Drugs & Aging

, Volume 28, Issue 3, pp 227–236 | Cite as

Potentially Inappropriate Medication Use Among Finnish Non-Institutionalized People Aged ≥65 Years

A Register-Based, Cross-Sectional, National Study
  • Saija Leikola
  • Maarit Dimitrow
  • Alan Lyles
  • Kaisu Pitkälä
  • Marja Airaksinen
Original Research Article

Abstract

Background

The Beers criteria and their modifications are the most frequently used tools for measuring potentially inappropriate medication (PIM) use among older people. The prevalence of such use in various settings has been high, but no data have been reported for an entire national non-institutionalized elderly population, nor is there information on the reimbursement costs for those medications.

Objective

To determine the prevalence of PIM use according to the Beers 2003 criteria, independent of diagnoses, among Finnish non-institutionalized people aged ≥65 years, and the reimbursement costs for these medications.

Methods

A register-based cross-sectional national study used drug reimbursement data from Finland’s Social Insurance Institution (SII). These data cover the entire non-institutionalized population aged ≥65 years in 2007. The number of persons who received reimbursements for each PIM according to the Beers 2003 criteria and the total annual reimbursement costs for PIMs were calculated. Indirect costs were excluded.

Results

Of the non-institutionalized population aged ≥65 years in Finland (n = 841 509), 14.7% (n = 123 545) had received PIMs according to the Beers 2003 criteria. Temazepam >15 mg/day was clearly the most commonly reimbursed PIM (4.4% of the population aged ≥65 years), followed by amitriptyline (2.0%) and diazepam (1.8%). The SII paid drug reimbursements of €2.9 million for PIMs, which was 0.7% of the total drug reimbursements (€421 million) for people aged ≥65 years in Finland in 2007.

Conclusions

The use of PIMs among outpatients aged ≥65 years in Finland (14.7%) was less than in several earlier large-scale studies in other countries (17–42%) and reimbursement costs were modest, mainly as a result of the limited availability in Finland of medicines identified as PIMs by the Beers 2003 criteria. However, benzodiazepines were commonly used and actions to improve medication safety should target reducing their use.

