Inappropriate Drug Use in the Elderly - Nepi

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Jun 26, 2007 - azepam, flunitrazepam, nitrazepam), concurrent use of 3 or more psychotropic drugs (ie, neuroleptics, anxiolytics, hypnotics/sedatives ...
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Inappropriate Drug Use in the Elderly: a Nationwide RegisterBased Study Kristina Johnell, Johan Fastbom, Måns Rosén, and Andrejs Leimanis

otentially inappropriate drug use (IDU) is an important and preventBACKGROUND: Potentially inappropriate drug use (IDU) is an important and preventable safety concern in the care of elderly patients and has been able safety concern in the care of elderly associated with adverse drug reactions, hospitalization, and mortality. patients and has been associated with adOBJECTIVE: To estimate the prevalence of potentially IDU among the elderly in verse drug reactions, hospitalization, and Sweden and investigate whether age, sex, and number of dispensed drugs are 1-4 mortality. These adverse outcomes are associated with IDU. believed to be at least partly preventable METHODS: We analyzed data on age, sex, and dispensed drugs for people aged 1,4 by more appropriate drug prescribing. 75 years and older who were listed in the Swedish Prescribed Drug Register Various studies using explicit criteria from October–December 2005 (N = 732 228). The main outcome measures of have reported the prevalence of IDU to IDU were prescription of anticholinergics, prescription of long-acting benzorange from 3% to 40%5; however, these diazepines, concurrent use of 3 or more psychotropic drugs, and an indication of potentially serious drug–drug interactions. studies vary greatly with regard to particRESULTS: Prevalence for IDU was 17%; for anticholinergic drugs 6%, long-acting ipants and setting. benzodiazepines 5%, 3 or more psychotropic drugs 5%, and potentially serious The Swedish National Board of drug–drug interactions 4%. After adjustment for age and sex, number of Health and Welfare has established qualdispensed drugs was strongly associated with all 4 measures of IDU. After ity indicators for drug use in elderly peradjustment for sex and number of dispensed drugs, increasing age was sons. These indicators are quantitative moderately associated with a higher probability of IDU, long-acting benzodimeasures based on international literaazepines, and 3 or more psychotropic drugs, After adjustment for age and number of dispensed drugs, women had a slightly increased probability of IDU, ture on the quality of drug use in older anticholinergic drugs, long-acting benzodiazepines, and 3 or more psychotropic people.6 The quality indicators are dedrugs. fined as follows: drug-specific, which CONCLUSIONS: IDU was fairly common among the elderly in Sweden in 2005 and describe the quality regarding choice of was strongly connected to the number of dispensed drugs they were taking. drug, regimen, dosage, and combinations Older age and female sex were related to inappropriate use of psychotropic of drugs; diagnosis-specific which dedrugs, whereas the opposite relationship prevailed for potentially serious scribe rational, irrational, and inappropridrug–drug interactions. Future research is needed to determine whether IDU will become more common due to increasing use of drugs among elderly persons. ate drug use in the most common disThe challenge is to balance the problems related to IDU without denying older eases in elderly persons. people potentially valuable drug therapy. We focused on 4 of the drug-specific KEY WORDS: drug register, elderly, inappropriate drug use, Sweden. quality indicators that could be applied Ann Pharmacother 2007;41:1243-8. to the Swedish Prescribed Drug RegisPublished Online, 26 Jun 2007, www.theannals.com, DOI 10.1345/aph.1K154 ter: anticholinergics, long-acting benzodiazepines, concurrent use of 3 or more psychotropic drugs, and potentially serirhythmias, urinary retention, impaired functional status, ous drug– drug interactions.4 Anticholinergic drugs can and confusion.7,8 Therefore, most anticholinergic drugs have serious effects in elderly persons, such as cardiac arshould be considered inappropriate for the elderly.8 Longacting benzodiazepines have prolonged half-lives (someAuthor information provided at the end of the text. times by days) in the elderly and may thus cause excessive

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sedation, cognitive impairment, and falls. Hence, benzodiazepines with short half-lives are preferable in this population.8,9 Concurrent use of 3 or more psychotropic drugs is a refined measure of polypharmacy and may raise concerns regarding adverse reactions and adherence issues.10 Research on the extent and correlates of IDU in the elderly is often limited by small study samples. Accordingly, we wanted to study IDU among a large sample of elderly by using the new Swedish Prescribed Drug Register, which contains data on all dispensed prescriptions in Sweden.11 The aims of this study were to estimate the prevalence of potentially IDU (ie, the prescription of anticholinergics and long-acting benzodiazepines, concurrent use of 3 or more psychotropic agents, and an indication of potentially serious drug– drug interactions) and to investigate whether age, sex, and number of drugs are associated with IDU in a large sample of elderly persons. Methods STUDY POPULATION

