Fourteen-Year Trends in the Use of Psychotropic Medications,Opioids, and Other Sedatives Among Institutionalized Older People in Helsinki,Finland

Objectives

The use of psychotropic drugs in long-term care (LTC) is very common, despite their known adverse effects. The prevalence of opioid use is growing among older adults. This study aimed to investigate trends in the prevalence of psychotropics, opioids, and sedative load in a LTC setting over a 14-year period. We also explored the interaction of psychotropic and opioid use according to residents’ dementia status in nursing home (NH) and assisted living facility (ALF) settings.

Use of Anticholinergic Drugs According to Various Criteria and Their Association With Psychological Well-Being and Mortality in Long-Term Care Facilities

ObjectivesTo compare 3 internationally established criteria for drugs with anticholinergic properties (DAPs) and their associated factors in long-term care facilities, and to investigate the association between use of DAPs and psychological well-being (PWB) or mortality.DesignCross-sectional study and 1-year follow-up of all-cause mortality.Setting and ParticipantsOf all 4449 residents living in long-term care facilities in Helsinki in 2011, 2432 (≥65 years of age) participated after exclusion of residents with severe dementia.MeasurementsData on demographics, medication use, and active diagnoses were collected by trained staff using structured questionnaires. DAP use was defined by the following 3 international criteria: Chew's list, the Anticholinergic Risk Scale, and the Anticholinergic Drug Scale. The total number of DAPs was counted and referred to as anticholinergic burden. PWB was assessed by a questionnaire and yielded a score ranging from 0 to 1. Mortality data was retrieved from central registers.ResultsOf all participants, 85% were DAP users according to at least 1 of the 3 criteria used. Overlap between the 3 criteria was only moderate. DAP users were younger and a larger proportion of them had better cognition. However, they suffered more often from depression and other psychiatric diagnoses than nonusers. DAP users had lower PWB scores than those not using DAPs, and PWB decreased linearly in the overlapping groups from nonusers to those using DAPs according to all 3 criteria. The total number of DAPs used predicted mortality.Conclusions and ImplicationsDAP use and PWB appear to be negatively associated. When combining several criteria of DAPs, their burden predicted mortality. Clinicians should carefully consider the potential benefits and harms when prescribing DAPs to older persons.     

Use of Anticholinergic Drugs and its Relationship With Psychological Well-Being and Mortality in Long-Term Care Facilities in Helsinki

Objectives

To assess the burden of drugs with anticholinergic properties (DAPs) and associated factors in long-term care facilities and to explore how psychological well-being and mortality are associated with the use of DAPs.