Title: Potentially Inappropriate Medication Use Among African American Older Adults Using Antidepressants

Importance: Independently, severe depression, chronic medical conditions and potentially inappropriate medications (PIM) are especially prevalent in African American (AA) older adults, resulting in poor health outcomes and complex treatment. However, whether antidepressant treatment increases risk for PIM use in AA older adults is unclear. 

Objective: This study aims to characterize a population of AA older adults in Los Angeles that use anti-depressants and examine their risk of PIM use compared to those who do not use antidepressants. 

Design: Data is based on a cross-sectional convenience sample from a previous study performed 2015-2017. Participants self-reported their medical conditions, medication use, and demographic characteristics. Participants were then sorted and compared based on antidepressant usage. PIMs were identifiedusing 2015 AGS Beers Criteria. 

Setting: Participants were collected from senior centers and housing units in majority AA areas of South Los Angeles. 

Participants: AA adults age 65 and older with hypertension were recruited. Four participants refused, while 193 enrolled. 

Results: Approximately 62.9% of participants using antidepressants had greater than 8 chronic medical conditions, compared with 41.7% of participants without depression. Nearly 86% of participants using antidepressants reported chronic/back pain. The proportion of participants with diabetes was similar in both groups. Significance is unknown. 

For both groups, medications that increased fall risk and PPIs were the most common PIMs. However, drug interactions, multiple CNS acting agents and benzodiazepines were used more frequently in participants using antidepressants (17.1%, 25.7%, 11.4% respectively) than those not using antidepressants (8.9%, 8.9%, 3.8%). Participants using antidepressants took an average of 1.6 PIMs while patients not using antidepressants 0.6. Significance is unknown. 

Discussion: AA older adults using antidepressants took more PIMs on average than those who do not take antidepressants in every category of contraindicated drug measured. In addition, those on antidepressants reported more chronic medical conditions, including chronic pain. Further statistical analysis is needed to determine significance of these differences. 

Our findings suggest that AA older adults on antidepressants may be at additional risk for PIM. Further exploration of the interaction between chronic medical conditions, antidepressants and PIM are needed to explain poor health outcomes in the AA older adult population.