The Swedish Prescribed Drug Register contains individual-based data on all dispensed prescriptions to the entire population of Sweden (about 9 million inhabitants). The data collection is administered by the state-owned National Corporation of Swedish Pharmacies and then transferred to the National Board of Health and Welfare.11 We analyzed data on age, sex, and dispensed drugs (date of redemption, amount of drug, dosage) from 732 228 individuals aged 75 years and older who were registered in the Swedish Prescribed Drug Register during October–December 2005. Data were nonidentifiable (ie, all unique personal identification numbers had been removed). First, information from the 3 month period concerning date of redemption, amount of drug, and dosage was processed to calculate the duration of drug exposure. Second, a list of current prescriptions was constructed for every individual on the arbitrarily chosen date of December 31, 2005.12 When dosage was incomplete or missing, we assumed 0.9 defined daily doses (DDDs)13 for regularly used drugs (based on calculations for regularly used drugs among the elderly in the database) and 0.5 DDDs (50% of 0.9) for drugs usually prescribed as needed. We also assumed 1 DDD for drugs for external use and for the eye. Finally, every individual’s list of prescriptions was analyzed with regard to IDU. DEFINITIONS

The dispensed drugs were classified according to the Anatomical Therapeutic Chemical (ATC) Classification System, as recommended by the World Health Organization (WHO).13 Determination of potentially IDU was based on 4 quality indicators developed by the National Board of 1244

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Health and Welfare: use of at least one anticholinergic drug, use of at least one long-acting benzodiazepine (ie, diazepam, flunitrazepam, nitrazepam), concurrent use of 3 or more psychotropic drugs (ie, neuroleptics, anxiolytics, hypnotics/sedatives, antidepressants), and at least one potentially serious drug– drug interaction.6 IDU was defined as exposure to at least one of the 4 quality indicators. Potentially serious drug– drug interactions were classified according to the Swedish system developed by Sjöqvist, which is published in the Swedish Physicians’ Desk Reference.14 In brief, the Sjöqvist system is divided into 4 levels of clinical relevance (types A, B, C, and D). We focused on potentially serious drug– drug interactions (type D), which should be avoided. Examples of type D drug– drug interactions are aspirin plus a nonsteroidal antiinflammatory drug (NSAID), aspirin plus warfarin, and potassium-sparing diuretics plus potassium. Age was categorized into 4 groups: 75–79 (reference), 80–84, 85–89, and 90 years and over. Number of dispensed drugs was divided into 4 categories: 0– 4 (reference), 5–9, 10–14, and 15 and over. STATISTICAL ANALYSIS

The total population in Sweden aged 75 years and older (N = 799 101)15 was used as the denominator for the calculation of prevalence.16 We used logistic regression to study the association between the explanatory variables (age, sex, number of dispensed drugs) and IDU. The results are shown as odds ratios with 95% confidence intervals. SPSS 14.0 for Windows (SPSS Inc., Chicago, IL, 1989–2005) was used for the analyses. The study was approved by the ethical board in Stockholm (Dnr 2006/948-31). Results Mean age among the 732 228 elderly was 82 years, an average of 5.4 drugs per person was dispensed, and 62% of the study sample were women (Table 1). The prevalence for IDU, by quality indicator, among people aged 75 years and older in Sweden is shown in Table 2. The 3 most frequently dispensed anticholinergic drugs were urinary antispasmodics, nonselective monoamine reuptake inhibitors, and hydroxyzine. Long-acting benzodiazepines were dispensed in the following decreasing order: flunitrazepam, diazepam, and nitrazepam. The most common potentially serious drug– drug interaction was aspirin plus an NSAID, followed by aspirin plus warfarin. After adjustment for sex and number of dispensed drugs, logistic regression analyses indicated that older age was associated with a higher probability of IDU, long-acting benzodiazepines, and 3 or more psychotropic drugs (Table 3). However, the opposite relationship prevailed for

