title: Potentially inappropriate psychotropic prescription at discharge is associated with lower functioning in the elderly psychiatric inpatients. A cross-sectional study.
abstract: The objectives are to determine the rate of potentially inappropriate psychotropic (PIP) prescription at discharge in the elderly psychiatric inpatients and to determine whether PIP is associated with lowered functioning outcomes.
  
  
  
  Sociodemographic, clinical, and treatment data for all inpatients aged ≥ 65 years consecutively hospitalized during 1 year in 13 psychiatry departments was analyzed. PIP+/PIP- groups were defined according to the French-updated Beers criteria. Daily functioning was evaluated by the daily living (ADL) scale. Logistic regression analysis was used to estimate odds ratios for the association between PIP administration at discharge and respectively functioning and potential confounding factors.
  
  
  
  Data was obtained for 327 patients. Overall, 124 (37.9 %) patients were males, and the mean age was 73.9 years (SD = 5.6); 163 (49.8 %) patients were diagnosed with affective disorders and 89 (27.2 %) with schizophrenia/schizotypal/delusional disorders. Overall, 249 (76.1 %) had one or more PIP medications, mainly anxiolytics (69.9 %) and hypnotics (17.2 %). In a multivariate analysis, PIP prescription at discharge has been associated with patient lowered personal care functioning, independently of age, gender, and psychiatric or somatic diagnoses (OR = 0.88 (0.79-0.97, p = 0.01).
  
  
  
  In the current increasingly fragmented health care systems, special attention must be given to PIP prescription in older population suffering from psychiatric disorders. Using the Beers criteria, the present study demonstrates the high prevalence of PIP prescription, which concerns a large panel of drugs but mostly anxiolytics and hypnotics independently of psychiatric or somatic diagnoses and sociodemographic characteristics. Our study has demonstrated for the first time an association between PIP prescription and lowered patient functioning. Further longitudinal studies should confirm a potential causal relation.
authors.affiliation: Fondation FondaMental, Créteil, France. guillaume.fond@gmail.com.|INSERM U955, Translational Psychiatry team, Créteil, France. guillaume.fond@gmail.com.|DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Paris Est University, Créteil, France. guillaume.fond@gmail.com.|Pole de Psychiatrie, Hôpital A. Chenevier, 40 rue de Mesly, Créteil, France, 94010. guillaume.fond@gmail.com.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Fond
authors.affiliation: Department of Psychiatry, Assistance Publique-Hôpitaux de Marseille, Sainte-Marguerite University Hospital, 13009, Marseille, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Fajula
authors.affiliation: Department of Psychiatry, Assistance Publique-Hôpitaux de Marseille, La Conception University Hospital, 13005, Marseille, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Dassa
authors.affiliation: Fondation FondaMental, Créteil, France.|Pole de Psychiatrie, Hôpital A. Chenevier, 40 rue de Mesly, Créteil, France, 94010.
authors.forename: Lore
authors.initials: L
authors.lastname: Brunel
authors.affiliation: Fondation FondaMental, Créteil, France.|Department of Public Health, EA 3279 Research Unit, University Hospital, Assistance Publique-Hôpitaux de Marseille, 13005, Marseille, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Lançon
authors.affiliation: Department of Public Health, EA 3279 Research Unit, University Hospital, Assistance Publique-Hôpitaux de Marseille, 13005, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Boyer
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D010351:Patient Discharge / Q000592:standards*; D019338:Polypharmacy; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000627:therapeutic use*
chemical_list: D011619:Psychotropic Drugs
keywords: Benzodiazepines; Elderly; Functioning; Inpatient; Potentially inappropriate psychotropic prescription; Psychiatric disorder