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Changes in Polypharmacy and Potentially Inappropriate Medications in Homebound Older Adults in Japan, 2015–2019: a Nationwide Study

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Abstract

Background

With rising worldwide population aging, the number of homebound individuals with multimorbidity is increasing. Improvement in the quality of home medical care (HMC), including medications, contributes to meeting older adults’ preference for “aging in place” and securing healthcare resources.

Objective

To evaluate the changes in drug prescriptions, particularly potentially inappropriate medications (PIMs), among older adults receiving HMC in recent years, during which measures addressing inappropriate polypharmacy were implemented, including the introduction of clinical practice guidelines and medical fees for deprescribing.

Design

A cross-sectional study.

Participants

Using data from the national claims database in Japan, this study included older adults aged ≥ 75 years who received HMC in October 2015 (N = 499,850) and October 2019 (N = 657,051).

Main Measures

Number of drugs, prevalence of polypharmacy (≥ 5 regular drugs), major drug categories/classes, and PIMs according to Japanese guidelines were analyzed. Random effects logistic regression models were used to evaluate the differences in medications between 2015 and 2019, considering the correlation within individuals who contributed to the analysis in both years.

Key Results

The number of drugs remained unchanged from 2015 to 2019 (median: 6; interquartile range: 4, 9). The prevalence of polypharmacy also remained unchanged at 70.0% in both years (P = 0.93). However, the prescription of some drugs (e.g., direct oral anticoagulants, new types of hypnotics, acetaminophen, proton pump inhibitors, and β-blockers) increased, whereas others (e.g., warfarin, vasodilators, H2 blockers, acetylcholinesterase inhibitors, and benzodiazepines) decreased. Among the frequently prescribed PIMs, benzodiazepines/Z-drugs (25.6% in 2015 to 21.1% in 2019; adjusted odds ratio: 0.52) and H2 blockers (11.2 to 7.3%; 0.45) decreased, whereas diuretics (23.8 to 23.6%; 0.90) and antipsychotics (9.7 to 10.5%; 1.11) remained unchanged.

Conclusions

We observed some favorable changes but identified some continuous and new challenges. This study suggests that continued attention to medication optimization is required to achieve safe and effective HMC.

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Data Availability

The datasets generated and/or analyzed during the current study are not publicly available because data extracted from the NDB is not permitted to use except for those who are authorized.

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Funding

This work was supported by the JSPS KAKENHI (grant numbers 20K18868 and 22K10406). The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan

    Shota Hamada DrPH

  2. Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan

    Shota Hamada DrPH, Masao Iwagami MD PhD, Nobuo Sakata MD PhD & Nanako Tamiya MD PhD

  3. Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Shota Hamada DrPH, Kiwami Kidana MD PhD & Takashi Yamanaka MD PhD

  4. Heisei Medical Welfare Group Research Institute, Tokyo, Japan

    Nobuo Sakata MD PhD

  5. Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Yukari Hattori MD PhD & Masahiro Akishita MD PhD

  6. Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan

    Tatsuro Ishizaki MD PhD

Authors
  1. Shota Hamada DrPH
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  2. Masao Iwagami MD PhD
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  3. Nobuo Sakata MD PhD
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  6. Tatsuro Ishizaki MD PhD
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  9. Takashi Yamanaka MD PhD
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Contributions

SH contributed to the study concept and design, acquisition of data, analysis and interpretation of data, and drafting of the manuscript. SH is responsible for the content as a guarantor. The other authors contributed to the study concept and design, interpretation of data, and critical revision of the manuscript for important intellectual content.

Corresponding author

Correspondence to Shota Hamada DrPH.

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Conflict of Interest

SH, KK, and TY belong to an endowed chair funded by donations from Mr. Kazuteru Noguchi, JSH, Towa Pharmaceutical, Sawai Pharmaceutical, and Ain Pharmaciez. SH received research funding from SOMPO Care Inc. outside of this work. NT received research funding from SMS and FAST DOCTOR. MA received remuneration from Astellas Pharma, Boehringer Ingelheim, Daiichi Sankyo, Eisai, Eli Lilly Japan, Mitsubishi-Tanabe Pharma, Mochida Pharmaceutical, MSD, Ono Pharmaceutical, Pfizer Japan, Sumitomo Dainippon Pharma, and Takeda Pharmaceutical, and received research funding from Astellas Pharma, AstraZeneca, Bayer Health Care, Boehringer Ingelheim, Chugai Pharmaceutical, Daiichi Sankyo, Eli Lilly Japan, Kowa Pharmaceutical, Mitsubishi-Tanabe Pharma, Mochida Pharmaceutical, MSD, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer Japan, Taisho Toyama Pharmaceutical, Takeda Pharmaceutical, and Tsumura. The other authors have no conflicts of interest to declare.

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Prior presentations: The results of this study were presented at the 5th Annual Meeting of the Japanese Association for Home Care Medicine in Niigata, Japan, on June 24th, 2023.

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Hamada, S., Iwagami, M., Sakata, N. et al. Changes in Polypharmacy and Potentially Inappropriate Medications in Homebound Older Adults in Japan, 2015–2019: a Nationwide Study. J GEN INTERN MED 38, 3517–3525 (2023). https://doi.org/10.1007/s11606-023-08364-4

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