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potentially serious drug– drug interactions, and there was no association between age and anticholinergic drugs. Furthermore, after adjustment for age and number of dispensed drugs, elderly women had a higher probability of IDU, anticholinergic drugs, long-acting benzodiazepines, and 3 or more psychotropic drugs than did elderly men. Interestingly, potentially serious drug– drug interactions showed the opposite pattern for both age and sex (OR 0.92; 95% CI 0.90 to 0.94 for women compared with men) from the other 3 measures of IDU. Also, after adjustment for age and sex, the number of dispensed drugs—especially the use of 3 or more psychotropic drugs—was strongly associated with all 4 measures of IDU (OR 138.24; 95% CI 130.64 to 146.29 for >15 drugs compared with 0– 4 drugs). Discussion MAIN FINDINGS

Our results indicate that 17% of the Swedish elderly are exposed to potentially IDU. The use of anticholinergic agents seems to have decreased slightly among Swedish elderly since the 1990s.17,18 Yet, potentially serious drug– drug interactions and concurrent use of 3 or more psychotropic drugs seem to have increased.18,19 The use of long-acting

Table 1. Characteristics of the Study Populationa Parameter Age, y 75–79 80–84 85–89 ≥90 Sex men women Dispensed drugs, n 0–4 5–9 10–14 ≥15

n

%

272 519 238 656 147 320 73 733

37.2 32.6 20.1 10.1

281 239 450 989

38.4 61.6

353 279 274 900 82 976 21 073

48.2 37.5 11.3 2.9

LIMITATIONS

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From the 2005 Swedish Prescribed Drug Register; N = 732 228.

Table 2. Inappropriate Drug Use Among Swedish Elderly Personsa Parameter

n

Prevalence, %b

≥1 indications of inappropriate drug use Types of inappropriate drug use anticholinergic drugs long-acting benzodiazepines ≥3 psychotropic drugs potentially serious drug–drug interactions

132 153

16.5

48 590 39 153 41 747 33 078

6.1 4.9 5.2 4.1

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2005. The population in Sweden aged ≥75 years (N = 799 101) was used as the denominator for the calculation of prevalence.

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benzodiazepines and 3 or more psychotropics seems to be less common in Sweden than in other places in Europe.10,20 Not surprisingly, the number of dispensed drugs was strongly related to all 4 measures of IDU, which has also been reported in previous studies.5 This emphasizes the importance of trying to keep the number of drugs used by elderly patients to a minimum. Further, elderly women had a higher probability of IDU than did elderly men, with the exception of potentially serious drug– drug interactions. The tendency for women to have a higher general probability of IDU has been reported in other articles.5,21 Other sources also report that women are less likely than are men to be prescribed combinations of drugs that may cause serious drug– drug interactions.22 Moreover, our study found that age was not consistently related to the 4 measures of IDU. Older age increased the probability of being dispensed long-acting benzodiazepines and 3 or more psychotropic drugs. Whether this reflects an age effect or a cohort effect (ie, whether older people are more frequently prescribed long-acting benzodiazepines or the prescription of these drugs was more common before) remains to be seen.23 In contrast, younger age was associated with potentially serious drug– drug interactions, and age was in no way related to anticholinergic drugs. These findings need to be supported by future studies. Overall, the different patterns for the 4 measures of IDU highlight the adequacy of studying separate aspects of IDU and not just one summarized measure.

In the logistic regression analyses, we used only data on the elderly who were registered in the Swedish Prescribed Drug Register between October and December 2005, which corresponds to 92% of the Swedish population aged 75 years and older.15 Further, the Swedish Prescribed Drug Register does not include data on over-the-counter agents, herbal products, or medications used in hospitals or from nursing home drug storerooms, which may lead to an underestimation of drug use in the sample population. Moreover, our method is built on an assumption that all current drugs were dispensed during the observed 3 month period, which is based on the fact that the maximum quantity of drugs prescribed in Sweden is a 90 day supply. Consequently, we might miss recording medications that were dispensed before the 3 month period and used at a slower rate than intended. At the same time, we run a risk of including drugs that were dispensed during the 3 month period but were discontinued prematurely. Our method is built on interpretation of the dispensed dosages in free text, as well as assumptions about DDDs when the information about dosage was incomplete or missing.12 We focused on 4 of the drug-specific quality indicators developed by the National Board of Health and Welfare

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because of their applicability to the Swedish Prescribed Drug Register. This may give an underestimation of IDU in the elderly study population. In the future, as the technique develops, we aim to include other quality indicators. We included the variables of age, sex, and number of dispensed drugs in our analyses; there are other factors (eg, socioeconomic status, comorbidity) that may also affect IDU, and residual confounding cannot be ruled out. However, we did not have access to those kinds of data in the Swedish Prescribed Drug Register. Since we did not have data on diagnoses, underuse of drugs in the elderly could not be detected by our study design. Finally, potentially IDU is not the same as actual IDU. For the individual patient, a drug judged to be inappropriate by definition may sometimes be justified.6 IMPLICATIONS

