Trends in polypharmacy and potentially inappropriate medication (PIM) in older and middle-aged people treated for diabetes

Abstract

Objective Polypharmacy is common in people with diabetes and associated with the use of potentially inappropriate medication (PIM). This study aimed to assess trends in prevalence of polypharmacy and PIM in older and middle-aged people with diabetes. Methods A repeated cross-sectional study using the University Groningen IADB.nl prescription database was conducted. All people [?]45 years treated for diabetes registered in the period 2012-2016 were included. PIMs were assessed using Beers criteria for people [?]65 years old, and PRescribing Optimally in Middle-aged People's Treatments (PROMPT) criteria for 45-64 years old. Chi-square tests and regression analysis were applied. Results The prevalence of polypharmacy increased from 56.5% to 58.2% during the study period. In 2016, the prevalence of polypharmacy was 36.9% in the group of 45-54 years old, 50.3% in 55-64 years old, and 66.2% in [?]65 years old. All age-groups showed significant increases. The prevalence of older people with at least one PIM decreased around 3%, while in the middle-aged group this prevalence increased around 1% with a highest level in 2015. The most common PIMs in both age groups were the use of long-term high-dose proton-pump-inhibitors, benzodiazepines, and strong opioids without laxatives. Of those, only benzodiazepines showed a decreasing trend. Conclusions Polypharmacy increased in older and middle-aged people with diabetes. While the prevalence of PIM decreased over time in older age, this trend was not observed in middle-aged people with diabetes. Efforts are needed to decrease the use of PIMs in populations already burdened with many drugs, notably at middle age

Potentially inappropriate medication use by level of polypharmacy among US Veterans 49–64 and 65–70 years old

“…Most previous PIMs research was focused on people of 65 years of age and older even though some included information on younger people. 15,16,22,23 In our study we observed that PIMs were as prevalent in people aged <65 as in older people. The prevalence of PIMs observed in younger individuals should raise concern.…”

“…in other studies such as in Japan where PIMs concerned 71.9% of patients older than 45 and receiving care at home 22 and in a study in the Netherlands that showed that younger patient were subjected to a higher prevalence of PIMs than older patients with polypharmacy between 2012 and 2016. 16 This suggests that initiation of PIMs in younger patients with polypharmacy is an increasing concern.…”

“…Studies using PROMPT showed similar results to ours: In the United Kingdom, France, and the Netherlands, proton pump inhibitors, benzodiazepines were among the most frequent PIMs. [14][15][16]23 Benzodiazepines and hypnotics are often reported as the most common PIMs for instance in Korea 30 and in most European countries (Spain, 25 France, 15,31 the Netherlands, 16 Lithuania, 32 Finland, 33 Germany, 34 and Scotland 35 ). Our data allowed the identification of patients with chronic anxiety, a condition for which Beers Laroche criteria considers short acting benzodiazepines appropriate, contrary to the PROMPT criteria.…”

“…14 These criteria overlap and commonalities and differences can help paint a more comprehensive picture of PIMs. [14][15][16] PIMs lists have been applied in health care databases mainly in Europe and among those over 65 years with few consideration of sex or race. 17 Very little work has been done among those under 65 years of age or according to sex and race/ethnicity.…”

Potentially inappropriate medications in the elderly

“…This practice often leads to increased morbidity, due in part to the age-related physiological and functional changes that alter the drugs' pharmacokinetics and pharmacodynamics. 1 PIMs are typically medications for which the potential risks of adverse drug reactions outweigh the clinical benefit. Several tools have been developed over the years to help identify PIMs and to minimize the occurrence of adverse drug reactions associated with their use, especially in the elderly.…”