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Analysis of Risk Factors for Inappropriate Prescribing of Psychotropic Drugs in Primary Health Care in Elderly Patients Cover

Analysis of Risk Factors for Inappropriate Prescribing of Psychotropic Drugs in Primary Health Care in Elderly Patients

EABR. Experimental and Applied Biomedical Research
Volume 26 (2025): Issue 2 (June 2025)
By: Filip Mihajlovic,  Filip Milutinovic,  Djordje Djordjevic,  Sara Mijailovic,  Sanja Vukojicic and  Dragan Milovanovic  
Open Access
|Dec 2025

Figures & Tables

Sociodemographic characteristics of the study population

Characteristics of the study populationTotal (n=492) n (%); mean+SD; median (IQR)
Age71.77±5.954; 70.0; (6.0)
Sex (female)306 (62.2%); 186; (37.8)
Total number of prescribed medications4.37±2.234; 4.0; (3.0)
Most common diagnoses
arterial hypertension254 (51.6%); 238; (48.4)
cardiac insufficiency218 (44.3%); 274; (55.7)
depression106 (21.5%); 386; (78.5)
type 1 diabetes mellitus80 (16.3%); 412; (83.7)
benign prostatic hyperplasia70 (14.2%); 422; (85.8)
asthma26 (5.3%); 466; (94.7)
epilepsy18 (3.7%); 474; (96.3)

Risk factors associated with potentially inappropriate prescribing of psychotropic drugs according to STOPP/START criteria

STOPP criteriaRaw OR 95% (CI)Adjusted OR 95% (CI)
Risk factors
Arterial hypertension2.451 (1.705–3.522)0.0000.419 (0.141–1.245)0.118
Cardiac insufficiency0.604 (0.422–0.864)0.0061.296 (0.470–3.575)0.617
Asthma2.431 (1.036–5.701)0.0411.329 (0.231–7.644)0.750
Depression93.449 (22.711–384.515)0.00018.138 (3.367–97.704)0.001
Number of diseases2.332 (1.858–2.927)0.0003.805 (1.911–7.578)0.001
Total number of drugs1.391 (1.265–1.530)0.0001.031 (0.812–1.310)0.801
Problems with the use of psychotropic drugs24.554 (5.863–102.834)0.00043.517 (5.453–347.267)0.001
Number of OTC sales2.029 (1.536–2.680)0.0001.625 (0.892–2.959)0.113
Number of dietary supplements1.538 (1.218–1.942)0.0021.262 (0.689–2.309)0.451
Use of antidepressants84.389 (20.501–347.370)0.00052.810 (6.217–448.561)0.000

  • PSR visits

  • once a week

  • two/more times a week

  • once every two weeks

  • Ref.

  • 0.203 (0.120–0.343)

  • 0.063 (0.037–0.109)

  • 0.000

  • 0.000

  • 0.069 (0.020–0.232)

  • 0.508 (0.196–1.316)

  • 0.001

  • 0.163

Number of patient examinations in the last 12 months1.388 (1.255–1.535)0.0001.307 (1.005–1.699)0.046
Number of hospitalizations in the last 12 months1.540 (1.248–1.900)0.0001.089 (0.736–1.612)0.669
Number of performed diagnostic procedures1.233 (1.111–1.369)0.0001.196 (0.930–1.539)0.163
Years of service of the eGP1.138 (1.104–1.173)0.0001.017 (0.926–1.116)0.728
Number of patients of the sGP1.004 (1.003–1.006)0.0001.003 (1.000–1.005)0.027
Number of adverse reactions to psychotropic drugs6.411 (2.222–18.500)0.0010.572 (0.029–11.313)0.714
Age1.031 (1.001–1.063)0.0450.920 (0.861–0.982)0.012

  • Place of residence

  • city

  • suburb

  • rural life

  • Ref.

  • 3.362 (2.241–5.044)

  • 6.562 (3.299–13.054)

  • 0.000

  • 0.000

  • 2.738 (1.059–7.078)

  • 2.979 (0.577–15.377)

  • 0.038

  • 0.192

  • Education

  • uneducated

  • primary school

  • High School

  • college

  • Ref.

