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One in five elderly people living in the community is prescribed an antidepressant, antianxiety agent, or other psychotropic medication, according to a study supported by the Agency for Healthcare Research and Quality (HS10813). A second AHRQ-supported study (K02 HS00006) found that depressive symptoms further increase the risk of death among elderly people who also have poor cognitive function. Both studies are summarized here.
Aparasu, R.R., Mort, J.R., and Brandt, H. (2003). "Psychotropic prescription use by community-dwelling elderly in the United States." Journal of the American Geriatrics Society 51, pp. 671-677.
This study found that 19 percent of community-dwelling elderly people used psychotropic medications in 1996, primarily antidepressants and antianxiety agents. Nearly one-fourth of those who were taking psychotropic medications were taking two or more of these drugs, most frequently antidepressants (9.1 percent) followed by antianxiety agents (7.5 percent), sedatives/hypnotics (4.8 percent), antipsychotics (1.8 percent), and stimulants (0.1 percent).
Several factors were associated with psychotropic prescription use in community-dwelling elderly. These included prescription insurance, health status, sex, race, region, and education. Among these factors, only sex was significantly associated with general psychotropic use and with the use of antidepressants and antianxiety agents in the elderly.
Elderly women were more likely to use psychotropic agents than elderly men and nearly one-and-a-half times as likely to use antidepressants and antianxiety agents as elderly men. This may be due to differences between men and women in disease prevalence, health care seeking behavior, and variations in physician prescribing. These findings are based on a retrospective analysis of data on elderly community-dwelling men and women from the 1996 Medical Expenditure Panel Survey, a nationally representative sample survey of the U.S. non-institutionalized population.
Mehta, K.M., Yaffe, K., Langa, K.M., and others (2003). "Additive effects of cognitive function and depressive symptoms on mortality in elderly community-living adults." Journal of Gerontology: Medical Sciences 58A(5), pp. 461-467.
Poor cognitive function and depressive symptoms are common in the elderly and frequently coexist. Each one independently increases mortality in the elderly, and their effects on mortality are additive, according to this study. The researchers studied 6,301 elderly community-dwelling adults enrolled in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study conducted from 1993 to 1995. They measured cognitive function and depressive symptoms and divided participants into three groups representing the best, middle, and worst scores. They also assessed mortality rates.
After adjustment for confounding factors, elderly people with the worst function on both measures had three times greater risk of death than those with the best function on both measures. Among the elderly with the best cognitive function, mortality rates were 3, 5, and 9 percent in those with low, middle, and high depressive symptoms, respectively. The corresponding rates were 6, 7, and 12 percent for elderly with the middle level of cognitive function, and 10, 13, and 16 percent in participants with the worst level of cognitive function. This finding highlights the need to consider both of these measures of mental well being as important indicators of vulnerability in community-dwelling elderly people.
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