Socio-demographic differences in polypharmacy and potentially inappropriate drug use among older people with different care needs and in care settings in Stockholm, Sweden

Aims: Polypharmacy and potentially inappropriate medications (PIM) are risk factors for negative health outcomes among older people. This study aimed to investigate socio-demographic differences in polypharmacy and PIM use among older people with different care needs in a standard versus an integrated care setting. Methods: Population-based register data on residents aged ⩾65 years in Stockholm County based on socio-demographic background and social care use in 2014 was linked to prescription drug use in 2015. A logistic regression analysis was used to estimate socio-demographic differences in polypharmacy and PIM, adjusting for education, age group, sex, country of birth, living alone, morbidity and dementia by care setting based on area and by care need (i.e. independent, home help or institutionalised). Results: The prevalence of polypharmacy and PIM was greater among home-help users (60.4% and 11.5% respectively) and institutional residents (74.4% and 11.9%, respectively). However, there were greater socio-demographic differences among the independent, with those with lower education, older age and females having higher odds of polypharmacy and PIM. Morbidity was a driver of polypharmacy (odds ratio (OR)=1.19, confidence interval (CI) 1.16–1.22) among home-help users. Dementia diagnosis was associated with reduced odds of polypharmacy and PIM among those in institutions (OR=0.78, CI 0.71–0.87 and OR 0.52, CI 0.45–0.59, respectively) and of PIM among home-help users (OR=0.53, 95% CI 0.42–0.67). Conclusions: Polypharmacy and PIM were associated with care needs, most prevalent among home-help users and institutional residents, but socio-demographic differences were most prominent among those living independently, suggesting that municipal care might reduce differences between socio-demographic groups. Care setting had little effect on inappropriate drug use, indicating that national guidelines are followed.

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Sex Differences in Inappropriate Drug Use: a Register-Based Study of Over 600,000 Older People

Annals of Pharmacotherapy ◽

10.1345/aph.1m147 ◽

2009 ◽

Vol 43 (7-8) ◽

pp. 1233-1238 ◽

Cited By ~ 46

Author(s):

Kristina Johnell ◽

Gunilla Ringbäck Weitoft ◽

Johan Fastbom

Keyword(s):

Sex Differences ◽

Drug Use ◽

Older People ◽

Inappropriate Drug ◽

Inappropriate Drug Use

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Potentially inappropriate drug use in older people: a nationwide comparison of different explicit criteria for population-based estimates

British Journal of Clinical Pharmacology ◽

10.1111/bcp.12615 ◽

2015 ◽

Vol 80 (2) ◽

pp. 315-324 ◽

Cited By ~ 36

Author(s):

Lucas Morin ◽

Johan Fastbom ◽

Marie-Laure Laroche ◽

Kristina Johnell

Keyword(s):

Drug Use ◽

Older People ◽

Population Based ◽

Inappropriate Drug ◽

Inappropriate Drug Use ◽

Explicit Criteria

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Prevalence and risk factors for inappropriate drug use among older people: results from an Indian public outpatient setting

Journal of Pharmaceutical Health Services Research ◽

10.1111/j.1759-8893.2010.00028.x ◽

2010 ◽

Vol 2 (1) ◽

pp. 29-34 ◽

Cited By ~ 3

Author(s):

Mandavi ◽

Sanjay D'Cruz ◽

Atul Sachdev ◽

Pramil Tiwari

Keyword(s):

Risk Factors ◽

Drug Use ◽

Older People ◽

Outpatient Setting ◽

Inappropriate Drug ◽

Inappropriate Drug Use

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Extent and quality of drug use in community-dwelling people aged ≥75 years: A Swedish nationwide register-based study

Scandinavian Journal of Public Health ◽

10.1177/1403494817744101 ◽

2017 ◽

Vol 48 (3) ◽

pp. 308-315 ◽

Cited By ~ 1

Author(s):

Annica Lagerin ◽

Lena Törnkvist ◽

Gunnar Nilsson ◽

Kristina Johnell ◽

Johan Fastbom

Keyword(s):

Drug Use ◽

Older People ◽

Home Visits ◽

Community Dwelling ◽

Inappropriate Drug ◽

Preventive Home Visits ◽

Inappropriate Drug Use ◽

District Nurses ◽

Community Dwelling Older People

Aims: It is important for district nurses and other health professionals in primary care to gain more insight into the patterns and quality of drug use in community-dwelling older people, particularly in 75-year-olds, who have been the target of preventive home visits. This study aimed to examine the extent and quality of drug use in community-dwelling older people and to compare drug use in 75-year-olds with that of older age groups. Methods: Data from 2013 on people aged ≥75 years were obtained from the Swedish Prescribed Drug Register. Those living in the community (671,940/739,734 people aged ≥75 years) were included in the study. Quality of drug use was assessed by using a selection of indicators issued by the Swedish National Board of Health and Welfare. Results: The prevalence of polypharmacy and of many drug groups increased with age, as did several indicators of inappropriate drug use. However some drug groups, as well as inappropriate drugs, were prevalent in 75-year-olds and declined with age, for example diabetes drugs, drugs with major anticholinergic effects and nonsteroidal anti-inflammatory drugs. Conclusions: The substantial use of some drugs as early as 75 years of age confirms the value of including drug use as a topic in preventive home visits to 75-year-olds. The finding that polypharmacy and many measures of inappropriate drug use increased with age in community-dwelling older people also underscores the importance of district nurses’ role in continuing to promote safe medication management at higher ages.

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