One-year persistence of potentially inappropriate medication use in older adults: A population-based study
Authors: Marie-Laure Laroche
Marc Simard
Marie-Eve Gagnon
Caroline Sirois
Barbara Roux
Journal: British journal of clinical pharmacology (2020)
Discipline: PHARMACOLOGY & TOXICOLOGY
Keywords: Beers criteria; community-dwelling; older adults; persistence; potentially inappropriate medications.
Affiliations: Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology-Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France., INSERM UMR 1248, Faculty of Medicine, University of Limoges, Limoges, France., Quebec National Institute of Public Health, Quebec, Canada., Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec, Canada., 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 1-year persistence of potentially inappropriate medication (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 1 April 2014 and 31 March 2015 were followed-up for 1 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 1-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 (interquartile range 21-92). Individuals were more persistent at 1 year with antipsychotics (43.9%), long-duration sulphonylureas (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 and 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. 

Retracted: No

PubPeer comments:
 **Potentially harmful drugs for older patients: used too often and for too long** Many drugs carry particular risks and side effects for older patients. For orientation on such  potentially inadequate drugs (PIM), there are aids such as the Beers criteria, which are particularly widespread in the American region, or the PRISCUS and FORTA lists used in this country ( Fit fOR The Aged ). A French study team has now looked into the question of how often PIM are used permanently ( 1 year) in older patients. In a retrospective cohort study, the investigators evaluated data from a national database for chronic diseases (Quebec Integrated Chronic Disease Surveillance System (QICDSS). For the period from April 2014 to March 2015, all 65-year-old patients who were prescribed a PIM according to the 2015 Beers criteria during this period were examined to determine whether they had been prescribed the drug in question for more than one year. The total number of new prescriptions of PIM was frequent at 7% (75,844 of 1,057,024 patients). Of these, 25% were long-term medications (19,051 of the 75,844 cases; 95% AI, 24.8-25.4), while 50% of patients were only prescribed for a short period (u226469 days). Antipsychotics, long-acting sulfonylureas, antiarrhythmics and proton pump inhibitors were most frequently prescribed long-term. Risk factors for the persistent use of PIM were old age, male gender, co-morbidity of several chronic diseases (especially dementia, diabetes and cardiovascular diseases) and the use of several drugs. Even though the data from Quebec cannot be transferred to Germany without restrictions, the study impressively shows two things: 1. the prescription of PIM in elderly patients is not an isolated phenomenon. 2. once prescribed, PIM often mutates into permanent medication. Therefore, a new prescription of a drug as well as the continuation of already prescribed drugs should be reviewed particularly critically in older patients. ,