  • 0.541 (0.316–0.929)

  • 0.847 (0.489–1.467)

  • 0.286 (0.082–0.998)

  • 0.026

  • 0.554

  • 0.050

  • 0.823 (0.240–2.823)

  • 0.484 (0.096–2.443)

  • 0.023 (0.000–2646.848)

  • 0.756

  • 0.379

  • 0.525

  • Cigarette consumption

  • non smoker

  • one pack a day

  • more than one pack

  • Ref.

  • 2.231 (1.537–2.504)

  • 1.468 (0.916–2.353)

  • 0.000

  • 0.111

  • 1.612 (0.493–5.266)

  • 0.098 (0.017–0.560)

  • 0.429

  • 0.009

  • Alcohol consumption

  • does not consume

  • one cup per day

  • more than one cup

  • Ref.

  • 2.530 (1.634–3.917)

  • 3.053 (1.947–4.788)

  • 0.000

  • 0.000

  • 2.824 (0.917–8.699)

  • 2.870 (0.600–13.716)

  • 0.071

  • 0.187

  • Physical activity

  • inactive

  • daily

  • once a week

  • several times a week

  • Ref.

  • 0.976 (0.622–1.531)

  • 1.174 (0.738–1.869)

  • 4.583 (2.254–9.318)

  • 0.914

  • 0.498

  • 0.000

  • 4.809 (1.370–16.882)

  • 2.167 (0.546–8.595)

  • 7.203 (1.562–33.210)

  • 0.014

  • 0.271

  • 0.011

  • Diet

  • less than three meals

  • three meals

  • three meals and two

  • snacks

  • Ref.

  • 0.447 (0.301–0.663)

  • 0.527 (0.313–0.888)

  • 0.000

  • 0.016

  • 0.491 (0.172–1.400)

  • 1.461 (0.330–6.470)

  • 0.183

  • 0.617

  • Monthly income

  • 5,000 – 10,000

  • 11,000 – 15,000

  • 16,000 – 20,000

  • over 20,000 RSD

  • Ref.

  • 0.626 (0.396–0.991)

  • 0.147 (0.086–0.253)

  • 0.293 (0.100–0.861)

  • 0.046

  • 0.000

  • 0.026

  • 0.372 (0.140–0.992)

  • 0.065 (0.016–0.270)

  • 1.050 (0.158–6.993)

  • 0.048

  • 0.000

  • 0.960

Risk factors associated with potential failure to prescribe psychotropic drugs according to STOPP / START criteria

START criteriaRaw OR 95% (CI)Adjusted OR 95% (CI)
Risk factors
Arrhythmia0.478 (0.303–0.752)0.0010.756 (0.331–1.724)0.505
COPD0.242 (0.075–0.782)0.0180.033 (0.005–0.207)0.001
Depression3.929 (2.278–6.779)0.0001.507 (0.499–4.552)0.467
Number of diseases1.277 (1.060–1.537)0.0101.198 (0.787–1.826)0.400
Total number of drugs1.227 (1.120–1.344)0.0001.458 (1.172–1.815)0.001
Number of OTC sales1.757 (1.321–2.338)0.0001.514 (0.943–2.433)0.086
Number of dietary supplements1.445 (1.136–1.838)0.0031.328 (0.867–2.036)0.192
Antipsychotics1.866 (1.167–2.982)0.0094.049 (1.730–9.476)0.001
Anxiolytics0.578 (0.349–0.849)0.0050.303 (0.140–0.657)0.002

  • PSR visits

  • once a week

  • two/more times a week

  • once every two weeks

  • Ref.

  • 0.238 (0.146–0.387)

  • 0.632 (0.390–1.026)

  • 0.000

  • 0.064

  • 1.689 (0.596–4.784)

  • 0.342 (0.132–0.886)

  • 0.324

  • 0.027

Number of patient examinations in the last 12 months1.110 (1.016–1.214)0.0210.968 (0.766–1.225)0.788
Number of hospitalizations in the last 12 months1.355 (1.090–1.685)0.0061.104 (0.820–1.486)0.514
Number of performed diagnostic procedures1.174 (1.056–1.305)0.0031.262 (1.036–1.537)0.021

  • Degree of professional development of the sGP

  • general practitioner

  • specialist in general medicine

  • Ref.

