An investigation of inappropriate medication use in treatment of depressivity in institutionalized older adults, based on a nurse-led evaluation of functional status and depressive symptoms in nursing home residents. Methods: A cross-sectional multicenter study was performed using records from 1087 residents cared for in fifteen nursing homes (NHs) in the Czech Republic. Inclusion criteria were being a permanent resident of one of the facilities, being 60 years of age or older, having a Geriatric Depression Scale score of 6 or more, and having a Mini Mental State examination score 10 or more. The final sample for analysis included 317 depressed NH residents. Results: 52 percent of NH residents with depressivity had no antidepressant treatment. Benzodiazepines were the only medication in 16 percent of depressed residents, and were added to antidepressant treatment in 18 percent of residents. Benzodiazepine users had significantly higher GDS scores compared to non-users (p = 0.007). Conclusion: More than half of depressed NH residents remained without antidepressant treatment. Residents inappropriately treated with benzodiazepines were more depressed than residents treated with antidepressants only, or even not treated at all. Cooperation of the interprofessional team in the screening of depressive symptoms has the potential to improve the quality of care.

3rd Faculty of Medicine Charles University 10000 Praha Czech Republic

Faculty of Humanities CELLO ILC CZ Charles University 18200 Praha Czech Republic

School of Aging Studies University of South Florida Tampa FL 34639 USA

Zobrazit více v PubMed

Thakur M., Blazer D.G. Depression in Long-Term Care. J. Am. Med. Dir. Assoc. 2008;9:82–87. doi: 10.1016/j.jamda.2007.09.007. PubMed DOI

Tsai Y.-F., Chung J., Wong T.K.S., Huang C.-M. Comparison of the prevalence and risk factors for depressive symptoms among elderly nursing home residents in Taiwan and Hong Kong. Int. J. Geriatr. Psychiatry. 2005;20:315–321. doi: 10.1002/gps.1281. PubMed DOI

Olin J.T., Schneider L.S., Katz I.R., Meyers B.S., Alexopoulos G.S., Breitner J.C., Bruce M.L., Caine E.D., Cummings J.L., Devanand D.P., et al. Provisional Diagnostic Criteria for Depression of Alzheimer Disease. Am. J. Geriatr. Psychiatry. 2002;10:125–128. doi: 10.1097/00019442-200203000-00003. PubMed DOI

Volicer L., Frijters D., van der Steen J. Underdiagnosis and undertreatment of depression in nursing home residents. Eur. Geriatr. Med. 2011;2:332–337. doi: 10.1016/j.eurger.2011.08.001. DOI

Onder G., Liperoti R., Bernabei R., Landi F., Project F.T.S., Fialova D., Topinkova E., Tosato M., Danese P., Gallo P.F., et al. Polypharmacy in Nursing Home in Europe: Results from the SHELTER Study. J. Gerontol. Ser. A Boil. Sci. Med. Sci. 2012;67A:698–704. doi: 10.1093/gerona/glr233. PubMed DOI

Giovannini S., Onder G., van der Roest H.G., Topinkova E., Gindin J., Cipriani M.C., Denkinger M.D., Bernabei R., Liperoti R., on behalf of the SHELTER Study Investigators Use of antidepressant medications among older adults in European long-term care facilities: A cross-sectional analysis from the SHELTER study. BMC Geriatr. 2020;20:310. doi: 10.1186/s12877-020-01730-5. PubMed DOI PMC

Yamamoto T., Hirano A. Nucleus raphe dorsalis in Alzheimer’s disease: Neurofibrillary tangles and loss of large neurons. Ann. Neurol. 1985;17:573–577. doi: 10.1002/ana.410170608. PubMed DOI

Chen K.H., Reese E.A., Kim H.-W., Rapoport S.I., Rao J.S. Disturbed Neurotransmitter Transporter Expression in Alzheimer’s Disease Brain. J. Alzheimer’s Dis. 2011;26:755–766. doi: 10.3233/JAD-2011-110002. PubMed DOI PMC

