The composition of polypharmacy: A register-based study of Swedes aged 75 years and older

Abstract

BackgroundPolypharmacy is common among older adults. However, little is known about the composition of polypharmacy: which are the most frequently used drugs, and how much do these drugs contribute to the overall prevalence of polypharmacy.MethodsA total of 822,619 Swedes aged ≥75 years was identified from the Total Population Register. Through record-linkage with the Swedish Prescribed Drug Register and the Social Services Register we could analyze concurrent drug use in the entire population (both individuals living in the community and institution) on the 31 December 2013.ResultsThe prevalence of polypharmacy (≥5 drugs) was 45%. The most frequently used drugs were cardiovascular drugs, analgesics, and psychotropics. By excluding the ten most frequently used drug classes or compounds, the prevalence of polypharmacy was reduced by 69% and 51% respectively. The majority of the users of either one of the 10 most frequently used drugs concurrently used at least 4 other drug classes (66%-85%).ConclusionAlmost half of the individuals aged ≥75 years are exposed to polypharmacy in Sweden. A handful of drugs make a large contribution to the overall prevalence of polypharmacy and the majority of drugs prescribed to persons aged ≥75 years are used in combination with other drugs. This highlights the high use of drugs, and the need to consider other concurrent drug treatments when prescribing for older adults.

Use of potentially inappropriate medication and polypharmacy in older adults: a repeated cross-sectional study

“…The decrease in PIM in this study was not parallel to a decrease in polypharmacy. The most common drug classes in patients 75 years and older with polypharmacy are not PIM (according to our definition) but cardiovascular drugs (including antithrombotic agents), analgesics and psychotropic drugs [32]. These are also the most commonly used drugs in adverse drug events, such as bleeding or bruising, which are associated with antithrombotic agents, or dizziness and unsteadiness due to psychotropic medicines [11].…”

Disease severity and proton pump inhibitor use impact strongest on faecal microbiome composition in liver cirrhosis

“…A population‐based deep sequencing study of the faecal microbiome revealed that proton pump inhibitors (PPI) were associated with the most profound microbiome changes, followed by statins, antibiotics, laxatives and beta blockers . Nearly 50% of older adults take one or more medications that are not medically indicated and 45% of patients over the age of 75 take five or more drugs per day . The known consequences of polypharmacy and over‐medication are increased healthcare costs, adverse drug reactions, increased rates of drug‐drug interactions, decreased performance status of the patients, cognitive impairment, higher risk of falls and non‐compliance.…”

“…20 Nearly 50% of older adults take one or more medications that are not medically indicated and 45% of patients over the age of 75 take five or more drugs per day. 21 The known consequences of polypharmacy and over-medication are increased healthcare costs, adverse drug reactions, increased rates of drug-drug interactions, decreased performance status of the patients, cognitive impairment, higher risk of falls and non-compliance. Interventions to reduce polypharmacy are difficult to implement.…”

Dysbiosis in dementia is associated with gut barrier dysfunction and linked to malnutrition and prescription drug use

“…Potentially influencing factors could be malnutrition, which is common in dementia and associated with disease severity, [12][13][14] or drug intake, since polypharmacy is a common problem in elderly persons and the impact of drugs on the microbiome has recently gained attention. [15][16][17] We hypothesize that dementia is associated with dysbiosis, gut barrier dysfunction and inflammation and we aim to identify external factors influencing microbiome composition in dementia, such as nutrition and drug intake. To study this, we conducted a prospective controlled cohort study in patients with dementia and age matched controls.…”