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BMC Geriatr. 2019 Feb 19;19(1):49. doi: 10.1186/s12877-019-1064-8.

Drug use differs by care level. A cross-sectional comparison between older people living at home or in a nursing home in Oslo, Norway.

Author information

1
Nursing Home Agency, Oslo Municipality, Oslo, Norway. a.f.fog@medisin.uio.no.
2
General Practice Research Unit, Department of General Practice, Institute of Health and Society, University of Oslo, Postbox 1130 Blinderen, N-0318, Oslo, Norway. a.f.fog@medisin.uio.no.
3
General Practice Research Unit, Department of General Practice, Institute of Health and Society, University of Oslo, Postbox 1130 Blinderen, N-0318, Oslo, Norway.
4
Norwegian National Advisory Unit for Aging and Health, Vestfold County Hospital HF, Toensberg and Oslo University Hospital, Oslo, Norway.
5
Department of Drug Statistics, Norwegian Public Institute of Health, Oslo, Norway.

Abstract

BACKGROUND:

Drug consumption increases with age, but there are few comparisons of drug use between old people living at home or in a nursing home. To identify areas of concern as well as in need for quality improvement in the two settings, we compared drug use among people aged ≥70 years living at home or in a nursing home.

METHODS:

Cross-sectional observational study from Oslo, Norway. Information about drug use by people living at home in 2012 was retrieved from the Norwegian Prescription Database. Drug use in nursing homes was recorded within a comprehensive medication review during November 2011-February 2014. Prevalence rates and relative risk (RR) with 95% confidence intervals were compared between uses of therapeutic groups with prevalence rates of ≥5%. Drug use was compared for the total population and by gender and age group.

RESULTS:

Older people (both genders) in nursing homes (n = 2313) were more likely than people living at home (n = 48,944) to use antidementia drugs (RR = 5.7), antipsychotics (RR = 4.0), paracetamol (RR = 4.0), anxiolytics (RR = 3.0), antidepressants (RR = 2.8), dopaminergic drugs (RR = 2.7), antiepileptic drugs (RR = 2.4), loop diuretics (RR = 2.3), cardiac nitrates (RR = 2.1) or opioids (RR = 2.0). By contrast, people living in a nursing home were less commonly prescribed statins (RR = 0.2), nonsteroidal antiinflammatory drugs (NSAIDs) (RR = 0.3), osteoporosis drugs (RR = 0.3), thiazide diuretics (RR = 0.4), calcium channel blockers (RR = 0.5) or renin-angiotensin inhibitors (RR = 0.5). Each of the populations had only minor differences in drug use by gender and a trend towards less drug use with increasing age (p <  0.01).

CONCLUSIONS:

Drug use by older people differs according to care level, and so do areas probably in need for quality improvement and further research. In nursing home residents, this relates to a probable overuse of psychotropic drugs and opioids. Among older people living at home, the probable overuse of NSAIDs and a possible underuse of cholinesterase inhibitors and osteoporosis drugs should be addressed.

KEYWORDS:

Cardiovascular drugs; Community; Dementia; Drug use; Nursing homes; Older people; Opioids; Prescription database; Prevalence; Psychotropic drugs

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