Decreasing trends in potentially inappropriate medications in older people: a nationwide repeated cross-sectional study

Drusch, Solène; Tri, Thien Le; Ankri, Joël; Zureik, Mahmoud; Herr, Marie

doi:10.1186/s12877-021-02568-1

Cited by 17 publications

(28 citation statements)

References 39 publications

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“…First, polypharmacy was common among older adults in our study. However, the observed prevalence of polypharmacy (23.5%) is lower than those reported from previous studies conducted in France and in other developed countries [ 21 – 23 ]. This can be explained by the heterogeneous measurements of the number of medications taken and also by different study populations.…”

Section: Discussioncontrasting

confidence: 75%

Uses and perceptions of medications among French older adults: results from the 2020 French Health Barometer survey

et al. 2022

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Background There are few studies reporting on self-medication, perceptions or difficulties older adults have with their medications. This study aimed to describe the uses and the perceptions of medications among older adults in France and to identify patient groups based on that information. Methods We used data from the 2020 ‘French Health Barometer’ – a nationally-representative cross-sectional survey. We assessed polypharmacy (five or more medications), self-medication, and patient perceptions of medications. Robust Poisson regression was used to investigate socio-demographic and health-related factors associated with the outcomes. Latent class analysis was used to identify patient groups classified by the use and the perceptions of medications. Factors associated with group assignment were investigated by multinomial logistic regression. All analyses were weighted. Results The study sample comprised 1,623 respondents aged 70–85 years. Polypharmacy and self-medication were reported in 23.5 and 48.7% of the older population, respectively. Polypharmacy was associated with increasing age, low education, and impaired health status. Self-medication was associated with female sex and high education. Among individuals taking at least 1 medication, 8.2% reported not to understand all their medications, and 9.7% having difficulty taking medications as prescribed. Among individuals taking at least 2 medications, 23.2% thought that they took too many medications. Three patient groups were identified: ‘Non-polypharmacy, positive perceptions’ (62.5%), ‘Polypharmacy, positive perceptions’ (28.0%), and ‘Negative perceptions’ (9.5%). Conclusions Polypharmacy and self-medication are common in French older adults. One segment of people reported negative perceptions of their medications regardless of their polypharmacy status. This underlines the difference between the objective and perceived measures of polypharmacy.

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Section: Discussioncontrasting

confidence: 75%

Uses and perceptions of medications among French older adults: results from the 2020 French Health Barometer survey

et al. 2022

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“…Second, international comparisons of psychotropic indicators are complicated due to differences in national drug formula across countries, for example no psycholeptics/psychoanaleptics combinations (ATC: N05C) are approved in Sweden. Last, we report a lower prevalence of excessive polypharmacy than most previous studies ( Drusch et al, 2021 ). This is mainly explained by the use of a 1-day point prevalence in our study, that can be compared with the 3 and 12-month periods used in most other studies ( Masnoon et al, 2017 ).…”

Section: Discussioncontrasting

confidence: 48%

Regional variations in excessive polypharmacy and potentially inappropriate drug use among older adults in Sweden: Trends from 2006 to 2020

Wastesson

Fritzell²,

Burström³

et al. 2023

Front. Pharmacol.

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Introduction: Potentially inappropriate drug use (PID) is common among older adults. Cross-sectional data suggest that there are marked regional variations in PID in Sweden. There is, however, a lack of knowledge about how the regional variations have changed over time.Objectives: This study aimed to investigate the regional differences in the prevalence of PID in Sweden, 2006–2020.Methods: In this repeated cross-sectional study, we included all older adults (≥75 years) registered in Sweden, yearly from 2006 to 2020. We used nationwide data from the Swedish Prescribed Drug Register linked at the individual level to the Swedish Total Population Register. We selected three indicators of PID according to the Swedish national “Quality indicators for good drug therapy in the elderly”: 1) Excessive polypharmacy (use of ≥10 drugs); 2) Concurrent use of three or more psychotropic drugs; 3) Use of “drugs that should be avoided in older adults unless specific reasons exist.” The prevalence of these indicators was calculated for each of Sweden’s 21 regions, yearly from 2006 to 2020. The annual coefficient of variation (CV) was calculated for each indicator by dividing the standard deviation of the regions by the national average, to measure relative variability.Results: In the population of about 800,000 older adults per year, the national prevalence of “drugs that should be avoided in older adults,” was reduced by 59% from 2006 to 2020. There was a slight decline in the use of three or more psychotropics, while the prevalence of excessive polypharmacy increased. The CV for excessive polypharmacy was 14% in 2006 and 9% in 2020 compared to 18% and 14% for “use of three or more psychotropics”, and stable at around 10% for ‘drugs that should be avoided in older adults.’Conclusions: The regional variation in potentially inappropriate drug use decreased or were stable from 2006 to 2020. The regional differences were largest for the use of three or more psychotropics. We found a general tendency that regions with a good performance at the start of the period performed well across the entire period. Future studies should investigate the reasons for regional variation and explore strategies to reduce unwarranted differences.

