Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Methods
2.1. Scope of Review: Eligibility Criteria
2.2. Information Sources
2.3. Search Strategy
2.4. Data Extraction
2.5. Assessment of Quality in Included Studies
2.6. Data Synthesis and Statistical Analysis
3. Results
3.1. Characteristics of the Included Studies
3.2. Trends in Global Use of CNS Drugs
3.3. Use of Psychotropic Drugs
3.4. Use of Antipsychotic Drugs
3.5. Use of Antidepressant Drugs
3.6. Use of Benzodiazepines
3.7. Use of Antiepileptic and Antiparkinson Drugs
4. Discussion
4.1. Trend in the Global Use of CNS Drugs
4.2. Benzodiazepines
4.3. Antidepressants
4.4. Antipsychotics
4.5. Antiepileptic and Antiparkinson Medicines
5. Conclusions
Supplementary Materials
Author Contributions
Conflicts of Interest
References
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Cross-Sectional Surveys or Observational (Prospective or Retrospective) Studies |
---|
Recruited adults (>90% of participants aged ≥60 years) |
Participants recruited from the aged care homes |
Reported frequency and/ or percentage of CNS drug use (total sample and number of users) |
Sample size of ≥50 participants |
Broad definition of CNS drugs including psychotropic, antipsychotic, antidepressant, benzodiazepines, antiparkinson, and antiepileptic medicines |
Region | Studies (n) | Pooled Proportion (%) | 95% CI (%) | I2 (%) | p-Value for I2 |
---|---|---|---|---|---|
Scandinavia | 23 | 42.5 | 39.8–45.3 | 99.4 | <0.001 |
Europe | 32 | 41.2 | 36.0–46.6 | 99.8 | <0.001 |
South East Asia | 2 | 38.2 | 13.8–65.8 | 97.4 | <0.001 |
ANZ | 15 | 34.3 | 28.1–40.8 | 99.7 | <0.001 |
North America | 17 | 31.7 | 27.8–35.7 | 99.9 | <0.001 |
All studies | 89 | 35.0 | 33.1–36.8 | 99.9 | <0.001 |
Country | No. Studies | Pooled Proportion (%) | 95% CI (%) |
---|---|---|---|
Belgium | 4 | 49.0 | 37.5–60.4 |
Finland | 4 | 44.8 | 37.9–51.8 |
Austria | 3 | 44.3 | 33.6–55.2 |
France | 4 | 41.3 | 30.1–52.9 |
Sweden | 9 | 38.9 | 30.0–48.2 |
Norway | 10 | 38.7 | 31.6–46.0 |
Spain | 2 | 37.0 | 19.5–56.3 |
US | 12 | 31.7 | 26.9–36.7 |
Australia | 11 | 31.7 | 24.6–39.3 |
New Zealand | 4 | 31.3 | 15.1–49.9 |
Canada | 5 | 30.0 | 23.3–37.3 |
Italy | 5 | 27.7 | 9.5–50.3 |
Germany | 3 | 25.1 | 14.1–38.0 |
UK | 5 | 22.3 | 16.5–28.7 |
Ireland | 2 | 20.3 | 14.7–26.6 |
Drug | Studies (n) | Pooled Proportion (%) | 95% CI (%) | I2 (%) | p-Value for I2 |
---|---|---|---|---|---|
Psychotropic drugs | 32 | 68.0 | 65.7–70.2 | 98.5 | <0.001 |
Europe | 10 | 72.2 | 67.1–77.1 | 99.0 | 0.001 |
Scandinavia | 10 | 71.6 | 69.2–74.0 | 91.0 | 0.001 |
North America | 3 | 69.3 | 65.0–73.6 | 98.0 | 0.001 |
ANZ | 9 | 56.9 | 52.2–61.4 | 98.0 | 0.001 |
Antipsychotics | 57 | 26.1 | 25.1–27.2 | 99.6 | <0.001 |
Europe | 18 | 27.7 | 23.9–31.6 | 99.0 | <0.001 |
Scandinavia | 14 | 26.3 | 22.8–30.0 | 98.0 | <0.001 |
North America | 15 | 24.6 | 22.7–26.6 | 100 | <0.001 |
ANZ | 10 | 23.5 | 20.7–26.4 | 96.0 | <0.001 |
Antidepressants | 47 | 38.3 | 35.1–41.6 | 99.7 | <0.001 |
North America | 10 | 44.9 | 35.3–54.5 | 100.0 | <0.001 |
Scandinavia | 18 | 41.0 | 39.2–42.9 | 93.0 | 0.001 |
Europe | 13 | 33.5 | 29.3–37.7 | 99.0 | <0.001 |
ANZ | 6 | 30.5 | 23.6–37.7 | 96.0 | 0.001 |
Benzodiazepines | 70 | 36.2 | 32.2–40.4 | 99.8 | <0.001 |