References

  1. 1.
    Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2004 Jan; 57(1): 6–14PubMedCrossRefGoogle Scholar
  2. 2.
    ElDesoky ES. Pharmacokinetic-pharmacodynamic crisis in the elderly. Am J Ther 2007 Sep–Oct; 14(5): 488–98PubMedCrossRefGoogle Scholar
  3. 3.
    Beijer HJM, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci 2002 Apr; 24(2): 46–54PubMedCrossRefGoogle Scholar
  4. 4.
    Budnitz DS, Pollock DA, Weidenbach KN, et al. National surveillance of emergency department visits for outpatient adverse drug events. JAMA 2006 Oct; 296(15): 1858–66PubMedCrossRefGoogle Scholar
  5. 5.
    van der Hooft CS, Dieleman JP, Siemes C, et al. Adverse drug reaction-related hospitalisations: a population-based cohort study. Pharmacoepidemiol Drug Saf 2008 Apr; 17(4): 365–71PubMedCrossRefGoogle Scholar
  6. 6.
    Beers MH, Ouslander JG, Rollinger I, et al. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 1991 Sep; 151(9): 1825–32PubMedCrossRefGoogle Scholar
  7. 7.
    Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med 1997 Jul 28; 157(14): 1531–6PubMedCrossRefGoogle Scholar
  8. 8.
    McLeod PJ, Huang AR, Tamblyn RM, et al. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ 1997 Feb 1; 156(3): 385–91PubMedGoogle Scholar
  9. 9.
    Naugler CT, Brymer C, Stolee P, et al. Development and validation of an improving prescribing in the elderly tool. Can J Clin Pharmacol 2000 Summer; 7(2): 103–7PubMedGoogle Scholar
  10. 10.
    Zhan C, Sangl J, Bierman AS, et al. Potentially inappropriate medication use in the community-dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. JAMA 2001 Dec 12; 286(22): 2823–9PubMedCrossRefGoogle Scholar
  11. 11.
    Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts [published erratum appears in Arch Intern Med 2004 Feb 9; 164 (3): 298]. Arch Intern Med 2003 Dec 8–22; 163(22): 2716–24PubMedCrossRefGoogle Scholar
  12. 12.
    Gallagher P, Ryan C, Byrne S, et al. STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment): consensus validation. Int J Clin Pharmacol Ther 2008 Feb; 46(2): 72–83PubMedGoogle Scholar
  13. 13.
    van der Hooft CS, Jong GW, Dieleman JP, et al. Inappropriate drug prescribing in older adults. The updated 2002 Beers criteria: a population-based cohort study. Br J Clin Pharmacol 2005 Aug; 60(2): 137–44PubMedCrossRefGoogle Scholar
  14. 14.
    Maio V, Yuen EJ, Novielli K, et al. Potentially inappropriate medication prescribing for elderly outpatients in Emilia Romagna, Italy: a population-based cohort study. Drugs Aging 2006; 23(11): 915–24PubMedCrossRefGoogle Scholar
  15. 15.
    Zuckerman IH, Langenberg P, Baumgarten M, et al. Inappropriate drug use and risk of transition to nursing homes among community-dwelling older adults. Med Care 2006 Aug; 44(8): 722–30PubMedCrossRefGoogle Scholar
  16. 16.
    De Wilde S, Carey IM, Harris T, et al. Trends in potentially inappropriate prescribing amongst older UK primary care patients. Pharmacoepidemiol Drug Saf 2007 Jun; 16(6): 658–67PubMedCrossRefGoogle Scholar
  17. 17.
    Pitkälä KH, Strandberg TE, Tilvis RS. Inappropriate drug prescribing in home-dwelling, elderly patients: a population-based survey. Arch Intern Med 2002 Aug 12–26; 162(15): 1707–12PubMedCrossRefGoogle Scholar
  18. 18.
    Curtis LH, Østbye T, Sendersky V, et al. Inappropriate prescribing for elderly Americans in a large outpatient population. Arch Intern Med 2004 Aug 9–23; 164(15): 1621–5PubMedCrossRefGoogle Scholar
  19. 19.
    Fialová D, Topinková E, Gambassi G, et al., AdHOC Project Research Group. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA 2005 Mar 16; 293(11): 1348–58PubMedCrossRefGoogle Scholar
  20. 20.
    Barnett MJ, Perry PJ, Langstaff JD, et al. Comparison of rates of potentially inappropriate medication use according to the Zhan criteria for VA versus private sector Medicare HMOs. J Manag Care Pharm 2006 Jun; 12(5): 362–70PubMedGoogle Scholar