Zweig R.M., Ross C.A., Hedreen J.C., Steele C., Cardillo J.E., Whitehouse P.J., Folstein M.F., Price D.L. The neuropathology of aminergic nuclei in Alzheimer’s disease. Ann. Neurol. 1988;24:233–242. doi: 10.1002/ana.410240210. PubMed DOI

Steffens D.C., Skoog I., Norton M.C., Hart A.D., Tschanz J.T., Plassman B.L., Wyse B.W., Welsh-Bohmer K.A., Breitner J.C. Prevalence of depression and its treatment in an elderly population: The Cache County study. Arch. Gen. Psychiatry. 2000;57:601–607. doi: 10.1001/archpsyc.57.6.601. PubMed DOI

Assem-Hilger E., Jungwirth S., Weissgram S., Kirchmeyr W., Fischer P., Barnas C. Benzodiazepine use in the elderly: An indicator for inappropriately treated geriatric depression? Int. J. Geriatr. Psychiatry. 2009;24:563–569. doi: 10.1002/gps.2155. PubMed DOI

Alexopoulos G.S. Pharmacotherapy for Late-Life Depression. J. Clin. Psychiatry. 2011;72:e04. doi: 10.4088/JCP.7085tx2cj. PubMed DOI PMC

O’Mahony D., O’Sullivan D., Byrne S., O’Connor M.N., Ryan C., Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2. Age Ageing. 2014;44:213–218. doi: 10.1093/ageing/afu145. PubMed DOI PMC

Gelenberg A.J., Freeman M.P., Markowitz J.C., Rosenbaum J.F., Thase M.E., Trivedi M.H., Silbersweig D.A. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder: Third Edition. Am. J. Psychiatry. 2010;167((Suppl. S10)):9–118.

Dunn R.L., Harrison N., Ripley T.L. The Beers Criteria as an Outpatient Screening Tool for Potentially Inappropriate Medications. Consult. Pharm. 2011;26:754–763. doi: 10.4140/TCP.n.2011.754. PubMed DOI

Cumming R.G., Le Couteur D.G., Le Conteur D.G. Benzodiazepines and Risk of Hip Fractures in Older People. CNS Drugs. 2003;17:825–837. doi: 10.2165/00023210-200317110-00004. PubMed DOI

De Gage S.B., Bégaud B., Bazin F., Verdoux H., Dartigues J.-F., Peres K., Kurth T., Pariente A. Benzodiazepine use and risk of dementia: Prospective population based study. BMJ. 2012;345:e6231. doi: 10.1136/bmj.e6231. PubMed DOI PMC

Weich S., Pearce H.L., Croft P., Singh S., Crome I., Bashford J., Frisher M. Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: Retrospective cohort study. BMJ. 2014;348:g1996. doi: 10.1136/bmj.g1996. PubMed DOI PMC

Olazarán J., Valle D., Serra J.A., Cano P., Muñiz R. Psychotropic Medications and Falls in Nursing Homes: A Cross-Sectional Study. J. Am. Med. Dir. Assoc. 2013;14:213–217. doi: 10.1016/j.jamda.2012.10.020. PubMed DOI

Hanlon J.T., Handler S.M., Castle N.G. Antidepressant Prescribing in US Nursing Homes between 1996 and 2006 and Its Relationship to Staffing Patterns and Use of Other Psychotropic Medications. J. Am. Med. Dir. Assoc. 2010;11:320–324. doi: 10.1016/j.jamda.2010.01.007. PubMed DOI PMC

Lai I.-C., Wang M.-T., Wu B.-J., Wu H.-H., Lian P.-W. The use of benzodiazepine monotherapy for major depression before and after implementation of guidelines for benzodiazepine use. J. Clin. Pharm. Ther. 2011;36:577–584. doi: 10.1111/j.1365-2710.2010.01213.x. PubMed DOI