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“…To the best of our knowledge, this is the first study to assess the trends of polypharmacy and PIM use in older Chinese lung cancer outpatients with multimorbidity. Previous studies based on national representative surveys have shown an alarming increase in the polypharmacy trends in the United States (from 8.2% in 1999 to 15% in 2012; Kantor et al, 2015 ), Sweden (from 16.9% in 2006 to 19.0% in 2014; Zhang et al, 2020 ), and France (from 44.9% in 2011 to 47.8% in 2019; Drusch et al, 2021 ), which are consistent with regional register-based studies on this period in the United Kingdom (a polypharmacy increase from 11.2% in 1995 to 22.8% in 2010; Guthrie et al, 2015 ) and those using the University Groningen IADB.nl prescription database in the Netherlands (showing an increase from 56.5% in 2012 to 58.2% in 2016; Oktora et al, 2021 ). Subjective measures, such as sleep diaries and anxiety and depression screening scales, also assist the diagnosis.…”

Section: Discussionmentioning

confidence: 96%

Increasing Trends of Polypharmacy and Potentially Inappropriate Medication Use in Older Lung Cancer Patients in China: A Repeated Cross-Sectional Study

Tian

Chen

et al. 2022

Front. Pharmacol.

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Objectives: Polypharmacy and potentially inappropriate medication (PIM) use are frequent in older lung cancer patients. This study aimed to examine the trends of polypharmacy and PIM use and explore risk factors for PIM use based on the 2019 Beers criteria in older Chinese lung cancer outpatients with multimorbidity.Methods: A repeated cross-sectional study was conducted using electronic medical data consisting of the prescriptions of older lung cancer outpatients in China from January 2016 to December 2018. Polypharmacy was defined as the use of five or more medications. The 2019 Beers criteria were used to evaluate the PIM use of older cancer outpatients (age ≥65 years), and multivariate logistic regression was used to identify the risk factors for PIM use.Results: A total of 3,286 older lung cancer outpatients and their prescriptions were included in the study. The prevalence of polypharmacy was 14.27% in 2016, 16.55% in 2017, and 18.04% in 2018. The prevalence of PIM use, according to the 2019 Beers criteria, was 31.94% in 2016, 35.78% in 2017, and 42.67% in 2018. The two most frequently used PIMs in older lung cancer outpatients were estazolam and tramadol. The logistic regression demonstrated that age 75 to 79, polypharmacy, irrational use of drugs, and lung cancer accompanied by sleep disorders, anxiety or depression, or pain were positively associated with PIM use in older lung cancer outpatients.Conclusion: The prevalence of polypharmacy and PIM use in older lung cancer outpatients with multimorbidity was high in China, and polypharmacy and PIM use increased over time. Further research on interventions rationing PIM use in the older lung cancer patient population is needed.

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Decreasing trends in potentially inappropriate medications in older people: a nationwide repeated cross-sectional study

Cited by 17 publications

References 39 publications

Uses and perceptions of medications among French older adults: results from the 2020 French Health Barometer survey

Uses and perceptions of medications among French older adults: results from the 2020 French Health Barometer survey

Regional variations in excessive polypharmacy and potentially inappropriate drug use among older adults in Sweden: Trends from 2006 to 2020

Increasing Trends of Polypharmacy and Potentially Inappropriate Medication Use in Older Lung Cancer Patients in China: A Repeated Cross-Sectional Study

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