Increasing use of medicines in elderly persons: a five-year follow-up of the Kuopio 75+Study

Jyrkkä, Johanna; Vartiainen, Leena; Hartikainen, Sirpa; Sulkava, Raimo; Enlund, Hannes

doi:10.1007/s00228-005-0079-6

Cited by 120 publications

(106 citation statements)

References 33 publications

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“…In our study, 43.8% of the sample had bought ! 10 medicines, which is many more than Jyrkkä et al (2006) reported: 28% of old people had used this many medicines. However, unlike such earlier work our study included all different medicines in the last 2 years of life, and not all of these were necessarily used at the same time.…”

Section: Discussionmentioning

confidence: 99%

Health and social service use among old people in the last 2 years of life

et al. 2007

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This study focuses on differences in health and social service use in the last 2 years of life among Finnish people aged 70-79, 80-89, and 90 or older and on the variation in service use in the various municipalities. The data set, derived from multiple national registers, consists of 75,578 people who died in 1998-2001. The services included hospitals and long-term-care facilities, use of regular home care, and prescribed medicines. General hospital and public long-term care were the services most commonly used: general hospitals for younger age groups and public long-term care for older groups. The number of inpatient days in hospital was lower with increasing age, but older age groups used long-term care more frequently. Men had more hospital inpatient days than women, but women used more long-term care. The number of hospital inpatient days increased rapidly in the last months of life, almost doubling in the final month. Days in public longterm care increased regularly in the last 2 years of life. Variation in both hospital and long-term care by municipality was remarkable. The results indicate that, among people aged 70 years and older, age is a major determinant of care in the last 2 years of life. The variation in the use of care by municipality and the differences between men and women deserve more detailed analysis in future.Keywords Last years of life Á Health and social care Á Use of care Á Ageing Á Older people Á Register study

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Section: Discussionmentioning

confidence: 99%

Health and social service use among old people in the last 2 years of life

et al. 2007

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“…The number could reflect the total numbers of drugs used in the patient's medication regimen, or it could refer to the number of drugs for a particular condition (15) which is often the case in studies of psychiatric disorders (16,20). Further, in research studies, the number of drugs which are defined as polypharmacy varies from study to study: 2 or more drugs (13,16,21), 3 or more drugs (22), 5 or more drugs (13,14,23,24), 6 drugs (9,25,26), 10 or more drugs (4,27). However, the most common definition is the use of 5 or more drugs (10).…”

Section: Definitionsmentioning

confidence: 99%

“…Studies exploring polypharmacy have been conducted in different clinical settings, in out-patients/ambulatory patients (14,25,(30)(31)(32)(33), hospitalised patients (26,(34)(35)(36), patients in nursing homes (37,38), and elderly patients (25)(26)(27)32,33,39). Studies have also been performed based on data from prescription or population databases (13,28,(40)(41)(42).…”

Section: Frequency Of Polypharmacymentioning

confidence: 99%

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The Janus face of polypharmacy – overuse versus underuse of medication

Viktil¹,

Blix²,

Reikvam³

2009

Nor J Epidemiol

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As modern guidelines may recommend several drugs for a single medical condition, it follows that many patients, especially if co-morbidity is present, use a number of medications. Also, an aging population implies more morbidity and consequently will have the result that many patients use many drugs -a situation often referred to as polypharmacy. Polypharmacy has been linked to negative health outcomes such as adverse drug reactions, interaction problems, poor patient adherence, and hospitalisations. Such experiences have led to the attitude that efforts should be made to reduce polypharmacy. However, this approach might prevent patients from obtaining optimal treatment. There is no universal definition of polypharmacy and measuring of a reduction in polypharmacy becomes problematic. Because polypharmacy is an imprecise term it should be used with caution in research as well as in patient management. Moreover, studies have shown that undertreatment occurs frequently also among patients using many drugs. This is the Janus face of polypharmacy: too many drugs should be avoided, but the individual patient should receive the appropriate drugs that have the potential to reduce morbidity and improve quality of life. It is the individual drugs themselves, along with patient specific factors, and not a fixed number of drugs, that we should pay attention to.

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“…6 It is estimated that by 2020, more than 50 % of persons living with HIV infection will be aged 50 years or older. 7 Polypharmacy, defined as the concomitant use of multiple medications (e.g., customarily five or more medications), has been associated with increasing age 8,9 and with an increased risk of adverse drug reactions, increased hospitalizations, poor adherence, inappropriate drugs, falls and fractures, and drug-drug interactions. [10][11][12][13][14][15] The risk for drug-drug interactions may be particularly increased among the aging population of HIV-infected adults due to treatments for multiple comorbidities in this population [16][17][18][19] as well as the concomitant use of ARV therapy.…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy and Risk of Antiretroviral Drug Interactions Among the Aging HIV-Infected Population

et al. 2013

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BACKGROUND: Among aging HIV-infected adults, polypharmacy and its consequences have not been welldescribed. OBJECTIVE: To characterize the extent of polypharmacy and the risk of antiretroviral (ARV) drug interactions among persons of different ages. DESIGN AND PARTICIPANTS: Cross-sectional analysis among patients within the HIV Outpatient Study (HOPS) cohort who were prescribed ARVs during 2006-2010. MAIN MEASURES: We used the University of Liverpool HIV drug interactions database to identify ARV/non-ARV interactions with potential for clinical significance. KEY RESULTS: Of 3,810 patients analyzed (median age 46 years, 34 % ≥ 50 years old) at midpoint of observation, 1,494 (39 %) patients were prescribed ≥ 5 non-ARV medications: 706 (54 %) of 1,312 patients ≥ 50 years old compared with 788 (32 %) of 2,498 patients < 50 years. During the five-year period, the number of patients who were prescribed at least one ARV/non-ARV combination that was contraindicated or had moderate or high evidence of interaction was 267 (7 %) and 1,267 (33 %), respectively. Variables independently associated with having been prescribed a contraindicated ARV/non-ARV combination included older age (adjusted odds ratio [aOR] per 10 years of age 1.17, 95 % CI 1.01-1.35), anxiety (aOR 1.78, 95 % CI 1.32-2.40), dyslipidemia (aOR 1.96, 95 % CI 1.28-2.99), higher daily non-ARV medication burden (aOR 1.13, 95 % CI 1.10-1.17), and having been prescribed a protease inhibitor (aOR 2.10, 95 % CI 1.59-2.76). Compared with patients < 50 years, older patients were more likely to have been prescribed an ARV/non-ARV combination that was contraindicated (unadjusted OR 1.44, 95 % CI 1.14-1.82), or had moderate or high evidence of interaction (unadjusted OR 1.29, 95 % CI 1.15-1.44). CONCLUSIONS: A substantial percentage of patients were prescribed at least one ARV/non-ARV combination that was contraindicated or had potential for a clinically significant interaction. As HIV-infected patients age and experience multiple comorbidities, systematic reviews of current medications by providers may reduce risk of such exposures.

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Increasing use of medicines in elderly persons: a five-year follow-up of the Kuopio 75+Study

Abstract: The number of medicines and the prevalence of polypharmacy and excessive polypharmacy increases with advancing age. In order to avoid possible harmful effects and to optimize medication it is necessary to assess the medication regimen at regular intervals.

Cited by 120 publications

References 33 publications

Health and social service use among old people in the last 2 years of life

Health and social service use among old people in the last 2 years of life

The Janus face of polypharmacy – overuse versus underuse of medication

Polypharmacy and Risk of Antiretroviral Drug Interactions Among the Aging HIV-Infected Population

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