Use of prescription drugs in the older adult population—a nationwide pharmacoepidemiological study
Multi-morbidity and polypharmacy are common among older people. It is essential to provide a better understanding of the complexity of prescription drug use among older adults to optimise rational pharmacotherapy. Population-based utilisation data in this age group is limited. Using the Danish nationwide health registries, we aimed to characterise drug use among Danish individuals ≥ 60 years.
This is a descriptive population-based study assessing drug prescription patterns in 2015 in the full Danish population aged ≥ 60 years. The use of specific therapeutic subgroups and chemical subgroups and its dependence on age were described using descriptive statistics. Profiles of drug combination patterns were evaluated using latent class analysis.
We included 1,424,775 residents (median age 70 years, 53% women). Of all the older adults, 89% filled at least one prescription during 2015. The median number of drug groups used was five per person. The most used single drug groups were paracetamol and analogues (34%), statins (33%) and platelet aggregation inhibitors (24%). Eighteen drug profiles with different drug combination patterns were identified. One drug profile with expected use of zero drugs and 11 drug profiles expected to receive more than five different therapeutic subgroup drugs were identified.
The use of drugs is extensive both at the population level and increasing with age at an individual level. Separating the population into different homogenous groups related to drug use resulted in 18 different drug profiles, of which 11 drug profiles received on average more than five different therapeutic subgroup drugs.
KeywordsPharmacoepidemiology Drug utilisation Drug profiles Older adults Prescription drugs
This study is a part of the Optimized Senior Patient Program (Optimed) at the Clinical Research Center, Hvidovre Hospital. We want to thank the Statistics Denmark for providing the data, Mikkel Ankarfeldt for the SAS support, Thomas Kallemose for the R support and Morten Baltzer Houlind for the support with the renal risk drug list.
Compliance with ethical standards
The study was approved by the Scientific Board of Statistics Denmark and the Danish Data Protection Agency (Ref. 00003115). An approval from an ethics committee is not required for registry-based studies in Denmark. No identifiable patient data could be retrieved. The study was conducted by following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations .
Conflict of interest
The authors declare that they have no conflicts of interest.
- 2.Schöttker B, Saum K-U, Muhlack DC, Hoppe LK, Holleczek B, Brenner H (2017) Polypharmacy and mortality: new insights from a large cohort of older adults by detection of effect modification by multi-morbidity and comprehensive correction of confounding by indication. Eur J Clin Pharmacol 73:1041–1048. https://doi.org/10.1007/s00228-017-2266-7 CrossRefGoogle Scholar
- 6.Mair A, Fernandez-Llimos F, Alonso A et al (2017) Polypharmacy management by 2030: a patient safety challenge. Coimbra SIMPATHY Consort 64Google Scholar
- 12.Alhawassi TM, Krass I, Bajorek BV, Pont LG (2014) A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting. Clin Interv Aging. https://doi.org/10.2147/CIA.S71178
- 15.Olivier P, Bertrand L, Tubery M, Lauque D, Montastruc JL, Lapeyre-Mestre M (2009) Hospitalizations because of adverse drug reactions in elderly patients admitted through the emergency department: a prospective survey. Drugs Aging 26:475–482. https://doi.org/10.2165/00002512-200926060-00004 CrossRefGoogle Scholar
- 18.WHO Collaborating Centre for Drug Statistics Methodology (2012) Guidelines for ATC classification and DDD assignment 2013. Norwegian Institute of Public HealthGoogle Scholar
- 28.Lagerin A, Törnkvist L, Nilsson G, Johnell K, Fastbom J (2017) Extent and quality of drug use in community-dwelling people aged ≥75 years: a Swedish nationwide register-based study. Scand J Public Health. https://doi.org/10.1177/1403494817744101
- 29.Marengoni A, Angleman S, Meinow B, Santoni G, Mangialasche F, Rizzuto D, Fastbom J, Melis R, Parker M, Johnell K, Fratiglioni L (2016) Coexisting chronic conditions in the older population: variation by health indicators. Eur J Intern Med 31:29–34. https://doi.org/10.1016/j.ejim.2016.02.014 CrossRefGoogle Scholar
- 32.Wastesson JW, Cedazo Minguez A, Fastbom J, Maioli S, Johnell K (2018) The composition of polypharmacy: a register-based study of Swedes aged 75 years and older. PLoS One 13. https://doi.org/10.1371/journal.pone.0194892
- 35.Woodman RJ, Wood KM, Kunnel A, Dedigama M, Pegoli MA, Soiza RL, Mangoni AA (2016) Patterns of drug use and serum sodium concentrations in older hospitalized patients: a latent class analysis approach. Drugs - Real World Outcomes 3:383–391. https://doi.org/10.1007/s40801-016-0094-1 CrossRefGoogle Scholar
- 36.Henriksen DP, Rasmussen L, Hansen MR, Hallas J, Pottegård A (2015) Comparison of the five Danish regions regarding demographic characteristics, healthcare utilization, and medication use—a descriptive cross-sectional study. PLoS One 10:e0140197. https://doi.org/10.1371/journal.pone.0140197 CrossRefGoogle Scholar
- 38.von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, for the STROBE Initiative (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147:573–577. https://doi.org/10.7326/0003-4819-147-8-200710160-00010 CrossRefGoogle Scholar