Psychoactive prescribing for older people-what difference does 15 years make?

Objective: The objective of the study was to review prescribing of psychoactive medications for older residents of the Tayside region of Scotland. Methods: The analysis used community prescribing data in 1995 and 2010 for all older residents in Tayside. For each psychoactive drug class, the name of the most recently prescribed drug and the date prescribed were extracted. The relative risk (RR) and 95% confidence intervals (CI) for patients receiving psychoactive medication in 2010 were compared with those for patients in 1995. Psychoactive prescribing was analyzed by year, age, gender, and deprivation classification. The chi-squared test was used to calculate statistical significance. Results: Total psychoactive prescribing in people over the age of 65years has increased comparing 1995 with 2010. Antidepressant [RR=2.5 (95% CI 2.41-2.59) p&lt;0.001] and opioid analgesia [RR=1.21 (1.19-1.24) p&lt;0.001] prescriptions increased between 1995 and 2010. Hypnotics/anxiolytic [RR=0.69 (0.66-0.71) p&lt;0.001] and antipsychotic [RR=0.83 (0.77-0.88) p&lt;0.001] prescriptions decreased between 1995 and 2010. An increase in psychoactive prescribing is particularly marked in lower socioeconomic groups. Patients in the least affluent fifth of the population had RR=1.25 (1.20-1.29) [p&lt;0.001] of being prescribed one to two psychoactive medications and RR=1.81 (1.56-2.10) [p&lt;0.001] of being prescribed three or more psychoactive medications in 2010 compared with those in 1995. The RRs for the most affluent fifth were RR=1.14 (1.1-1.19) [p&lt;0.001] and RR=1.2 (1.01-1.42) [p&lt;0.001] for one to two, and three or more medications, respectively. Conclusion: Psychoactive medication prescribing has increased comparing 1995 with 2010, with increases disproportionately affecting patients in lower socioeconomic groups. The availability of new psychoactive drugs, safety concerns, and economic factors may explain these increases.</p

Upper gastrointestinal bleeding in neck of femur fracture patients: a single tertiary centre experience

This study aimed to identify the incidence of perioperative acute upper gastrointestinal bleeding (UGIB) in our hip fracture patients; to evaluate the characteristics, management and clinical outcomes of these patients; and to explore risk factors and protective factors. Of the 1691 consecutive patients admitted for surgical management of hip fractures, 11 (0.65%) had UGIB and a further four patients for each case were selected as controls for evaluation of risk factors and protective factors. Pre-existing peptic ulcer disease was identified as a risk factor for acute UGIB (odds ratio 7.9; 95% confidence interval: 1.1-54.9). This study reported a very low incidence of UGIB in hip fracture patients. Despite being a high-risk population, timely endoscopic evaluation can be safely undertaken to optimise patient outcome. When risk factors such as history of peptic ulcer disease are present, additional precaution including gastro-protective agent and nutritional support should be undertaken