Mental health-related drug utilization among older adults: prevalence, trends, and costs.
OBJECTIVE
Authors assessed temporal changes in mental health-related drug utilization and costs in an older population.


METHODS
This was a population-based, cross-sectional time-series analysis of more than 1.4 million residents of Ontario, Canada, age 65 years or older. The study examined mental health-related drug utilization and costs, as derived from administrative databases from 1993 through 2002. They assessed use of antidepressants, antipsychotics, mood stabilizers, benzodiazepines, and acetylcholinesterase inhibitors (AChEIs), assessing trends over time.


RESULTS
The prevalence of mental health-related drug use increased from 21.3% of the older population in the beginning of 1993 to 23.8% by the end of 2002. The proportion of benzodiazepine prescriptions was the highest of all such drugs, but declined from approximately 67% of prescriptions, in 1993, to 38%, in 2002. Significant temporal increases were observed for use of antidepressants (5.6%, in 1993, to 10.9%, in 2002), antipsychotics (1.9% in 1993; 2.9% in 2002), and AChEIs (0.1% in 1999; 1.5% in 2002). These increases were associated with a 210% increase in total standardized expenditures on mental health-related drugs, from approximately $32 per older resident ($40 million total) in 1993 to $99 per older resident ($149 million total) in 2002. AChEIs accounted for fewer than 6% of prescriptions, but 25% of the costs.


CONCLUSIONS
Significant shifts in prescription of mental health-related drugs and their costs have occurred over the past decade among older individuals with the introduction of newer, more expensive agents. Future research should address the appropriate balancing of increased costs versus their benefits in this population.
Mamdani
Muhammad
M
Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G119, Toronto, Ontario, Canada. muhammad.mamdani@ices.on.ca
Rapoport
Mark
M
Shulman
Kenneth I
KI
Herrmann
Nathan
N
Rochon
Paula A
PA
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors