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 - 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 - TY - JOUR A1 - Bohlken, Jens A1 - Schulz, Mandy A1 - Rapp, Michael Armin A1 - Baetzing-Feigenbaum, Joerg T1 - Pharmacotherapy of dementia in Germany: Results from a nationwide claims database JF - European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology N2 - In 2011, about 1.1-1.4 million patients with dementia were living in Germany, a number expected to rise to three million by 2050. Dementia poses a major challenge to the healthcare system and neuropharmacological service provision. The aim of this study was to determine prescription rates for anti-dementia drugs as well as for neuroleptics, sedative-hypnotics and antidepressants in dementia using the complete nationwide outpatient claims data pertaining to the services of statutory health insurance. We controlled for gender, age, dementia diagnosis, physician specialty (general practitioner GP versus neuropsychiatry specialist physician NPSP), and rural and urban living area. In about one million prevalent dementia patients (N=1,014,710) in 2011, the prescription prevalence rate of anti-dementia drugs was 24.6%; it varied with gender, age, and diagnosis (highest in Alzheimer's disease; 42%), and was higher in patients treated by NPSPs (48% vs. 25% in GPs). At the same time, we found an alarmingly high rate of treatment with neuroleptics in dementia patients (35%), with an only slightly decreased risk in patients treated exclusively by NPSPs (OR=0.86). We found marginal differences between rural and urban areas. Our results show that the majority of anti-dementia drug prescriptions appear guideline-oriented, yet prescription rates are overall comparatively low. On the other hand, neuroleptic drugs, which are associated with excess morbidity and mortality in dementia, were prescribed very frequently, suggesting excess use given current guidelines. We therefore suggest that guideline implementation measures and increasing quality control procedures are needed with respect to the pharmacotherapy of this vulnerable population. (C) 2015 Elsevier B.V. and ECNR All rights reserved. KW - Psychotropics KW - Drug prescription KW - Germany Y1 - 2015 U6 - https://doi.org/10.1016/j.euroneuro.2015.09.014 SN - 0924-977X SN - 1873-7862 VL - 25 IS - 12 SP - 2333 EP - 2338 PB - Elsevier CY - Amsterdam ER -