title: Primary care providers' perspectives on psychoactive medication disorders in older adults.
abstract: BACKGROUND
  Compared with younger adults, older adults consume a disproportionate percentage of pain and sleep medications. Some studies have reported that psychoactive medication misuse and abuse in older populations is a significant problem.
  
  
  OBJECTIVE
  The aim of this study was to understand the perspective of primary care providers (PCPs) regarding the extent and clinical presentations of misuse and abuse of psychoactive medications in older patients and to explore PCPs' perceived barriers to identifying affected individuals.
  
  
  METHODS
  Seventeen physicians and 5 nurse practitioners from 2 ambulatory care practices serving older adults in New York City participated in this study. Six focus group discussions were audiotaped and transcribed. Two raters coded transcripts to identify recurring themes. Qualitative analysis software was employed for data coding and sorting purposes.
  
  
  RESULTS
  Although PCPs indicated that only a small percentage of older patients were actively misusing or abusing their psychoactive medications (average estimate given by providers, 8%), they felt that these patients placed significant time burdens on them. Perceived risk factors included psychiatric disorders, previous substance abuse history, and cognitive impairment, but many PCPs found it impossible to predict which patients were at increased risk. PCPs identified multiple barriers to identifying affected patients, including lack of communication (between provider and patient, provider and patients' caregivers, and between different providers), nonspecific symptoms, and the lack of a clear definition of misuse and abuse.
  
  
  CONCLUSIONS
  The lack of a clear definition, absence of well-defined risk factors, and ambiguous clinical manifestations of psychoactive medication misuse and abuse present substantial barriers to diagnosis. A standard, age-appropriate definition could help PCPs establish a diagnosis, clarify what constitutes appropriate psychoactive medication use, define the extent of the problem, and pave the way for the development of effective screening and diagnostic tools.
authors.affiliation: Division of Geriatrics and Gerontology, Weill Cornell Medical College, New York, New York 10065, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Payne
authors.forename: Megan
authors.initials: M
authors.lastname: Gething
authors.forename: Alison A
authors.initials: AA
authors.lastname: Moore
authors.forename: M Carrington
authors.initials: MC
authors.lastname: Reid
mesh_terms: D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D003625:Data Collection; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D011619:Psychotropic Drugs