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Psychotropic Drug Use and Alcohol Consumption Among Older Adults in Germany: Results of the German Health Interview and Examination Survey for Adults 2008–2011

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Psychotropic Drug Use and Alcohol Consumption Among Older Adults in Germany: Results of the German Health Interview and Examination Survey for Adults 2008–2011 Open Access Research BMJ Open: first published as 10.1136/bmjopen-2016-012182 on 8 October 2016. Downloaded from Psychotropic drug use and alcohol consumption among older adults in Germany: results of the German Health Interview and Examination Survey for Adults 2008–2011 Yong Du, Ingrid-Katharina Wolf, Hildtraud Knopf To cite: Du Y, Wolf I-K, ABSTRACT Strengths and limitations of this study Knopf H. Psychotropic drug Objectives: The use and combined use of use and alcohol consumption psychotropic drugs and alcohol among older adults is a ▪ among older adults in A large sample of concurrent data on medication growing public health concern and should be constantly Germany: results of the use, sociodemographic and health characteristics German Health Interview and monitored. Relevant studies are scarce in Germany. allows analyses of psychotropic drug and Examination Survey Using data of the most recent national health survey, we alcohol use on a population representative level. for Adults 2008–2011. BMJ analyse prevalence and correlates of psychotropic drug ▪ The short observation period (7 days) minimises Open 2016;6:e012182. and alcohol use among this population. recall bias concerning medication use, and doi:10.1136/bmjopen-2016- Methods: Study participants were people aged 60– quality control is ensured by checking original 012182 79 years (N=2508) of the German Health Interview and packages. Examination Survey for Adults 2008–2011. Medicines ▪ Alcohol consumption was measured by fre- ▸ Prepublication history for used during the last 7 days were documented. quency and quantity. this paper is available online. Psychotropic drugs were defined as medicines acting ▪ The use of psychotropic drugs is likely to be To view these files please on the nervous system (ATC code N00) excluding underestimated as people who are institutiona- visit the journal online anaesthetics (N01), analgesics/antipyretics (N02B), but lised and those with severe disease and psychi- (http://dx.doi.org/10.1136/ including opiate codeines used as antitussives (R05D). atric disorders (including cognitive impairments, bmjopen-2016-012182). Alcohol consumption in the preceding 12 months was depression, dementia, etc) are less likely to par- http://bmjopen.bmj.com/ Received 8 April 2016 measured by frequency (drinking any alcohol- ticipate in national health surveys. Revised 8 August 2016 containing beverages at least once a week/a day) and ▪ Under-reporting of alcohol use is possible as Accepted 24 August 2016 quantity (alcohol consumed in grams/day; cut-offs: 10/ people tend to answer questions concerning 20 g/day for women/men defining moderate and risky intoxicating substances according to social drinking). SPSS complex sample module was used for desirability. analysis. Results: 21.4% of study participants use psychotropic medications, 66.9% consume alcohol moderately and INTRODUCTION 17.0% riskily, 51.0% drink alcohol at least once a week Psychotropic drugs such as antidepressants, on September 25, 2021 by guest. Protected copyright. and 18.4% daily, 2.8% use psychotropic drugs sedatives or hypnotics are characterised by combined with daily alcohol drinking. Among their impact on the central nervous system psychotropic drug users, 62.7% consume alcohol (CNS) and influence perception, mood, con- moderately, 14.2% riskily. The most frequently used sciousness or behaviour. They are established psychotropic medications are antidepressants (7.9%) clinical treatments for a variety of neuro- and antidementia (4.2%). Factors associated with a higher rate of psychotropic drug use are female sex, logical and mental diseases but also harbour worse health status, certified disability and risks of side effects and the development of polypharmacy. Risky alcohol consumption is positively dependency. Older adults, due to the loss of associated with male sex, smoking, upper social class, close persons, social networks or autonomy, Department of Epidemiology better health status, having no disability and not living may suffer from emotional and mental disor- and Health Monitoring, Robert Koch Institute, Berlin, alone. ders and are a major group of psychotropic 12 Germany Conclusions: Despite the high risk of synergetic drug users. Nevertheless, the use of psy- YD and I-KW contributed effects of psychotropic drugs and alcohol, a substantial chotropic medications by older adults should equally part of older psychotropic drug users consume alcohol be considered carefully. Older adults are riskily and daily. Health professionals should talk about Correspondence to particularly vulnerable