Elderly persons with low income use inappropriate psychotropic drugs more often

Every fifth elderly person uses inappropriate psychotropic drugs with an increased risk for adverse events, despite that safer alternatives are available. Elderly with low income more often use such inappropriate drugs, according to Eva Lesén's thesis from the Nordic School of Public Health, NHV.

Elderly persons often have several diseases and use many drugs; they are also more sensitive to drugs compared to younger persons. Use of more drugs than necessary tends to occur among the elderly, however, underuse of drugs and use of inappropriate types of drugs also occur. Psychotropic drugs, such as hypnotics, anxiolytics and antidepressant drugs, are common among the elderly.

- Every fifth person aged 75 years and older in Sweden use inappropriate psychotropic drugs with an increased risk for adverse effects, such as daytime drowsiness, cognitive decline or falls. This despite that safer alternatives are available, says Eva Lesén, who will defend her thesis "Psychotropic drugs among the elderly" at NHV on May 6th.

Low income worse drugs 

The thesis also suggests inequities in the use of psychotropic drugs among the elderly, since those with low income more often use the inappropriate psychotropic drugs. The results suggest an association between income level and use of inappropriate drugs. This may be in conflict with the aims of equity in the health care, where all individuals should be entitled to health care, including drugs, based on their needs, irrespective of their age, sex or status in society.

- The use of drugs should instead be based on clinical factors and patient needs, says Eva Lesén. The deficiencies and inequities in the use of drugs among the elderly that have been identified in these studies suggest a great public health problem. But we also see improvements over time. Sales of inappropriate psychotropics decreased during the years 2000-2008, while the recommended psychotropics increased.

Too many drugs

The elderly often use many drugs, but underuse of drugs is also present. Antidepressant drugs can be effective for depression among the elderly. However, the findings in the thesis show that only one out of ten 95-year olds with depression use these drugs, while hypnotics were used by more than half.

- This pattern suggests that depressions among the oldest people are not sufficiently recognised and that the symptoms, such as sleeping problems and anxiety, are treated instead. There is thus a large room for improvement, Eva Lesén states. Regular and systematic reviews of drug use among the elderly could improve the situation for a large part of the elderly population. This would be beneficial for the entire society.