TY - JOUR A1 - Bohlken, Jens A1 - Jacob, Louis A1 - Schaum, Peter A1 - Rapp, Michael Armin A1 - Kostev, Karel T1 - Hip fracture risk in patients with dementia in German primary care practices JF - Dementia N2 - The aim was to analyze the risk of hip fracture in German primary care patients with dementia. This study included patients aged 65-90 from 1072 primary care practices who were first diagnosed with dementia between 2010 and 2013. Controls were matched (1:1) to cases for age, sex, and type of health insurance. The primary outcome was the diagnosis of hip fracture during the three-year follow-up period. A total of 53,156 dementia patients and 53,156 controls were included. A total of 5.3% of patients and 0.7% of controls displayed hip fracture after three years. Hip fracture occurred more frequently in dementia subjects living in nursing homes than in those living at home (9.2% versus 4.3%). Dementia, residence in nursing homes, and osteoporosis were risk factors for fracture development. Antidementia, antipsychotic, and antidepressant drugs generally had no significant impact on hip fracture risk when prescribed for less than six months. Dementia increased hip fracture risk in German primary care practices. KW - hip fracture KW - dementia KW - nursing homes KW - osteoporosis KW - risk factors Y1 - 2015 U6 - https://doi.org/10.1177/1471301215621854 SN - 1471-3012 SN - 1741-2684 VL - 16 SP - 853 EP - 864 PB - Sage Publ. CY - London ER - TY - GEN A1 - Bohlken, Jens A1 - Jacob, Louis A1 - Schaum, Peter A1 - Rapp, Michael Armin A1 - Kostev, Karel T1 - Hip fracture risk in patients with dementia in German primary care practices T2 - Postprints der Universität Potsdam : Humanwissenschaftliche Reihe N2 - The aim was to analyze the risk of hip fracture in German primary care patients with dementia. This study included patients aged 65-90 from 1072 primary care practices who were first diagnosed with dementia between 2010 and 2013. Controls were matched (1:1) to cases for age, sex, and type of health insurance. The primary outcome was the diagnosis of hip fracture during the three-year follow-up period. A total of 53,156 dementia patients and 53,156 controls were included. A total of 5.3% of patients and 0.7% of controls displayed hip fracture after three years. Hip fracture occurred more frequently in dementia subjects living in nursing homes than in those living at home (9.2% versus 4.3%). Dementia, residence in nursing homes, and osteoporosis were risk factors for fracture development. Antidementia, antipsychotic, and antidepressant drugs generally had no significant impact on hip fracture risk when prescribed for less than six months. Dementia increased hip fracture risk in German primary care practices. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 395 KW - hip fracture KW - dementia KW - nursing homes KW - osteoporosis KW - risk factors Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-404526 IS - 395 ER - TY - JOUR A1 - Bookers, Anke A1 - Jacob, Louis A1 - Bohlken, Jens A1 - Rapp, Michael Armin A1 - Kostev, Karel T1 - Persistence with antipsychotics in dementia patients in Germany JF - International journal of clinical pharmacology and therapeutics N2 - Background/Aims: To analyze the duration of treatment with antipsychotics in German dementia patients. Methods: This study included patients aged 60 years and over with dementia who received a first-time antipsychotic prescription by psychiatrists between 2009 and 2013. The main outcome measure was the treatment rate for more than 6 months following the index date. Results: A total of 12,979 patients with dementia (mean age 82 years, 52.1% living in nursing homes) were included. After 2 years of follow-up, 54.8%, 57.2%, 61.1%, and 65.4% of patients aged 60 - 69, 70 - 79, 80 - 89, and 90 - 99 years, respectively, received antipsychotic prescriptions. 63.9% of subjects living in nursing homes and 55.0% of subjects living at home also continued their treatment (p-value < 0.001). Conclusion: The percentage of dementia patients treated with anti psychotics is very high. KW - persistence KW - antipsychotics KW - dementia Y1 - 2016 U6 - https://doi.org/10.5414/CP202631 SN - 0946-1965 VL - 54 SP - 835 EP - 840 PB - Dustri-Verlag Dr. Karl Feistle CY - Deisenhofen-München ER - TY - JOUR A1 - Drosselmeyer, Julia A1 - Jacob, Louis A1 - Rathmann, Wolfgang A1 - Rapp, Michael Armin A1 - Kostev, Karel T1 - Depression risk in patients with late-onset rheumatoid arthritis in Germany JF - Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation N2 - The goal of this study was to determine the prevalence of depression and its risk factors in patients with late-onset rheumatoid arthritis (RA) treated in German primary care practices. Longitudinal data from general