National trends in antidepressant, benzodiazepine, and other sedative-hypnotic treatment of older adults in psychiatric and primary care

Donovan T. Maust, Frederic C. Blow, Ilse R. Wiechers, Helen C. Kales, Steven C. Marcus

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective: To describe how use of antidepressants, benzodiazepines, and other anxiolytic/sedative-hypnotics among older adults (age = 65 years) has changed over time among visits to primary care providers and psychiatrists. Methods: Data were from the National Ambulatory Medical Care Survey (years 2003-2005 and 2010-2012), a nationally representative cross-section of outpatient physician visits. Analysis focused on visits to primary care providers (n = 14,282) and psychiatrists (n = 1,095) at which an antidepressant, benzodiazepine, or other anxiolytic/sedativehypnotic was prescribed, which were stratified by demographic and clinical characteristic (including ICD-9-CM diagnosis) and compared across study intervals. Odds of medication use were calculated for each stratum, adjusting for demographic and clinical characteristics. Results: The visit rate by older adults to primary care providers where any of the medications were prescribed rose from 16.4% to 21.8% (adjusted odds ratio [AOR] = 1.43, P < .001) while remaining steady among psychiatrists (75.4% vs 68.5%; AOR = 0.69, P = .11). Primary care visits rose for antidepressants (9.9% to 12.3%; AOR = 1.28, P = .01) and other anxiolytic/sedative-hypnotics (3.4% to 4.7%; AOR = 1.39, P = .01), but the largest growth was among benzodiazepines (5.6% to 8.7%; AOR = 1.62, P < .001). Among patients in primary care, increases primarily occurred among men, non-Hispanic white patients, and those with pain diagnoses as well as those with no mental health or pain diagnoses. Conclusions: From 2003 to 2012, use of the most common psychotropic medications among older adults seen in primary care increased, with concentration among patients with no mental health or pain diagnosis. As the population of older adults grows and receives mental health treatment in primary care, it is critical to examine the appropriateness of psychotropic use.

Original languageEnglish (US)
Pages (from-to)e363-e371
JournalJournal of Clinical Psychiatry
Volume78
Issue number4
DOIs
StatePublished - Apr 2017
Externally publishedYes

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Hypnotics and Sedatives
Benzodiazepines
Antidepressive Agents
Psychiatry
Primary Health Care
Odds Ratio
Anti-Anxiety Agents
Mental Health
Pain
Therapeutics
Demography
Health Care Surveys
International Classification of Diseases
Outpatients
Physicians
Growth
Population

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

National trends in antidepressant, benzodiazepine, and other sedative-hypnotic treatment of older adults in psychiatric and primary care. / Maust, Donovan T.; Blow, Frederic C.; Wiechers, Ilse R.; Kales, Helen C.; Marcus, Steven C.

In: Journal of Clinical Psychiatry, Vol. 78, No. 4, 04.2017, p. e363-e371.

Research output: Contribution to journalArticle

Maust, Donovan T. ; Blow, Frederic C. ; Wiechers, Ilse R. ; Kales, Helen C. ; Marcus, Steven C. / National trends in antidepressant, benzodiazepine, and other sedative-hypnotic treatment of older adults in psychiatric and primary care. In: Journal of Clinical Psychiatry. 2017 ; Vol. 78, No. 4. pp. e363-e371.
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T1 - National trends in antidepressant, benzodiazepine, and other sedative-hypnotic treatment of older adults in psychiatric and primary care

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AU - Kales, Helen C.

AU - Marcus, Steven C.

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