McGivney S.A., Mulvihill M., Taylor B. Validating the GDS Depression Screen in the Nursing Home. J. Am. Geriatr. Soc. 1994;42:490–492. doi: 10.1111/j.1532-5415.1994.tb04969.x. PubMed DOI

Vankova H., Holmerova I., Machacova K., Volicer L., Veleta P., Celko A.M. The Effect of Dance on Depressive Symptoms in Nursing Home Residents. J. Am. Med. Dir. Assoc. 2014;15:582–587. doi: 10.1016/j.jamda.2014.04.013. PubMed DOI

Susman J., Klee B. The Role of High-Potency Benzodiazepines in the Treatment of Panic Disorder. Prim. Care Companion J. Clin. Psychiatry. 2005;7:5–11. doi: 10.4088/PCC.v07n0101. PubMed DOI PMC

Mahoney F.I. Functional evaluation: The Barthel Index. Md. State Med. J. 1965;14:61–65. PubMed

Folstein M.F., Folstein S.E., McHugh P.R. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6. PubMed DOI

Yesavage J.A., Sheikh J.I. 9/Geriatric Depression Scale (GDS) recent evidence and development of a shorter violence. Clin. Gerontol. 1986;5:165–173. doi: 10.1300/J018v05n01_09. DOI

D’Ath P., Katona P., Mullan E., Evans S., Katona C. Screening, Detection and Management of Depression in Elderly Primary Care Attenders. I: The Acceptability and Performance of the 15 Item Geriatric Depression Scale (GDS15) and the Development of Short Versions. Fam. Pract. 1994;11:260–266. doi: 10.1093/fampra/11.3.260. PubMed DOI

Almeida O.P., Almeida S.A. Short versions of the geriatric depression scale: A study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int. J. Geriatr. Psychiatry. 1999;14:858–865. doi: 10.1002/(SICI)1099-1166(199910)14:10<858::AID-GPS35>3.0.CO;2-8. PubMed DOI

De Craen A.J.M., Heeren T.J., Gussekloo J. Accuracy of the 15-item geriatric depression scale (GDS-15) in a community sample of the oldest old. Int. J. Geriatr. Psychiatry. 2003;18:63–66. doi: 10.1002/gps.773. PubMed DOI

Underwood M., Lamb S., DiazOrdaz K., Ellard D.R., Potter R., Spanjers K., Taylor S.J.C., Eldridge S., Sheehan B., Slowther A., et al. Exercise for depression in care home residents: A randomised controlled trial with cost-effectiveness analysis (OPERA) Health Technol. Assess. 2013;17:1–281. doi: 10.3310/hta17180. PubMed DOI PMC

Underwood M., Eldridge S., Lamb S., Potter R., Sheehan B., Slowther A.-M., Taylor S., Thorogood M., Weich S. The OPERA trial: Protocol for a randomised trial of an exercise intervention for older people in residential and nursing accommodation. Trials. 2011;12:27. doi: 10.1186/1745-6215-12-27. PubMed DOI PMC

Jirak R. Evaluation of psychological functioning in the elderly. In: Kalvach Z., Zadak Z., Jirak R., editors. Geriatrics and Gerontology. Grada Publishing; Prague, Czech Republic: 2004.

Vankova H. Current challenges in the field of geriatrics; Proceedings of the 25th Congress of Gerontology; Hradec Králové, Czech Republic. 20 November 2019.

Holmerova I., Vankova H., Hradcova D. The role of General Practitioner in Long Term Care of older adults; Proceedings of the 20th WONCA World Conference 2013: Family Medicine_Care for Generations; Prague, Czech Republic. 26–29 June 2013.

