Psychotropic Drug Consumption Among Older People Enrolled in a French Private Health Insurance Plan

BACKGROUND In France, little information exists on psychotropic drug consumption in the elderly. OBJECTIVE This study aimed to describe the patterns of psychotropic drug consumption, including the extent of inappropriate prescribing, in elderly subjects enrolled in a large health insurance plan in France (MGEN). METHODS In 2011, 5840 MGEN affiliates aged at least 65 years were randomly selected. Reimbursement claims were organized into a 1-year cross-sectional data set. The EphMRA (European Pharmaceutical Market Research Association) classification was used to identify prescriptions of psychotropic drugs, and the Laroche criteria to identify potentially inappropriate medications (PIMs). Treatment duration was estimated using WHO defined daily doses (DDDs). A multivariate analysis was performed to identify factors associated with the prescription of PIMs. RESULTS In 2011, 2213 subjects (37.9 %) made at least one reimbursement claim for a psychotropic drug, with the claims rate increasing with age. The mean annual volume of prescriptions per user was 193 DDDs. General practitioners were found to generate most of these prescriptions (81.8 %). Of these 2213 users, only 137 (6.2 %) had consulted a mental health specialist, and this rate decreased with age. Moreover, 1428 (64.5 %) subjects were prescribed at least one PIM, rising to 1711 (77.3 %) when including concomitant use of psychotropic drugs. Finally, the number of psychotropic drugs prescribed was associated with a higher odds ratio (OR) of PIM prescription. CONCLUSIONS Efforts should be made to reduce psychotropic drug prescriptions in elderly patients. This may contribute to reduce the amount of PIM prescriptions and the occurrence of iatrogenic side effects.