Antidepressant prescribing in older primary care patients in community and care home settings in England and Wales

Objective: To compare the prevalence and predictors of antidepressant prescribing in older care home and community residents in England and Wales.

Design: Retrospective analysis of primary care consultation and antidepressant prescribing data.

Setting: The setting included 326 general (family) practices in England and Wales supplying data to The Health Improvement Network database between 2008 and 2009.

Participants: Participants were 10,387 care home and 403,259 community residents aged 65 to 104.

Main outcome measure: Antidepressant prescription in the last 3 months of recorded data for each patient.

Results: Prevalence rates for antidepressant prescribing were 10.3% (95% confidence interval 10%-10.6%) for community and 37.5% (36.2%-38.9%) for care home residents. After excluding low-dose tricyclics (often used for other indications) prevalences were 7.3% (7.1%-7.5%) and 33.6% (32.3%-34.9%) respectively; of these, 21.7% (20.8%-22.6%) of community and 4.8% (3.9%-5.6%) of care home prescriptions were for antidepressants advised as best avoided in this age group. After indirect standardization for age, sex, and chronic disease prevalence, the ratio for prescribing was 2.4 (2.3-2.5) in care homes compared with the community; 28.3% (26.6%-30.1%) of community and 42.5% (39.4%-45.7%) of care home residents prescribed antidepressants had no appropriate recorded indication.

Conclusions: This national sample confirms the high prevalence of antidepressant prescribing to older people, particularly in care homes, frequently without a documented indication. The strong association found between chronic disease and antidepressant prescribing did not explain the higher care home prescribing rate. Widespread community use of nonrecommended antidepressants is also a concern.