Prescribing psychotropic medication for elderly patients: some physicians' perspectives.

BACKGROUND: The inappropriate use of psychotropic medication is widespread and has potential consequences for the autonomy of elderly people. This study explored physicians' perceptions and attitudes and the decision-making process associated with prescribing psychotropic medications for elderly patients.

METHODS: In this qualitative study conducted between February and April 1996, 9 of 12 physicians who offered consultation services for elderly people in private apartment buildings in a suburban region of Montreal were interviewed. The transcripts of the interviews were analysed quantitatively using an iterative process. The authors assessed the physicians' perceptions of the elderly patient population, the decision-making process leading to the prescription of psychotropic medication and the nature of follow-up.

RESULTS: All of the physicians interviewed perceived the aging process as a negative experience and stated that the long-term use of psychotropic medication is justified by the distress of their aging patients and the few negative side effects that are noticed. Most said that, when they re-prescribe, they see their role as a "gatekeeper" to monitor and control the type and quantity of medication prescribed. Most physicians felt that the solutions to the inappropriate prescribing of psychotropic medication were beyond the scope of the individual physician.

INTERPRETATION: Physicians interviewed in this study had a patient-centered perspective. From a public health viewpoint this calls for an innovative approach to involve physicians in a multidisciplinary intervention strategy to examine the inappropriate use of psychotropic medication among elderly patients.