  • 3.919 (2.211–6.945)

0.0000.953 (0.205–4.440)0.952
Number of patients of the sGP1.003 (1.002–1.004)0.0001.002 (1.000–1.004)0.091

  • Place of residence

  • city

  • suburb

  • rural life

  • Ref.

  • 1.308 (0.878–1.947)

  • 3.385 (1.636–7.000)

  • 0.186

  • 0.001

  • 2.065 (1.021–4.177)

  • 11.334 (2.838–45.273)

  • 0.05

  • 0.001

  • Community living

  • marriage

  • alone

  • with friends

  • with relatives

  • Ref.

  • 0.404 (0.275–0.593)

  • 1.327 (0.263–6.698)

  • 0.442 (0.108–1.807)

  • 0.000

  • 0.732

  • 0.256

  • 0.276 (0.148–0.516)

  • 4.437 (0.043–452.717)

  • 0.070 (0.002–2.256)

  • 0.001

  • 0.528

  • 0.148

  • Cigarette consumption

  • non smoker

  • one pack a day

  • more than one pack

  • Ref.

  • 1.984 (1.301–3.025)

  • 2.104 (1.277–3.466)

  • 0.001

  • 0.004

  • 1.242 (0.535–2.883)

  • 1.862 (0.663–5.233)

  • 0.614

  • 0.238

  • Alcohol consumption

  • does not consume

  • one cup per day

  • more than one cup

  • Ref.

  • 2.824 (1.804–4.422)

  • 2.527 (1.607–3.974)

  • 0.000

  • 0.000

  • 2.094 (0.884–4.956)

  • 1.478 (0.556–3.931)

  • 0.093

  • 0.433

  • Diet

  • less than three meals

  • three meals

  • three meals and two snacks

  • Ref.

  • 0.640 (0.431–0.951)

  • 1.219 (0.700–2.121)

  • 0.027

  • 0.484

  • 1.399 (0.663–2.953)

  • 4.376 (1.540–12.430)

  • 0.379

  • 0.006

  • Monthly income

  • 5,000 – 10,000

  • 11,000 – 15,000

  • 16,000 – 20,000

  • over 20,000 RSD

  • Ref.

  • 0.603 (0.381–0.953)

  • 0.977 (0.586–1.629)

  • 0.488 (0.171–1.392)

  • 0.030

  • 0.928

  • 0.180

  • 0.774 (0.345–1.737)

  • 2.900 (1.203–6.993)

  • 1.426 (0.310–6.550)

  • 0.535

  • 0.018

  • 0.648

  • Social activities

  • parties

  • travel adventures

  • theatrical performances

  • sport matches

  • political activities

  • Ref.

  • 1.476 (0.789–2.784)

  • 0.278 (0.085–0.905)

  • 1.997 (1.085–3.678)

  • 1.216 (0.633–2.336)

  • 0.229

  • 0.034

  • 0.026

  • 0.558

  • 1.903 (0.702–5.158)

  • 0.253 (0.044–1.457)

  • 0.709 (0.282–4.841)

  • 1.492 (0.460–4.841)

  • 0.206

  • 0.124

  • 0.464

  • 0.505

DOI: https://doi.org/10.2478/sjecr-2022-0020 | Journal eISSN: 2956-2090 | Journal ISSN: 2956-0454
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Language: English
Page range: 137 - 144
Submitted on: Mar 31, 2022
|
Accepted on: Apr 17, 2022
|
Published on: Dec 31, 2025
Published by: University of Kragujevac, Faculty of Medical Sciences
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
STOPP/START,
psychotropic drugs,
older population
Related subjects:
Medicine,
Clinical medicine,
Clinical medicine, other

© 2025 Filip Mihajlovic, Filip Milutinovic, Djordje Djordjevic, Sara Mijailovic, Sanja Vukojicic, Dragan Milovanovic, published by University of Kragujevac, Faculty of Medical Sciences
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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