Hattem, B. van (Bernard) (2015) What is the risk for depressed elderly on somatic multimorbidity and polypharmacy as compared to non-depressed elderly? thesis, Medicine.
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Abstract
Depression among elderly is associated with the presence of comorbid chronic diseases and, consequently, medication related problems due to polypharmacy. Because of the complexity of therapy in elderly patients with a depressive disorder, it is important to get a better understanding of the prevalence and nature of comorbid chronic somatic diseases and the polypharmacy and adverse drug reactions in which such comorbidity result in Dutch general practice. This case-control study aims primarily to determine to what extent comorbidity and polypharmacy occur in depressed elderly patients and in the near future to contribute to the quality of care for elderly patients with a depressive disorder. Method Data on 4477 patients aged 60 years and older were retrieved from a comprehensive database that consists of morbidity and GP-care data from NIVEL Primary Care Database (NIVEL-PCD), combined with pharmacy dispensing data from the Foundation of Pharmaceutical Statistics (SFK), and socio-demographic data from Statistics Netherlands (CBS). Data on multimorbidity and polypharmacy was retrieved from this database of 1512 depressed elderly patients, matched with patients with a psychological disorder not being depression, and matched with controls without any psychological disorder in the past year of 2012. Furthermore, the drug burden index (DBI), a qualitative assessment tool for the burden of medication, was calculated in each of the three groups, to provide insight into potential drug-related sources of functional impairment. Results A depressive disorder in elderly patients was associated with an increased number of chronic diseases (IRR = 1.18; 95%CI = 1.12-1.26), but so was a psychological disorder, not being depression (IRR = 1.14; 95%CI = 1.07-1.21). This resulted in higher rates of multimorbidity among these groups, compared to mentally healthy elderly patients. A depression in an elderly individual was most strongly associated with an increase in the number of chronically used medicines (IRR = 1.45; 95%CI = 1.38-1.52), regardless the number of chronic conditions. This amounted to the highest prevalence of polypharmacy of about 43% in depressed elderly patients, compared to 22% in mentally healthy elderly patients. A higher DBI was also associated most with a depressive disorder in the elderly, regardless the number of chronic diseases. The DBI in the depressed group was 1.55 (SD = 1.29). The odds of having multimorbidity, polypharmacy and a higher DBI increased with age. Furthermore, an increase in the number of chronic diseases was strongly associated with polypharmacy and a higher DBI. Conclusion A depressive disorder is a serious health problem in the elderly patient, and therefore health care providers should have a raised awareness of high prevalence rates of comorbid chronic diseases and medication related problems, due to polypharmacy, among them. This study highlights the importance of developing multimorbidity guidelines, especially for depressed elderly patients, which recommend a uniform treatment, and so, avoid treatment conflicts. Future research should focus on which combinations of diseases and their accompanying drugs lead to the highest burden of medication for a patient.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisors: and Verhaak, Prof. Dr. P.F.M. and Holvast, Drs. F. and Department of General Medicine and Research line: Mental health care |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:02 |
| Last Modified: | 25 Jun 2020 11:02 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2242 |
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