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.

Inappropriate Medication Use and Related Factors in the Elderly Living in Northern Iran

Objectives: Older people are more prone to chronic diseases and are being treated than other age groups; as a result, they use more drugs that may be inappropriate and lead to adverse drug reactions. This study aimed to determine the rate of inappropriate drug use using the Beers criterion among the elderly in Amirkola City. Methods & Materials: The current descriptive-analytical study is part of the comprehensive plan "Study of the health status of the elderly in the Amirkola City” AHAP" (No.: 892917) which has been conducted as a Cohort study since 2011 on all people aged 60 and over in the Amirkola City, north of Iran. Necessary information was collected by a trained person using standard questionnaires that included the number, type and duration of drug use. The collected data were analyzed after entering the SPSS statistical software using Chi-square, Fisher's Exact Test, and Logistic Regression to evaluate the status of inappropriate drug. P-value=0.05 was considered as a significant level. Results: The Mean±SD age of the elderly was 69.71±7.47 years. Prevalence of inappropriate drug use and drugs that should use by caution among the elderly was 37.58% and 29.85%, respectively. Glibenclamide (12.7%), Diclofenac (8.8%) and Clidinium C (5.4%) were among the most inappropriate drugs used in this population. The highest drug-drug interaction was related to the simultaneous use of two anticholinergic drugs. There was a statistically significant relationship between inappropriate drug use with gender, age, education level, employment status and marriage status (P<0.05). Conclusion: The rate of inappropriate drug use among the elderly in Amirkola is high compared to many other studies that expose the elderly to adverse drug reactions.