  21. 21.
    Lau DT, Kasper JD, Potter DE, et al. Potentially inappropriate medication prescriptions among elderly nursing home residents: their scope and associated resident and facility characteristics. Health Serv Res 2004 Oct; 39(5): 1257–76PubMedCrossRefGoogle Scholar
  22. 22.
    Laroche ML, Charmes JP, Nouaille Y, et al. Impact of hospitalisation in an acute medical geriatric unit on potentially inappropriate medication use. Drugs Aging 2006; 23(1): 49–59PubMedCrossRefGoogle Scholar
  23. 23.
    Johnell K, Fastbom J, Rosén M, et al. Inappropriate drug use in the elderly: a nationwide register-based study. Ann Pharmacother 2007 Jul; 41(7): 1243–8PubMedCrossRefGoogle Scholar
  24. 24.
    Haider SI, Johnell K, Weitoft GR, et al. The influence of educational level on polypharmacy and inappropriate drug use: a register-based study of more than 600,000 older people. J Am Geriatr Soc 2009 Jan; 57(1): 62–9PubMedCrossRefGoogle Scholar
  25. 25.
    Johnell K, Weitoft GR, Fastbom J. Sex differences in inappropriate drug use: a register-based study of over 600,000 older people. Ann Pharmacother 2009 Jul; 43(7): 1233–8PubMedCrossRefGoogle Scholar
  26. 26.
    Wahlbeck K, Manderbacka K, Vuorenkoski L, et al. Quality and equality of access to healthcare services. HealthQUEST country report for Finland. Helsinki: National Research and Development Centre for Welfare and Health (STAKES), 2008 [online]. Available from URL: http://www.stakes.fi/verkkojulkaisut/raportit/R1-2008-VERKKO.pdf [Accessed 2010 May 4]Google Scholar
  27. 27.
    World Health Organization. WHO Collaborating Centre for Drug Statistics Methodology. ATC index [online]. Available from URL: http://www.whocc.no/atcddd/ [Accessed 2010 May 16]
  28. 28.
    Pharmaceutical Information Centre Ltd. Nordic article number instruction booklet. Version 1.3 [online]. Available from URL: http://www.laaketietokeskus.fi/tiedostot/Vnr_Ohjekirja_Eng_2007.pdf [Accessed 2010 Sep 27]
  29. 29.
    Statistics Finland. Population according to age (1-year) and gender and gender by area 1980–2009 [online]. Available from URL: http://pxweb2.stat.fi/database/StatFin/vrm/vaerak/vaerak_en.asp [Accessed 2010 Oct 4]
  30. 30.
    Sjöholm M. Elderly care organized by municipalities in 2006 [in Finnish]. Helsinki: Kuntaliitto, 2008 [online]. Available from URL: http://www.kunnat.net/k_peruslistasivu.asp?path=1;29;353;11124;80434 [Accessed 2010 Oct 11]Google Scholar
  31. 31.
    Hosia-Randell HMV, Muurinen SM, Pitkälä KH. Exposure to potentially inappropriate drugs and drug-drug interactions in elderly nursing home residents in Helsinki, Finland: a cross-sectional study. Drugs Aging 2008; 25(8): 683–92PubMedCrossRefGoogle Scholar
  32. 32.
    Ensrud KE, Blackwell TL, Mangione CM, et al., Study of Osteoporotic Fractures Research Group. Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc 2002 Oct; 50(10): 1629–37PubMedCrossRefGoogle Scholar
  33. 33.
    Wagner AK, Zhang F, Soumerai SB, et al. Benzodiazepine use and hip fractures in the elderly: who is at greatest risk? Arch Intern Med 2004 Jul 26; 164(14): 1567–72PubMedCrossRefGoogle Scholar
  34. 34.
    Landi F, Onder G, Cesari M, et al., Silver Network Home Care Study Group. Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study. J Gerontol A Biol Sci Med Sci 2005 May; 60(5): 622–6PubMedCrossRefGoogle Scholar
  35. 35.
    Barker MJ, Greenwood KM, Jackson M, et al. Cognitive effects of long-term benzodiazepine use: a meta-analysis. CNS Drugs 2004; 18(1); 37–48PubMedCrossRefGoogle Scholar
  36. 36.
    Attal N, Gruccu G, Baron R, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 2010 Sep; 17(9): 1113–23PubMedCrossRefGoogle Scholar
  37. 37.
    Davis MP, Srivastava M. Demographics, assessment and management of pain in the elderly. Drugs Aging 2003; 20(1): 23–57PubMedCrossRefGoogle Scholar
