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

Abstract

Background: With age, the number of chronic conditions increases along with the use of medications. For several years, polypharmacy has been found to be on the increase in western societies. Polypharmacy is associated with an increased risk of adverse drug events (ADE). Medications called potentially inappropriate medications (PIM) have also been found to increase the risk of ADEs in an older population. In this study, which we conducted during a national information campaign to reduce PIM, we analysed the prevalence of PIM in an older adult population and in different strata of the variables age, gender, number of chronic conditions and polypharmacy and how that prevalence changed over time. Methods: This is a registry-based repeated cross-sectional study including two cohorts. Individuals aged 75 or older listed at a primary care centre in Blekinge on the 31st March 2011 (cohort 1, 15,361 individuals) or on the 31st December 2013 (cohort 2, 15,945 individuals) were included in the respective cohorts. Using a chi2 test, the two cohorts were compared on the variables age, gender, number of chronic conditions and polypharmacy. Use of five or more medications at the same time was the definition for polypharmacy. Results: Use of PIM decreased from 10.60 to 7.04% (p-value < 0.001) between 2011 and 2013, while prevalence of five to seven chronic conditions increased from 20.55 to 23.66% (p-value < 0.001). Use of PIM decreased in all strata of the variables age, gender number of chronic conditions and polypharmacy. Except for age 80-84 and males, where it increased, prevalence of polypharmacy was stable in all strata of the variables. Conclusions: Use of potentially inappropriate medications had decreased in all variables between 2011 and 2013; this shows the possibility to reduce PIM with a focused effort. Polypharmacy does not increase significantly compared to the rest of the population.

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

“…The analysis of the literature suggests a general trend of an increasing - or at best stable - prevalence of polypharmacy among older people [ 12 , 13 , 16 , 31 – 33 ]. For instance, in Belgium, where the use of 5 or more drugs in 2015 among people aged 75 years and older was close to our results (49.5% in women and 50.9% in men), a relative increase of 89 and 80% was reported between 2000 and 2015, in men and women respectively [ 33 ].…”

The Burden of Potentially Inappropriate Medications in Chronic Polypharmacy

“…In the literature, an increase in the prevalence of PIM with polypharmacy has already been observed in both inpatients and ambulatory patients [ 28 , 29 ], especially in the elderly [ 30 , 31 ]. Similarly, PPIs, benzodiazepines, and sulfonylureas are frequent PIMs reported.…”

Combined Multimorbidity and Polypharmacy Patterns in the Elderly: A Cross-Sectional Study in Primary Health Care

“…While a homogeneous operational definitional is lacking throughout the field, literature supports the definition of polypharmacy as the consumption of five or more drugs daily in the same individual [7]. Polypharmacy is considered a critical public health problem that is related to drug-drug and drug-disease interactions, adverse drug events [8][9][10][11][12], falls, hospital admissions and mortality [13,14]. Polypharmacy has been on the rise over the past several decades [11] and is highly associated to multimorbidity [8].…”