to drug-related the additional health risks of alcohol consumption when adverse health consequences due to Yong Du; prescribing psychotropic drugs to older adults. [email protected] significant changes in pharmacokinetic and Du Y, et al. BMJ Open 2016;6:e012182. doi:10.1136/bmjopen-2016-012182 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2016-012182 on 8 October 2016. Downloaded from pharmacodynamic properties of drugs related to ageing For the present analyses, only participants aged 60– processes.3 Additionally, an age-related increase in multi- 79 years with complete interview and examination data morbidity and polypharmacy among older adults aggra- were included, resulting in a total of 2508 participants vates those risks.4 (1277 women, 1231 men) (table 1). Alcohol is a substance with psychotropic characteristics DEGS1 was approved by the Federal and State and also widely consumed by older adults. Sharing the Commissioners for Data Protection and the same metabolic enzymes with psychotropic drugs, Charité-Universitätsmedizin Berlin ethics committee alcohol is broken down mainly in the liver.5 The intake (number EA2/047/08). Survey participants provided of alcohol alters the activity of the metabolic enzymes written informed consent prior to interviews and and may result in pharmacokinetic and pharmacody- examinations. namic interactions with psychotropic drugs.5 Combined use of psychotropic drugs with alcohol, even in small Data collection amounts, can produce synergistic effects and therefore Data collection in DEGS1 was conducted via self- may be harmful and risky for older adults.56For administered questionnaires, standardised physician- example, alcohol enhances the sedative effects of fre- administered computer-assisted personal interviews quently used antidepressants, benzodiazepines and sleep (CAPI), standardised personal interviews on medicine medications,5 increasing greatly the risks of falls and hip usage, medical examinations, physiological measure- fractures.7 The use of alcohol and psychotropic drugs ments and laboratory tests.15 among older adults, particularly combined use of both, Self-administered questionnaires were used to collect constitutes a growing public health concern and should data on sociodemographic characteristics (age, sex, be constantly monitored and carefully reviewed over region of residence), individual information on house- time.8 hold size (number of persons living in household), Psychotropic drug use and alcohol consumption have income, profession and educational attainment, been investigated previously in the general adult popula- health-related behaviour (such as tobacco use), dietary tion or in studies regarding alcohol-interactive medica- and nutritional habits (including alcohol consumption), – tion use.9 12 Only a few studies investigated specifically self-rated health status and officially certified disability.15 the use of psychotropic drugs and alcohol among older Detailed information on medication use was recorded – adults.12 14 Our own previous study, which also investi- by trained health professionals. In the invitation letter, gated the use of psychotropic drugs and alcohol among participants were asked to bring the original packages of older adults, was conducted using data of a national all medications—prescribed and Over-The-Counter health survey from 1998.14 An update is needed, given (OTC) products—used during the past 7 days to the significant changes in demographics, health behaviour examination site for the purpose of documentation and as well as disease profiles over the last decade. verification. This permitted automated recording of http://bmjopen.bmj.com/ With the recent data of the German Health Interview unique product identifiers and drug coding according and Examination Survey for Adults 2008–2011, we to the WHO ‘Anatomical Therapeutic Chemical’ (ATC) analyse prevalence and correlates of psychotropic medi- classification system.17 cine use and alcohol consumption as well as the con- comitant use of both among older people. Defining psychotropic drug use and measuring alcohol consumption In the present study, we included psychotropic drugs METHODS belonging to the nervous system class (ATC code N00) on September 25, 2021 by guest. Protected copyright. Study design and participants as well as opiates used as antitussives (ATC code R05DA) As database for the present study served the German and aspirin–caffeine combination preparations (ATC Health Interview and Examination Survey for Adults, code N02BA71) considering their CNS effects.14 We wave 1 (DEGS1), which was conducted by the Robert excluded other analgesics and antipyretics such as Koch Institute from November 2008 to December 2011. aspirin and paracetamol (ATC code N02B), local anaes- DEGS1 aims to provide representative data on the thetics (ATC code N01B), homeopathic drugs of the health of adults aged 18–79 years living in Germany. ATC class N00 and drugs with
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