Association between depressive and anxiety disorders and adherence to antihypertensive medication in community-living elderly adults.

OBJECTIVES: To identify the determinants of antihypertensive medication adherence in community-living elderly adults. DESIGN: Longitudinal observational study. SETTING: Population-based health survey in the province of Quebec, Canada. PARTICIPANTS: Data from a representative sample (N = 2,811) of community-dwelling adults in Quebec aged 65 and older participating in the Étude sur la Santé des Aînés study. The final study sample analyzed consisted of 926 participants taking antihypertensive drugs during the 2 years of the study. MEASUREMENTS: Adherence to antihypertensive medication was measured using days of supply obtained during a specified time period. Depression and anxiety disorders were assessed using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, and physical health status was measured using the Charlson Comorbidity Index. Other factors considered were age, education, marital status, annual family income, and number of antihypertensive drugs that participants used. RESULTS: Mean antihypertensive proportion (percentage) of days supplied in was 92.5% in Year 1 and 59.4% in Year 2. The presence of depression and anxiety disorders and the number of antihypertensive medications significantly predicted medication adherence. The sex by depression and anxiety disorders interaction term was significant. CONCLUSION: Adherence to antihypertensive medication was significantly associated with depression and anxiety disorders in men but not women. The treatment of depression and anxiety disorders in individuals with hypertension may be helpful in improving medication adherence rates and healthcare outcomes.

Correlates of potentially inappropriate prescriptions of benzodiazepines among older adults: results from the ESA study.

ESA study data were paired with Quebec medical and pharmaceutical services records to document potentially inappropriate benzodiazepines (Bzs) prescriptions among community-dwelling adults aged 65 and older. Results indicate that 32 per cent of respondents took a mean daily dose of 6.1 mg of equivalent diazepam for, on average, 205 days per year. Almost half (48%) of Bzs users received a potentially inappropriate benzodiazepine prescription at least once during the year preceding the survey. About 23 per cent received at least one concomitant prescription of a Bz and another drug that could result in serious interaction. In addition, individuals aged 75 and older were more likely to receive Bzs for a longer period of time than those aged 65-74. Number of pharmacies used was associated with inappropriate Bzs prescriptions. Our results argue in favour of a more integrated health services system, including a regular review of older adults' drug regimens.

Pattern of psychotropic drug use among older adults having a depression or an anxiety disorder: results from the longitudinal ESA study.

OBJECTIVE: To document the use of psychotropic drugs in Quebec older adult population with a depressive or anxiety disorder. METHOD: Data from the Enquête sur la Santé des Aînés (ESA) study conducted between 2005 and 2008 using a representative sample (n = 1869) of community-dwelling adults aged 65 years and older were used to examine the use of psychotropic drugs in the Quebec older adult population. RESULTS: Our results indicate that only 46.9% of the older adults with a diagnosis of depression or anxiety during the 24-month period studied according to the Régie de l'assurance maladie du Quebec (RAMQ) register used antidepressants (AD) for 400 days (12.9 months) on average during this period. Also, 59% of the RAMQ's mental health disorder patients used a mean daily dose of 5 mg of a diazepam equivalent for 338 days (10.9 months) on average during the same period. However, 10.0% of the older adults without any symptoms (ESA) at T1 and at T2 and any RAMQ depression and anxiety diagnosis between T0 and T2 were AD users during the 24-month period studied. They represent 26.2% of the AD users and consumed them for 494 days (15.9 months) on average during the 24-month period studied. Finally, the number of days of AD and benzodiazepine use was not associated with partial or total remission. CONCLUSIONS: This result questions the population effectiveness of these drugs in this population.

The association between length of benzodiazepine use and sleep quality in older population.

BACKGROUND: Sleep disturbances are frequently reported in the older adult population and benzodiazepines are the drugs most often prescribed to treat these problems. Nearly 25% of the older adult population uses these drugs and 83% of benzodiazepine users report sleep problems. Although the Collège des Médecins du Québec suggests a maximum length of use of 3 months, according to most studies the mean length of benzodiazepine use is longer. The goal of this study was to document the association between length of benzodiazepine use and sleep quality as reported by adults 65 years older and over. METHODS: Data used in this study came from the Seniors' Health Survey (ESA) conducted in a representative sample of the community-dwelling older population in Quebec, Canada. Inclusion criteria included the ability to speak and understand French. Data were analyzed using a structural equation modeling strategy. RESULTS: Long-term benzodiazepine users were more likely to report poor sleep quality. Sleep quality of initial probable problematic sleepers tended to increase over 1 year but sleep quality in benzodiazepines users increased less rapidly than in non-users. Also, women were more likely to report using benzodiazepines and having poorer sleep quality. CONCLUSION: Longitudinal studies using incident cases of benzodiazepine use should be conducted to better determine the causal relationship between sleep quality and benzodiazepine use in the older population.