriate antidepressant followed by amitriptyline (N = 104), nortriptyline (N = 35), and doxepin (N = 32). Initiation of a potentially inappropriate antidepressant was associated with age and baseline use of anxiolytic medications. Conclusion: More than 7{\%} of older adults in the study sample initiated a potentially inappropriate antidepressant, and the authors identified a few individual-level factors significantly associated with it. Appropriately tailored interventions to address modifiable and nonmodifiable factors significantly associated with potentially inappropriate antidepressant prescribing are required to minimize risks in this vulnerable population.",
keywords = "antidepressants, Beers Criteria, Dementia, depression, psychotherapy, Screening Tool of Older Persons’ potentially inappropriate Prescriptions criteria",
author = "Sandipan Bhattacharjee and Lee, {Jeannie K} and Patanwala, {Asad E} and Nina Vadiei and Malone, {Daniel C} and Knapp, {Shannon M.} and Lo-Ciganic, {Wei Hsuan} and Burke, {William J.}",
year = "2019",
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T1 - Extent and Predictors of Potentially Inappropriate Antidepressant Use Among Older Adults With Dementia and Major Depressive Disorder

AU - Bhattacharjee, Sandipan

AU - Lee, Jeannie K

AU - Patanwala, Asad E

AU - Vadiei, Nina

AU - Malone, Daniel C

AU - Knapp, Shannon M.

AU - Lo-Ciganic, Wei Hsuan

AU - Burke, William J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To quantify the extent and identify predictors of potentially inappropriate antidepressant use among older adults with dementia and newly diagnosed major depressive disorders (MDD). Methods: This retrospective cohort study included older adults (aged ≥65 years) with dementia and newly diagnosed MDD using Medicare 5% sample claims data (2012–2013). Based on Healthcare Effectiveness Data and Information Set guidelines, intake period for new antidepressant medication use was from May 1, 2012, through April 30, 2013. Index prescription start date was the first date of antidepressant prescription claim during the intake period. Dependent variable of this study was potentially inappropriate antidepressant use as defined by the Beers Criteria and the Screening Tool of Older Persons’ potentially inappropriate Prescriptions criteria. The authors conducted multiple logistic regression analysis to identify individual-level predictors of potentially inappropriate antidepressant use. Results: The authors’ final study sample consisted of 7,625 older adults with dementia and newly diagnosed MDD, among which 7.59% (N = 579) initiated treatment with a potentially inappropriate antidepressant. Paroxetine (N = 394) was the most commonly initiated potentially inappropriate antidepressant followed by amitriptyline (N = 104), nortriptyline (N = 35), and doxepin (N = 32). Initiation of a potentially inappropriate antidepressant was associated with age and baseline use of anxiolytic medications. Conclusion: More than 7% of older adults in the study sample initiated a potentially inappropriate antidepressant, and the authors identified a few individual-level factors significantly associated with it. Appropriately tailored interventions to address modifiable and nonmodifiable factors significantly associated with potentially inappropriate antidepressant prescribing are required to minimize risks in this vulnerable population.

AB - Objective: To quantify the extent and identify predictors of potentially inappropriate antidepressant use among older adults with dementia and newly diagnosed major depressive disorders (MDD). Methods: This retrospective cohort study included older adults (aged ≥65 years) with dementia and newly diagnosed MDD using Medicare 5% sample claims data (2012–2013). Based on Healthcare Effectiveness Data and Information Set guidelines, intake period for new antidepressant medication use was from May 1, 2012, through April 30, 2013. Index prescription start date was the first date of antidepressant prescription claim during the intake period. Dependent variable of this study was potentially inappropriate antidepressant use as defined by the Beers Criteria and the Screening Tool of Older Persons’ potentially inappropriate Prescriptions criteria. The authors conducted multiple logistic regression analysis to identify individual-level predictors of potentially inappropriate antidepressant use. Results: The authors’ final study sample consisted of 7,625 older adults with dementia and newly diagnosed MDD, among which 7.59% (N = 579) initiated treatment with a potentially inappropriate antidepressant. Paroxetine (N = 394) was the most commonly initiated potentially inappropriate antidepressant followed by amitriptyline (N = 104), nortriptyline (N = 35), and doxepin (N = 32). Initiation of a potentially inappropriate antidepressant was associated with age and baseline use of anxiolytic medications. Conclusion: More than 7% of older adults in the study sample initiated a potentially inappropriate antidepressant, and the authors identified a few individual-level factors significantly associated with it. Appropriately tailored interventions to address modifiable and nonmodifiable factors significantly associated with potentially inappropriate antidepressant prescribing are required to minimize risks in this vulnerable population.

KW - antidepressants

KW - Beers Criteria

KW - Dementia

KW - depression

KW - psychotherapy

KW - Screening Tool of Older Persons’ potentially inappropriate Prescriptions criteria

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