Europe | 14 | 44.8 | 38.4–51.2 | 100 | <0.001 |
Scandinavia | 18 | 42.3 | 37.8–46.8 | 99.0 | <0.001 |
ANZ | 8 | 29.4 | 21.1–38.2 | 99.0 | <0.001 |
North America | 9 | 18.9 | 13.5–24.8 | 99.0 | <0.001 |
Antiepileptics | 17 | 10.8 | 9.1–12.6 | 98.4 | <0.001 |
Antiparkinsons | 4 | 6.5 | 5.2–8.0 | 79.0 | 0.003 |
Country | No. Studies | Drug Class | Pooled Proportion (%) | 95% CI (%) |
---|---|---|---|---|
Australia | 5 | Psychotropic | 60.2 | 54.5–65.8 |
7 | Antipsychotic | 24.8 | 21.3–28.5 | |
5 | Antidepressant | 30.6 | 21.8–40.1 | |
6 | Benzodiazepine | 27.4 | 17.4–38.7 | |
Austria | 2 | Antipsychotic | 45.9 | 44.3–47.5 |
2 | Antidepressant | 36.8 | 35.3–38.4 | |
2 | Benzodiazepine | 35.0 | 33.5–36.5 | |
Belgium | 2 | Psychotropic | 77.2 | 72.9–81.2 |
2 | Antipsychotic | 24.2 | 10.6–41.0 | |
3 | Antidepressant | 40.3 | 38.8–41.8 | |
3 | Benzodiazepine | 54.1 | 51.8–56.4 | |
Canada | 5 | Antipsychotic | 28.6 | 24.5–32.9 |
3 | Antidepressant | 27.7 | 8.9–51.2 | |
4 | Benzodiazepine | 23.9 | 12.3–37.7 | |
Finland | 2 | Psychotropic | 78.0 | 74.2–81.6 |
6 | Antipsychotic | 37.0 | 31.9–42.2 | |
4 | Antidepressant | 43.3 | 41.2–45.5 | |
4 | Benzodiazepine | 40.8 | 26.6–55.8 | |
3 | Antiepileptic | 10.8 | 6.5–15.9 | |
France | 3 | Antipsychotic | 26.0 | 23.8–28.3 |
2 | Antidepressant | 43.3 | 42.2–44.5 | |
2 | Benzodiazepine | 48.4 | 38.4–58.4 | |
Germany | 2 | Antipsychotic | 31.6 | 25.0–38.7 |
Italy | 3 | Antiepileptic | 13.5 | 3.5–28.0 |
New Zealand | 4 | Psychotropic | 52.5 | 40.4–64.4 |
3 | Antipsychotic | 20.3 | 16.6–24.4 | |
2 | Antidepressant | 25.4 | 16.5–35.5 | |
2 | Benzodiazepine | 35.1 | 32.6–37.7 | |
Norway | 8 | Psychotropic | 70.4 | 68.0–72.8 |
10 | Antipsychotic | 23.5 | 22.5–24.5 | |
12 | Antidepressant | 38.7 | 35.5–42.0 | |
10 | Benzodiazepine | 44.8 | 39.2–50.4 | |
3 | Antiepileptic | 9.8 | 7.2–12.7 | |
Spain | 2 | Benzodiazepine | 41.4 | 32.2–50.9 |
Sweden | 4 | Psychotropic | 70.1 | 67.7–72.5 |
5 | Antipsychotic | 20.3 | 16.4–24.7 | |
8 | Antidepressant | 43.9 | 41.2–46.6 | |
4 | Benzodiazepine | 37.1 | 34.0–40.3 | |
UK | 5 | Antipsychotic | 18.9 | 17.5–20.3 |
2 | Antidepressant | 35.3 | 30.1–40.7 | |
US | 2 | Psychotropic | 71.2 | 68.1–74.1 |
10 | Antipsychotic | 22.8 | 20.7–24.9 | |
7 | Antidepressant | 52.0 | 43.2–60.7 | |
5 | Benzodiazepine | 14.7 | 8.8–21.8 |
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Hasan, S.S.; Zaidi, S.T.R.; Nirwan, J.S.; Ghori, M.U.; Javid, F.; Ahmadi, K.; Babar, Z.-U.-D. Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis. J. Clin. Med. 2019, 8, 1292. https://doi.org/10.3390/jcm8091292
Hasan SS, Zaidi STR, Nirwan JS, Ghori MU, Javid F, Ahmadi K, Babar Z-U-D. Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2019; 8(9):1292. https://doi.org/10.3390/jcm8091292
Chicago/Turabian StyleHasan, Syed Shahzad, Syed Tabish Razi Zaidi, Jorabar Singh Nirwan, Muhammad Usman Ghori, Farideh Javid, Keivan Ahmadi, and Zaheer- Ud-Din Babar. 2019. "Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis" Journal of Clinical Medicine 8, no. 9: 1292. https://doi.org/10.3390/jcm8091292
APA StyleHasan, S. S., Zaidi, S. T. R., Nirwan, J. S., Ghori, M. U., Javid, F., Ahmadi, K., & Babar, Z. -U. -D. (2019). Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 8(9), 1292. https://doi.org/10.3390/jcm8091292