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Objectif. Identifier les facteurs influençant l’utilisation des psychotropes et des psychotropes potentiellement inappropriés (PPI) chez les résidents en établissement d’hébergement pour personnes âgées dépendantes (Ehpad). Méthodes. Étude transversale multicentrique à partir des coupes Pathos et des ordonnances médicamenteuses. Les médicaments ont été codés avec la classification ATC. Les psychotropes ont été identifiés par la classification de Delay et Denicker, et les psychotropes inappropriés par la liste de Beers 2015. Résultats. Les 2 343 résidents ont consommé en moyenne 7,8 ± 3,5 médicaments ; 71,6 % avaient au moins un psychotrope, et 44,1 % un PPI. Les facteurs indépendamment associés à l’usage de psychotrope étaient les troubles du comportement (OR = 3,21), le syndrome dépressif (OR = 8,79), les troubles anxieux (OR = 3,43), les troubles psychotiques (OR = 2,05), la polymédication (OR = 4,85), et la déshydratation (OR = 0,49). L’usage des PPI était indépendamment associé aux troubles du comportement (OR = 1,56), au syndrome dépressif (OR = 2,90), aux troubles anxieux (OR = 1,68), au syndrome démentiel (OR = 2,43), à la polymédication (OR = 3,41), la déshydratation (OR = 0,53), l’arthrite/arthrose du genou (OR = 1,48), et de l’épaule (OR = 2,06). Conclusion. La révision régulière des ordonnances et l’usage de traitements non médicamenteux dans les troubles du comportement du sujet âgé peuvent permettre de réduire la prescription de psychotropes et de PPI chez les résidents en Ehpad.

Aim. To identify factors that influence use of potentially inappropriate psychotropic drugs among elderly residents living in nursing homes (NH). Methods. Cross-sectional, multicentre study among 65+ years NH residents, based on queries performed on the PATHOS database and on prescription information from residents’ medical data. Medications were coded using the Anatomical Therapeutical Chemical classification. Psychotropic agents were classed using Delay and Deniker's classification, and the Beers Criteria (Beers list 2015 update) were used to identify potentially inappropriate psychotropic drugs (PIPs). Logistic regression was performed to identify factors related to use of potentially inappropriate psychotropic drugs, and factors related to PIPs. Results. The average number of drugs per subject (n=2,343) was 7.8±3.5. In total, 1,709 (71.6%) subjects were taking psychotropic drugs (1.8±0.9 psychotropic drugs per user). Psychotropic agents represented 17.4% of the 18,143 drugs used by the whole study population. The frequency of PIPs was 44.1%. By multivariable analysis, the use of psychotropic drug was significantly associated with behavioural disorders (OR 3.21, 95%CI [2.46-4.18]); depression (OR 8.79, 95%CI [6.64-11.6]); anxiety (OR 3.43, 95%CI [2.45-4.8]); psychosis (OR 2.05, 95%CI [1.28-3.30]), use of >4 drugs (OR 4.85, 95%CI [3.60-6.53]); and dehydration (OR 0.49, 95%CI [0.32-0.75]). PIPs was significantly associated to behavioural disorders (odds ratio (OR) 1.56, 95% confidence interval (CI) [1.89-1.29]); depression (OR 2.90, 95%CI [3.60-2.3]); anxiety (OR 1.68, 95%CI [2.32-1.22]); dementia (OR 2.43, 95%CI [2.96-1.99]); use of >4 drugs (OR 3.41, 95%CI [4.90-2.37]); dehydration (OR 0.53, 95%CI [0.76-0.37]), arthritis/arthrosis of the hip (OR 1.48, 95%CI [2.04-1.07]) and arthritis/arthrosis of the shoulder (OR 2.06, 95%CI [3.43-1.23]). Conclusion. Regular review of prescriptions and emphasis on non-drug therapy of behavioural disorders in elderly subjects can help to reduce the rate of prescription of psychotropic drugs and PIPs in NH residents.