Chang C.-B., Chan D.-C. Comparison of Published Explicit Criteria for Potentially Inappropriate Medications in Older Adults. Drugs Aging. 2010;27:947–957. doi: 10.2165/11584850-000000000-00000. PubMed DOI

Brett J., Maust D.T., Bouck Z., Ignacio R.V., Mecredy G., Kerr E.A., Bhatia S., Elshaug A., Pearson S.A. Benzodiazepine Use in Older Adults in the United States, Ontario, and Australia from 2010 to 2016. J. Am. Geriatr. Soc. 2018;66:1180–1185. doi: 10.1111/jgs.15292. PubMed DOI PMC

Lader M. Dependence and withdrawal: Comparison of the benzodiazepines and selective serotonin re-uptake inhibitors. Addiction. 2012;107:909–910. doi: 10.1111/j.1360-0443.2011.03736.x. PubMed DOI

Beekman A.T., de Beurs E., van Balkom A.J., Deeg D.J., van Dyck R., van Tilburg W. Anxiety and depression in later life: Co-occurrence and communality of risk factors. Am. J. Psychiatry. 2000;157:89–95. doi: 10.1176/ajp.157.1.89. PubMed DOI

Moscati A., Flint J., Kendler K.S. Classification of anxiety disorders comorbid with major depression: Common or distinct influences on risk? Depress. Anxiety. 2016;33:120–127. doi: 10.1002/da.22432. PubMed DOI PMC

Vink D., Aartsen M., Comijs H.C., Heymans M., Penninx B.W., Stek M.L., Deeg D.J., Beekman A.T. Onset of Anxiety and Depression in the Aging Population: Comparison of Risk Factors in a 9-Year Prospective Study. Am. J. Geriatr. Psychiatry. 2009;17:642–652. doi: 10.1097/JGP.0b013e3181a65228. PubMed DOI

Kendall T., Cape J., Chan M., Taylor C. Guidelines: Management of generalised anxiety disorder in adults: Summary of NICE guidance. BMJ. 2011;342:c7460. doi: 10.1136/bmj.c7460. PubMed DOI PMC

Fick D.M., Cooper J.W., Wade W.E., Waller J.L., Maclean J.R., Beers M.H. Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts. Arch. Intern. Med. 2003;163:2716–2724. doi: 10.1001/archinte.163.22.2716. PubMed DOI

Gallagher P., O’Mahony D. STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): Application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing. 2008;37:673–679. doi: 10.1093/ageing/afn197. PubMed DOI

Cassel C.K., Guest J.A. Choosing wisely: Helping physicians and patients make smart decisions about their care. JAMA. 2012;307:1801–1802. doi: 10.1001/jama.2012.476. PubMed DOI

Lankova J., Raboch J. Depression. Guidelines for General Practitioners. Deprese. Doporučený Postup pro Všeobecné Praktické Lékaře. Novelizace 2013. Společnost Všeobecného Lékařství ČLS JEP, CDP-PL; Praha, Czech Republic: 2013.

Cerveny R. Geriatrics. Guidelines for General Practitioners. Geriatrie. Doporučený Postup pro Všeobecné Praktické Lékaře. Novelizace 2014. Společnost Všeobecného Lékařství ČLS JEP, CDP-PL; Praha, Czech Republic: 2014.

Barreto P., Lapeyre-Mestre M., Mathieu C., Piau C., Bouget C., Cayla F., Vellas B., Rolland Y. Indicators of Benzodiazepine Use in Nursing Home Residents in France: A Cross-Sectional Study. J. Am. Med. Dir. Assoc. 2013;14:29–33. doi: 10.1016/j.jamda.2012.09.002. PubMed DOI

Vetrano D.L., Tosato M., Colloca G., Topinkova E., Fialova D., Gindin J., van der Roest H.G., Landi F., Liperoti R., Bernabei R., et al. Polypharmacy in nursing home residents with severe cognitive impairment: Results from the SHELTER Study. Alzheimer’s Dement. 2013;9:587–593. doi: 10.1016/j.jalz.2012.09.009. PubMed DOI