  38. 38.
    Barber JB, Gibson SJ. Treatment of chronic non-malignant pain in the elderly: safety considerations. Drug Saf 2009; 32(6): 457–74PubMedCrossRefGoogle Scholar
  39. 39.
    Klarin I, Wimo A, Fastbom J. The association of inappropriate drug use with hospitalisation and mortality: a population-based study of the very old. Drugs Aging 2005; 22(1): 69–82PubMedCrossRefGoogle Scholar
  40. 40.
    Lau DT, Kasper JD, Potter DEB, et al. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med 2005 Jan 10; 165(1): 68–74PubMedCrossRefGoogle Scholar
  41. 41.
    Perri 3rd M, Menon AM, Deshpande AD, et al. Adverse outcomes associated with inappropriate drug use in nursing homes. Ann Pharmacother 2005 Mar; 39(3): 405–11PubMedCrossRefGoogle Scholar
  42. 42.
    Lin HY, Liao CC, Cheng SH, et al. Association of potentially inappropriate medication use with adverse outcomes in ambulatory elderly patients with chronic diseases: experience in a Taiwanese medical setting. Drugs Aging 2008; 25(1): 49–59PubMedCrossRefGoogle Scholar
  43. 43.
    Ruggiero C, Dell’Aquila G, Gasperini B, et al., ULISSE Study Group. Potentially inappropriate drug prescriptions and risk of hospitalization among older, Italian, nursing home residents: the ULISSE project. Drugs Aging 2010; 27(9): 747–58PubMedCrossRefGoogle Scholar
  44. 44.
    Spinewine A, Schmader KE, Barber N, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 2007 Jul 14; 370(9582): 173–84PubMedCrossRefGoogle Scholar
  45. 45.
    Onder G, Landi F, Liperoti R, et al. Impact of inappropriate drug use among hospitalized older adults. Eur J Clin Pharmacol 2005 Jul; 61(5–6): 453–9PubMedCrossRefGoogle Scholar
  46. 46.
    Fu AZ, Liu GG, Christensen DB. Inappropriate medication use and health outcomes in the elderly. J Am Geriatr Soc 2004 Nov; 52(11): 1934–9PubMedCrossRefGoogle Scholar
  47. 47.
    Chrischilles EA, VanGilder R, Wright K, et al. Inappropriate medication use as a risk factor for self-reported adverse drug effects in older adults. J Am Geriatr Soc 2009 Jun; 57(6): 1000–6PubMedCrossRefGoogle Scholar
  48. 48.
    Landi F, Russo A, Liperoti R, et al. Impact of inappropriate drug use on physical performance among a frail elderly population living in the community. Eur J Clin Pharmacol 2007 Aug; 63(8): 791–9PubMedCrossRefGoogle Scholar
  49. 49.
    Berdot S, Bertrand M, Dartigues J-F, et al. Inappropriate medication use and risk of falls: a prospective study in a large community-dwelling elderly cohort. BMC Geriatr 2009 Jul; 9: 30PubMedCrossRefGoogle Scholar
  50. 50.
    Fu AZ, Jiang JZ, Reeves JH, et al. Potentially inappropriate medication use and healthcare expenditures in the US community-dwelling elderly. Med Care 2007 May; 45(5): 472–6PubMedCrossRefGoogle Scholar
  51. 51.
    Caterino JM, Emond JA, Camargo Jr CA. Inappropriate medication administration to the acutely ill elderly: a nationwide emergency department study, 1992–2000. J Am Geriatr Soc 2004 Nov; 52(11): 1847–55PubMedCrossRefGoogle Scholar
  52. 52.
    Bongue B, Naudin F, Laroche M-L, et al. Trends of the potentially inappropriate medication consumption over 10 years in older adults in the East of France. Pharmacoepidemiol Drug Saf 2009 Dec; 18(12): 1125–33PubMedCrossRefGoogle Scholar
  53. 53.
    Carey IM, De Wilde S, Harris T, et al. What factors predict potentially inappropriate primary care prescribing in older people? Analysis of UK primary care patient record database. Drugs Aging 2008; 25(8): 693–706PubMedCrossRefGoogle Scholar
  54. 54.
    Hartikainen S, Rahkonen T, Kautiainen H, et al. Use of psychotropics among home-dwelling nondemented and demented elderly. Int J Geriatr Psychiatry 2003 Dec; 18(12): 1135–41PubMedCrossRefGoogle Scholar
  55. 55.
