Suboptimal antidepressant use in the elderly.
Suboptimal antidepressant use in the elderly.
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老年人抗抑郁药的使用不理想。
DOI：
10.1097/01.jcp.0000155819.67209.e5
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发表时间：
2005
影响因子：
2.9
通讯作者：
Avorn,Jerry
中科院分区：
文献类型：
--
作者：
Wang,PhilipS;Schneeweiss,Sebastian;Brookhart,MAlan;Glynn,RobertJ;Mogun,Helen;Patrick,AmandaR;Avorn,Jerry
现有药物和卫生保健提供系统的持续变化使得研究易受伤害和传统上服务不足的老年人使用抗抑郁药的质量势在必行。从1994年1月1日至1999年12月31日，我们对12130名年龄≥65岁的新抗抑郁药物使用者进行了回顾性队列研究，这些人最近被诊断为抑郁症，他们来自宾夕法尼亚州老年人药物援助合同项目。其他使用信息可通过医疗保险数据获得。潜在危险的抗抑郁治疗方案被定义为使用高抗胆碱能药物或每日剂量超过老年处方指南。低强度方案的定义是低于推荐的每日剂量，治疗持续时间过短，或缺乏随访。在所有老年抗抑郁药使用者中，43.3%的人服用的是次优方案。11.9%的人使用有潜在危险的治疗方案，其中7.3%的人使用高度抗胆碱能药物，5.3%的人使用过高的日剂量。34.8%的患者使用低强度方案，其中7.6%的患者日剂量过低，19.3%的患者治疗时间短，14.8%的患者随访不足。潜在的危险方案与65 - 74岁、养老院居住、癌症诊断、合并症较少、使用其他精神药物、就诊次数较多和日历年份较早有关。低强度方案与年龄≥85岁、非白种人、更多合并症、基线6个月内就诊或住院天数较少以及未使用其他精神科药物相关。抗抑郁药的次优使用在老年人中仍然很常见，特别是使用强度不足的方案。需要采取干预措施，以改善这一弱势群体使用抗抑郁药的质量和结果。
Ongoing changes in available agents and health care delivery systems have made it imperative to study the quality of antidepressant use in vulnerable and traditionally underserved elderly. We conducted a retrospective cohort study among 12,130 new antidepressant users aged≥ 65 years with a recent diagnosis of depression in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly Program from January 1, 1994, to December 31, 1999. Additional use information was available through Medicare data. Potentially hazardous antidepressant regimens were defined as use of highly anticholinergic agents or daily dosages in excess of geriatric prescribing guidelines. Low-intensity regimens were defined by lower than recommended daily dosages, too-short durations of therapy, or lack of follow-up. Of all elderly antidepressant users, 43.3% were taking suboptimal regimens. Potentially hazardous regimens were used by 11.9%, including 7.3% taking highly anticholinergic agents and 5.3% using excessively high daily dosages. Low-intensity regimens were used by 34.8% of patients, including 7.6% with excessively low daily dosages, 19.3% with short durations of therapy, and 14.8% with inadequate follow-up. Potentially hazardous regimens were associated with ages 65 to 74 years, nursing home residence, cancer diagnoses, less comorbidity, use of other psychiatric medications, making more physician visits, and earlier calendar years. Low-intensity regimens were associated with ages≥ 85 years, nonwhite race, greater comorbidity, fewer physician visits or inpatient days in the baseline 6 months, and not using other psychiatric medications. Suboptimal antidepressant use remains common in the elderly, especially the use of inadequately intensive regimens. Interventions are needed to improve the quality and outcomes of antidepressant use in this vulnerable population.