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Br J Clin Pharmacol. 2020 Jan 9. doi: 10.1111/bcp.14214. [Epub ahead of print]

One-year persistence of potentially inappropriate medication use in older adults: a population-based study.

Author information

1
Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology-Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France.
2
INSERM UMR 1248, Faculty of Medicine, University of Limoges, Limoges, France.
3
Quebec National Institute of Public Health, Quebec, Canada.
4
Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Canada.
5
Centre of Excellence on Aging of Quebec, Integrated University Health and Social Services Centres of the Capitale-Nationale, Québec, Canada.

Abstract

AIMS:

To assess the one-year persistence of PIM use and identify associated factors in community-dwelling older adults in Quebec, Canada.

METHODS:

A population-based cohort study was conducted using the Quebec Integrated Chronic Disease Surveillance System. Individuals insured by the public drug plan and aged ≥66 years who initiated a PIM between April 1, 2014 and March 31, 2015 were followed-up for one-year. PIMs were identified using the 2015 Beers criteria. One-year persistence of PIM use was defined as continuous treatment with any PIM, without interruption for more than 60 days between prescriptions refills. Poisson regression models were performed to identify factors associated with one-year persistence of any PIM.

RESULTS:

In total, 25.1% of PIM initiators were persistent at 1 year. In non-persistent individuals, the median time to PIM discontinuation was 31 days (IQR: 21-92). Individuals were more persistent at 1 year with antipsychotics (43.9%), long-duration sulfonylureas (40.2%), antiarrhythmics/immediate-release nifedipine (36.5%), and proton pump inhibitors (36.0%). Factors significantly associated with persistence were an increased age, being a man, having a high number of medications and chronic diseases, especially dementia, diabetes and cardiovascular diseases.

CONCLUSIONS:

One-quarter of community-dwelling older adults are continuously exposed to PIMs. To optimize medication prescribing in the older population, further interventions are needed to limit the use of PIMs most likely to be continued, especially in individuals most at risk of being persistent and also particularly vulnerable to adverse events.

KEYWORDS:

Beers criteria; community-dwelling; older adults; persistence; potentially inappropriate medications

PMID:
31916266
DOI:
10.1111/bcp.14214

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