Extent and Predictors of Potentially Inappropriate Antidepressant Use Among Older Adults With Dementia and Major Depressive Disorder |
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| Affiliation: | 1. Department of Pharmacy Practice and Science (SB, JKL, NV, DCM), College of Pharmacy, University of Arizona, Tucson, AZ;2. University of Sydney School of Pharmacy (AEP), Royal Prince Alfred Hospital, Faculty of Medicine and Health, University of Sydney, NSW, Australia;3. Statistics Consulting Laboratory (SMK), Bio5 Institute, University of Arizona, Tucson, AZ;4. Department of Pharmaceutical Outcomes & Policy (WHLC), College of Pharmacy, University of Florida, Gainesville, FL;5. Banner Alzheimer''s Institute (WJB), Phoenix;6. University of Arizona College of Medicine (WJB), Phoenix;7. Arizona Alzheimer''s Consortium (WJB), Phoenix |
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| Abstract: | ObjectiveTo quantify the extent and identify predictors of potentially inappropriate antidepressant use among older adults with dementia and newly diagnosed major depressive disorders (MDD).MethodsThis 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.ResultsThe 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.ConclusionMore 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. |
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