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首页> 外文期刊>The American journal of geriatric pharmacotherapy >Prevalence and predictors of antidepressant prescribing in nursing home residents in the United States
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Prevalence and predictors of antidepressant prescribing in nursing home residents in the United States

机译：在美国疗养院居民中抗抑郁药处方的流行和预测因素

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Background: Late-life depression is a common psychiatric disorder associated with increased morbidity and mortality. Depression is often under-detected and undertreated in elderly nursing home residents. Objectives: The aim of this study was to examine the prevalence of antidepressant drug use and to identify the factors associated with its use among elderly nursing home residents. Methods: The study involved the analysis of a nationally representative sample of prescription and resident files from the 2004 National Nursing Home Survey (NNHS). The study sample included all elderly nursing home residents <65 years of age. The analysis focused on prescribing from any antidepressant class, including selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), serotonin modulators, serotonin- norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and others. Descriptive weighted analysis was performed to examine antidepressant use prevalence patterns in elderly nursing home residents. Multiple logistic regression analysis within the conceptual framework of Anderson's behavioral model was used to examine the predisposing, enabling, and need characteristics associated with antidepressant use. Results: According to the 2004 NNHS, overall prevalence of antidepressant use among elderly nursing home residents was 46.22% (95% CI, 45.16-47.27). Most antidepressant users were <85 years of age (49.7%), female (75.7%), non-Hispanic (96.4%), and white (91.1%). The most prescribed class of antidepressants was SSRIs (31.09%; 95% CI, 30.12-32.07), followed by serotonin modulators (4.65%; 95% CI, 4.22-5.09), SNRIs (2.78%; 95% CI, 2.45-3.12), TCAs (2.34%; 95% CI, 2.03-2.65), and MAOIs (0.01%; 95% CI, 0.00-0.03). Citalopram (12.92%; 95% CI, 12.21-13.63) was the most prescribed individual antidepressant, followed by mirtazapine (10.19%; 95% CI, 9.55-10.84). Among the predisposing characteristics, age, race, and marital status were significantly associated with antidepressant use. The odds of receiving an antidepressant were lower for those aged <85 years and those who were unmarried elderly residents, when compared with their counterparts; whites were more likely to receive an antidepressant than nonwhites. Enabling factors such as Medicaid and bed capacity significantly predicted antidepressant use. Having Medicaid was positively associated with antidepressant prescription, whereas an increase in the total number of beds decreased the probability of an antidepressant prescription. Among need characteristics, the likelihood of antidepressant prescription use decreased with increased dependence in decision-making ability and out-of-bed mobility. The presence of depressed mood indicators and a history of falls/fractures increased the likelihood of antidepressant prescription use. The odds of receiving an antidepressant increased with diagnosis of depression but decreased with diagnosis of anxiety. Conclusion: Nearly half of elderly nursing home residents received antidepressants. In addition to need factors, predisposing and enabling factors played an important role in influencing the use of antidepressants in elderly nursing home residents.
机译：背景：晚年抑郁症是一种常见的精神疾病，与发病率和死亡率增加有关。在老年疗养院居民中，抑郁症经常被发现不足并且未得到充分治疗。目的：本研究的目的是检查抗抑郁药的使用率，并确定老年人疗养院居民使用抗抑郁药的相关因素。方法：该研究涉及对2004年全国疗养院调查（NNHS）中具有全国代表性的处方和住院医生档案进行分析。该研究样本包括所有65岁以下的养老院老人。该分析着重于开出任何抗抑郁药的处方，包括选择性5-羟色胺再摄取抑制剂（SSRI），三环抗抑郁药（TCA），5-羟色胺调节剂，5-羟色胺去甲肾上腺素再摄取抑制剂（SNRIs），单胺氧化酶抑制剂（MAOIs）等。进行描述性加权分析，以检查老年人疗养院居民中抗抑郁药的使用情况。在安德森行为模型的概念框架内的多重逻辑回归分析被用来检验与抗抑郁药使用相关的易感性，促成性和需求特征。结果：根据2004年的NNHS，老年人疗养院居民使用抗抑郁药的总体患病率为46.22％（95％CI，45.16-47.27）。大多数抗抑郁药使用者的年龄分别是<85岁（49.7％），女性（75.7％），非西班牙裔（96.4％）和白人（91.1％）。规定最抗抑郁的药物是SSRIs（31.09％; 95％CI，30.12-32.07），其次是血清素调节剂（4.65％; 95％CI，4.22-5.09），SNRIs（2.78％; 95％CI，2.45-3.12） ），TCA（2.34％; 95％CI，2.03-2.65）和MAOI（0.01％; 95％CI，0.00-0.03）。西酞普兰（12.92％; 95％CI，12.21-13.63）是处方量最大的个体抗抑郁药，其次是米氮平（10.19％; 95％CI，9.55-10.84）。在易感特征中，年龄，种族和婚姻状况与抗抑郁药的使用显着相关。与同龄人相比，年龄<85岁的人和未婚的老年居民接受抗抑郁药的几率更低;白人比非白人更有可能接受抗抑郁药。诸如医疗补助和床容量之类的有利因素显着预测了抗抑郁药的使用。服用Medicaid与抗抑郁药处方呈正相关，而增加床位数则降低了抗抑郁药处方的可能性。在需求特征中，使用抗抑郁药的可能性随着对决策能力和床外活动能力的依赖性增加而降低。情绪低落指标的存在和跌倒/骨折的历史增加了使用抗抑郁药处方的可能性。诊断为抑郁症时接受抗抑郁药的几率增加，但随着焦虑症的诊断而降低。结论：将近一半的老年人疗养院居民接受了抗抑郁药治疗。除需要因素外，诱发因素和促成因素在影响老年人疗养院居民抗抑郁药的使用方面也起着重要作用。

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