practices (n=1072) throughout Germany were analyzed. Individuals initially diagnosed with RA (2009-2013) were identified, and 7301 patients were included and matched (1:1) to 7301 controls. The primary outcome measure was the initial diagnosis of depression within 5 years after the index date in patients with and without RA. Cox proportional hazards models were used to adjust for confounders. The mean age was 72.2 years (SD: 7.6 years). A total of 34.9 % of patients were men. Depression diagnoses were present in 22.0 % of the RA group and 14.3 % of the control group after a 5-year follow-up period (p < 0.001). In the multivariate regression model, RA was a strong risk factor for the development of depression (HR: 1.55, p < 0.001). There was significant interaction of RA and diagnosed inflammatory polyarthropathies (IP) (RA*IP interaction: p < 0.001). Furthermore, dementia, cancer, osteoporosis, hypertension, and diabetes were associated with a higher risk of developing depression (p values < 0.001). The risk of depression is significantly higher in patients with late-onset RA than in patients without RA for subjects treated in primary care practices in Germany. RA patients should be screened routinely for depression in order to ensure improved treatment and management. KW - Late-onset rheumatoid arthritis KW - Depression KW - Primary care KW - Risk factors KW - Germany Y1 - 2016 U6 - https://doi.org/10.1007/s11136-016-1387-2 SN - 0962-9343 SN - 1573-2649 VL - 26 IS - 2 SP - 437 EP - 443 PB - Springer CY - Dordrecht ER - TY - JOUR A1 - Jacob, Louis A1 - Rapp, Michael Armin A1 - Kostev, Karel T1 - Long-term use of benzodiazepines in older patients in Germany BT - a retrospective analysis JF - Therapeutic Advances in Psychopharmacology N2 - Background: The purpose of this study was to analyze the prevalence of long-term benzodiazepine use in older adults treated in general and neuropsychiatric practices in Germany. Methods: This study included 32,182 patients over the age of 65 years who received benzodiazepine prescriptions for the first time between January 2010 and December 2014 in general and neuropsychiatric practices in Germany. Follow up lasted until July 2016. The main outcome measure was the proportion of patients treated with benzodiazepines for >6 months. Results: The proportion of patients with benzodiazepine therapy for >6 months increased with age (65-70 years: 12.3%; 71-80 years: 15.5%; 81-90 years: 23.7%; >90 years: 31.6%) but did not differ significantly between men (15.5%) and women (17.1%). The proportion of patients who received benzodiazepines for >6 months was higher among those with sleep disorders (21.1%), depression (20.8%) and dementia (32.1%) than among those with anxiety (15.5%). By contrast, this proportion was lower among people diagnosed with adjustment disorders (7.7%) and back pain (3.8%). Conclusion: Overall, long-term use of benzodiazepines is common in older people, particularly in patients over the age of 80 and in those diagnosed with dementia, sleep disorders, or depression. KW - benzodiazepines KW - Germany KW - long-term use KW - older people KW - risk factors Y1 - 2017 U6 - https://doi.org/10.1177/2045125317696454 SN - 2045-1253 SN - 2045-1261 VL - 7 IS - 6/7 SP - 191 EP - 200 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Konrad, Marcel A1 - Jacob, Louis A1 - Rapp, Michael Armin A1 - Kostev, Karel T1 - Treatment of depression in patients with cardiovascular diseases by German psychiatrists JF - International journal of clinical pharmacology and therapeutics N2 - Objective: To estimate the prevalence and the type of antidepressant medication prescribed by German psychiatrists to patients with depression and cardiovascular diseases (CVD). Methods: This study was a retrospective database analysis in Germany using the Disease Analyzer Database (IMS Health, Germany). The study population included 2,288 CVD patients between 40 and 90 years of age from 175 psychiatric practices. The observation period was between 2004 and 2013. Follow-up lasted up to 12 months and ended in April 2015. Also included were 2,288 non-CVD controls matched (1 : 1) to CVD cases on the basis of age, gender, health insurance coverage, depression severity, and diagnosing physician. Results: Mean age was 68.6 years. 