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Mental Health-Related Drug Utilization Among Older Adults

Prevalence, Trends, and Costs

Received January 14, 2004; revised July 27, November 15, 2004; accepted November 17, 2004. From the Institute for Clinical Evaluative Sciences (MM, PAR), Sunnybrook and Women’s College Health Sciences Centre Departments of Psychiatry (MR, KIS, NH), University of Toronto Faculty of Pharmacy (MM), Faculty of Medicine (all), and Baycrest Centre for Geriatric Care (PAR), Toronto, Ontario, Canada. Send correspondence and reprint requests to Muhammad Mamdani, Pharm.D., M.A., M.P.H., Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G119, Toronto, Ontario, Canada. e-mail: muhammad.mamdani{at}ices.on.ca
© 2005 American Association for Geriatric Psychiatry

Objective: Authors assessed temporal changes in mental health-related drug utilization and costs in an older population. Methods: This was a population-based, cross-sectional time-series analysis of more than 1.4 million residents of Ontario, Canada, age 65 years or older. The study examined mental health-related drug utilization and costs, as derived from administrative databases from 1993 through 2002. They assessed use of antidepressants, antipsychotics, mood stabilizers, benzodiazepines, and acetylcholinesterase inhibitors (AChEIs), assessing trends over time. Results: The prevalence of mental health-related drug use increased from 21.3% of the older population in the beginning of 1993 to 23.8% by the end of 2002. The proportion of benzodiazepine prescriptions was the highest of all such drugs, but declined from approximately 67% of prescriptions, in 1993, to 38%, in 2002. Significant temporal increases were observed for use of antidepressants (5.6%, in 1993, to 10.9%, in 2002), antipsychotics (1.9% in 1993; 2.9% in 2002), and AChEIs (0.1% in 1999; 1.5% in 2002). These increases were associated with a 210% increase in total standardized expenditures on mental health-related drugs, from approximately $32 per older resident ($40 million total) in 1993 to $99 per older resident ($149 million total) in 2002. AChEIs accounted for fewer than 6% of prescriptions, but 25% of the costs. Conclusions: Significant shifts in prescription of mental health-related drugs and their costs have occurred over the past decade among older individuals with the introduction of newer, more expensive agents. Future research should address the appropriate balancing of increased costs versus their benefits in this population.

Key Words: Psychotropic Drugs • Antidepressants • Anxiolytics • Mood Stabilizers • Benzodiazepines • Acetylcholinesterase Inhibitors • Antipsychotics • Psychopharmacology • Epidemiology

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