Mhaoláin A.N., Gallagher D., O’Connell H., Chin A.-V., Bruce I., Hamilton F., Tehee E., Coen R.F., Coakley D., Walsh B., et al. Benzodiazepine use amongst community dwelling elderly: 10 years on. Int. J. Geriatr. Psychiatry. 2010;25:650–651. doi: 10.1002/gps.2362. PubMed DOI

Biering P. Helpful approaches to older people experiencing mental health problems: A critical review of models of mental health care. Eur. J. Ageing. 2019;16:215–225. doi: 10.1007/s10433-018-0490-3. PubMed DOI PMC

Tannenbaum C., Martin P., Tamblyn R., Benedetti A., Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: The EMPOWER cluster randomized trial. JAMA Intern. Med. 2014;174:890–898. doi: 10.1001/jamainternmed.2014.949. PubMed DOI

Vicens C., Bejarano F., Sempere E., Mateu C., Fiol F., Socias I., Aragonès E., Palop V., Beltran J.L., Piñol J.L., et al. Comparative efficacy of two interventions to discontinue long-term benzodiazepine use: Cluster randomised controlled trial in primary care. Br. J. Psychiatry. 2014;204:471–479. doi: 10.1192/bjp.bp.113.134650. PubMed DOI

Paquin A.M., Zimmerman K., Rudolph J.L. Risk versus risk: A review of benzodiazepine reduction in older adults. Expert Opin. Drug Saf. 2014;13:919–934. doi: 10.1517/14740338.2014.925444. PubMed DOI

Tannenbaum C. Inappropriate benzodiazepine use in elderly patients and its reduction. J. Psychiatry Neurosci. 2015;40:E27–E28. doi: 10.1503/jpn.140355. PubMed DOI PMC

Martin P., Tamblyn R., Ahmed S., Tannenbaum C. A drug education tool developed for older adults changes knowledge, beliefs and risk perceptions about inappropriate benzodiazepine prescriptions in the elderly. Patient Educ. Couns. 2013;92:81–87. doi: 10.1016/j.pec.2013.02.016. PubMed DOI

Bourgeois J., Elseviers M., Azermai M., Van Bortel L., Petrovic M., Stichele R.V. Barriers to discontinuation of chronic benzodiazepine use in nursing home residents: Perceptions of general practitioners and nurses. Eur. Geriatr. Med. 2014;5:181–187. doi: 10.1016/j.eurger.2013.11.005. DOI

Bourgeois J., Elseviers M.M., Van Bortel L., Petrovic M., Stichele R.H.V. Feasibility of discontinuing chronic benzodiazepine use in nursing home residents: A pilot study. Eur. J. Clin. Pharmacol. 2014;70:1251–1260. doi: 10.1007/s00228-014-1725-7. PubMed DOI

Souto Barreto P., Lapeyre-Mestre M., Cestac P., Vellas B., Rolland Y. Effects of a geriatric intervention aiming to improve quality care in nursing homes on benzodiazepine use and discontinuation. Br. J. Clin. Pharmacol. 2016;81:759–767. doi: 10.1111/bcp.12847. PubMed DOI PMC

Leggett A., Kavanagh J., Zivin K., Chiang C., Kim H.M., Kales H.C. The Association between Benzodiazepine Use and Depression Outcomes in Older Veterans. J. Geriatr. Psychiatry Neurol. 2015;28:281–287. doi: 10.1177/0891988715598227. PubMed DOI PMC

Morley J.E. Inappropriate Drug Prescribing and Polypharmacy Are Major Causes of Poor Outcomes in Long-Term Care. J. Am. Med. Dir. Assoc. 2014;15:780–782. doi: 10.1016/j.jamda.2014.09.003. PubMed DOI

Cestac P., Tavassoli N., Vellas B., Rolland Y. Improving Medication Use in the Nursing Homes: A European Perspective. J. Am. Med. Dir. Assoc. 2013;14:6–9. doi: 10.1016/j.jamda.2012.09.013. PubMed DOI