46.2% of patients were men, and 5.9% had private health insurance coverage. Mild, moderate, or severe depression was present in 18.7%, 60.7%, and 20.6% of patients, respectively. Most patients had treatment within a year, many of them immediately after depression diagnosis. Patients with moderate and severe depression were more likely to receive treatment than patients with mild depression. There was no difference between CVD and non-CVD in the proportion of patients treated. Nonetheless, CVD patients received selective serotonin reuptake inhibitors / serotonin-noradrenaline reuptake inhibitors (SSRIs/SNRIs) significantly more frequently. Conversely, patients without CVD were more often treated with TCA. Conclusion: There was no association between CVD and the initiation of depression treatment. Furthermore, CVD patients received SSRIs/SNRIs more frequently. KW - depression KW - cardiovascular diseases KW - antidepressant therapy KW - psychiatric practices Y1 - 2016 U6 - https://doi.org/10.5414/CP202591 SN - 0946-1965 VL - 54 SP - 557 EP - 563 PB - Dustri-Verlag Dr. Karl Feistle CY - Deisenhofen-München ER - TY - JOUR A1 - Konrad, Marcel A1 - Jacob, Louis A1 - Rapp, Michael Armin A1 - Kostev, Karel T1 - Depression risk in patients with coronary heart disease in Germany JF - World Journal of Cardiology N2 - AIM To determine the prevalence of depression and its risk factors among patients with coronary heart disease (CHD) treated in German primary care practices. METHODS Longitudinal data from nationwide general practices in Germany (n = 1072) were analyzed. Individuals initially diagnosed with CHD (2009-2013) were identified, and 59992 patients were included and matched (1: 1) to 59992 controls. The primary outcome measure was an initial diagnosis of depression within five years after the index date among patients with and without CHD. Cox proportional hazards models were used to adjust for confounders. RESULTS Mean age was equal to 68.0 years (SD = 11.3). A total of 55.9% of patients were men. After a five-year follow-up, 21.8% of the CHD group and 14.2% of the control group were diagnosed with depression (P < 0.001). In the multivariate regression model, CHD was a strong risk factor for developing depression (HR = 1.54, 95% CI: 1.49-1.59, P < 0.001). Prior depressive episodes, dementia, and eight other chronic conditions were associated with a higher risk of developing depression. Interestingly, older patients and women were also more likely to be diagnosed with depression compared with younger patients and men, respectively. CONCLUSION The risk of depression is significantly increased among patients with CHD compared with patients without CHD treated in primary care practices in Germany. CHD patients should be routinely screened for depression to ensure improved treatment and management. KW - Coronary heart disease KW - Depression KW - Primary care KW - Risk factors KW - Quality of life Y1 - 2016 U6 - https://doi.org/10.4330/wjc.v8.i9.547 SN - 1949-8462 VL - 8 SP - 547 EP - 552 PB - Baishideng Publishing Group CY - Pleasanton ER - TY - JOUR A1 - Mell, Thomas A1 - Jacob, Louis A1 - Fuhr, Ida A1 - Dick, Sandra A1 - Rapp, Michael Armin A1 - Kostev, Karel T1 - Patterns of benzodiazepine prescribing by neuropsychiatrists and general practitioners for elderly patients in Germany in 2014 JF - International journal of clinical pharmacology and therapeutics N2 - Background: The patterns of benzodiazepine prescriptions in older adults are of general and scientific interest as they are not yet well understood. The aim of this study was to compare the prescription patterns of benzodiazepines in elderly people in Germany to determine the share or proportion treated by general practitioners (GP) and neuropsychiatrists (NP). Methods: This study included 31,268 and 6,603 patients between the ages of 65 and 100 with at least one benzodiazepine prescription in 2014 from GP and NP, respectively. Demographic data included age, gender, and type of health insurance coverage. The share of elderly people with benzodiazepine prescriptions was estimated in different age and disease groups for both GP and NP patients. The share of the six most commonly prescribed drugs was also calculated for each type of practice. Results: The share of people taking benzodiazepines prescribed by GP increased from 3.2% in patients aged between 65 and 69 years to 8.6% in patients aged between 90 and 100 years, whereas this share increased from 5.4% to 7.1% in those seen by NP. Benzodiazepines were frequently used by patients suffering from sleep disorders (GP: 33.9%; NP: 5.5%), depression (GP: 17.9%; NP: 29.8%), and anxiety disorders (GP: 14.5%; NP: 22.8%). Lorazepam (30.3%), oxazepam (24.7%), and bromazepam (24.3%) were the three most commonly prescribed drugs for GP patients. In contrast, lorazepam (60.4%), diazepam (14.8%), and oxazepam (11.2%) were those more frequently prescribed to NP patients. Conclusion: Prescription patterns of benzodiazepine in the elderly varied widely between GP and NP. KW - benzodiazepines KW - prescription patterns KW - elderly people KW - Germany Y1 - 2017 U6 - https://doi.org/10.5414/CP202904 SN - 0946-1965 VL - 55 SP - 466 EP - 471 PB - Dustri-Verlag Dr. Karl Feistle CY - Deisenhofen-München ER -