    Hartikainen S, Rahkonen T, Kautiainen H, et al. Kuopio 75+ study: does advanced age predict more common use of psychotropics among the elderly? Int Clin Psychopharmacol 2003 May; 18(3): 163–7PubMedGoogle Scholar
  56. 56.
    The Ministry of Social Affairs and Health, Finland. Development of geriatric care and elderly care. Report by Rapporteur ad int. Sosiaalija terveysministeriön selvityksiä 2006:30 [in Finnish, English summary; online]. Available from URL: http://www.stm.fi/c/document_library/get_file?folderId=28707&name=DLFE-3666.pdf&title=Geriatrisen_hoidon_ja_vanhustyon_kehittaminen_fi.pdf [Accessed 2010 May 8]
  57. 57.
    Tamblyn R, Huang A, Perreault R, et al. The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ 2003 Sep 16; 169(6): 549–56PubMedGoogle Scholar
  58. 58.
    Simon SR, Smith DH, Feldstein AC, et al. Computerized prescribing alerts and group academic detailing to reduce the use of potentially inappropriate medications in older people. J Am Geriatr Soc 2006 Jun; 54(6): 963–8PubMedCrossRefGoogle Scholar
  59. 59.
    Nishtala PS, McLachlan AJ, Bell JS, et al. Psychotropic prescribing in long-term care facilities: impact of medication reviews and educational interventions. Am J Geriatr Psychiatry 2008 Aug; 16(8): 621–32PubMedCrossRefGoogle Scholar
  60. 60.
    Castelino RL, Bajorek BV, Chen TF. Targeting suboptimal prescribing in the elderly: a review of the impact of pharmacy services. Ann Pharmacother 2009 Jun; 43(6): 1096–106PubMedCrossRefGoogle Scholar
  61. 61.
    The Ministry of Social Affairs and Health, Finland. Safe pharmacotherapy among the aged: obligations for the municipalities. Kuntainfo 6/2007 [in Finnish; online]. Available from URL: http://www.stm.fi/tiedotteet/kuntainfot/kuntainfo/view/1236539 [Accessed 2010 May 8]
  62. 62.
    The Swedish National Board of Health and Welfare. Indicators for good drug therapy in the elderly [Swedish]. Stockholm: The Swedish National Board of Health and Welfare, 2010 [online]. Available from URL: http://socialstyrelsen.se/Lists/Artikelkatalog/Attachments/18085/2010-6-29.pdf [Accessed 2010 Dec 16]Google Scholar
  63. 63.
    Laroche M-L, Charmes J-P, Merle L. Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol 2007 Aug; 63(8): 725–31PubMedCrossRefGoogle Scholar
  64. 64.
    Rognstad S, Brekke M, Fetveit A, et al. The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients: a modified Delphi study. Scand J Prim Health Care 2009; 27(3): 153–9PubMedCrossRefGoogle Scholar
  65. 65.
    Maio V, Del Canale S, Abouzaid S, Gap Investigators. Using explicit criteria to evaluate the quality of prescribing in elderly Italian outpatients: a cohort study. J Clin Pharmacol Ther 2010 Apr; 35(2): 219–29CrossRefGoogle Scholar
  66. 66.
    National Agency for Medicines, Social Insurance Institution. Finnish national statistics on medicines [online]. Available from URL: http://www.laakelaitos.fi/medicines/drug_consumption [Accessed 2010 May 8]
  67. 67.
    Wuorela M, Kouri T, Laato M, et al., working group set up by the Finnish Medical Society Duodecim, the Finnish Society of Nephrology and the Finnish Association for General Practice. Urinary tract infections: current care summary, 2007 May 25 [online]. Available from URL: http://www.kaypahoito.fi/web/kh/suositukset/naytaartikkeli/tunnus/ccs00027 [Accessed 2010 May 8]

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  • Saija Leikola
    • 1
  • Maarit Dimitrow
    • 1
  • Alan Lyles
    • 1
    • 2
  • Kaisu Pitkälä
    • 3
    • 4
  • Marja Airaksinen
    • 1
  1. 1.Division of Social Pharmacy, Faculty of PharmacyUniversity of HelsinkiHelsinkiFinland
  2. 2.School of Health and Human ServicesUniversity of BaltimoreBaltimoreUSA
  3. 3.Unit of General PracticeHelsinki University Central HospitalHelsinkiFinland
  4. 4.Department of General Practice and Primary Health Care, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland

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