The risk of potentially IDU grows as more drugs are given to an elderly patient, and drug use among the elderly is continually increasing.24 Therefore, it becomes increasingly important to monitor drug use among older people closely. WHO gives the following advice to prescribers of drugs for the elderly: “When adding a new drug to the therapeutic regimen, see whether another can be withdrawn.”25 Both practitioners and researchers benefit from the development of explicit criteria for the definition of IDU. However, because separate measures of IDU may be connected differently to sociodemographic factors, a summarized measure of IDU may be inadequate. There is great potential in Sweden for conducting indepth research on both potentially IDU and actual adverse drug reactions by using the Swedish Prescribed Drug Register. The register provides complete national data on individuals to whom drugs are dispensed. By using the unique

personal identification number, it is possible to link data on individual drug use with socioeconomic data (eg, education, income, family situation) and outcomes (eg, mortality, hospitalization). The register represents one of the largest population-based pharmacoepidemiologic databases in the world and its value will increase as time passes. Conclusions IDU was fairly common among the elderly in Sweden in 2005 and was strongly associated with the number of drugs that they were prescribed. Older age and female gender were related to inappropriate use of psychotropic drugs, whereas the opposite relationship prevailed for potentially serious drug– drug interactions. Future research is needed to determine whether IDU will become more common due to the increasing use of drugs among the elderly. The challenge is to balance the problems related to IDU without denying older people potentially valuable drug therapy. Kristina Johnell MScPharm PhD, Postdoctoral Fellow, Aging Research Center, Karolinska Institutet, Stockholm, Sweden Johan Fastbom MD PhD, Associate Professor, Aging Research Center, Karolinska Institutet Måns Rosén PhD, Professor, SBU—The Swedish Council on Technology Assessment in Health Care, Stockholm Andrejs Leimanis, Centre for Epidemiology, National Board of Health and Welfare, Stockholm Reprints: Dr. Johnell, Aging Research Center, Karolinska Institutet, Gävlegatan 16, 113 30 Stockholm, Sweden, fax 46 (0)8 690 68 89, [email protected] This study was supported financially by the Swedish Council for Working Life and Social Research.

References 1. Passarelli MC, Jacob-Filho W, Figueras A. Adverse drug reactions in an elderly hospitalised population: inappropriate prescription is a leading cause. Drugs Aging 2005;22:767-77.

Table 3. Logistic Regression for Inappropriate Drug Use Among Swedish Elderly Personsa

Parameter Age, y 75–79 80–84 85–89 ≥90 Sex men women Dispensed drugs, n 0–4 5–9 10–14 ≥15

Potentially Serious Drug– Drug Interactions OR (95% CI)

Anticholinergic Drugs OR (95% CI)

Long-Acting Benzodiazepines OR (95% CI)

≥3 Psychotropic Drugs OR (95% CI)

reference 1.04 (1.02 to 1.06) 1.13 (1.11 to 1.15) 1.29 (1.26 to 1.32)

reference 0.95 (0.92 to 0.97) 0.95 (0.93 to 0.98) 1.02 (0.99 to 1.06)

reference 1.14 (1.11 to 1.17) 1.30 (1.26 to 1.33) 1.60 (1.55 to 1.66)

reference 1.11 (1.08 to 1.15) 1.28 (1.25 to 1.32) 1.53 (1.48 to 1.59)

reference 0.92 (0.89 to 0.94) 0.86 (0.83 to 0.88) 0.78 (0.75 to 0.81)

reference 1.29 (1.27 to 1.31)

reference 1.23 (1.20 to 1.25)

reference 1.45 (1.42 to 1.48)

reference 1.47 (1.43 to 1.50)

reference 0.92 (0.90 to 0.94)

reference 4.12 (4.05 to 4.19) 12.30 (12.06 to 12.55) 34.12 (33.02 to 35.25)

reference 3.26 (3.18 to 3.35) 7.24 (7.04 to 7.45) 13.51 (13.01 to 14.03)

reference 2.41 (2.35 to 2.47) 4.36 (4.23 to 4.49) 7.37 (7.07 to 7.68)

Inappropriate Drug Use OR (95% CI)

reference 12.25 (11.63 to 12.90) 51.29 (48.68 to 54.04) 138.24 (130.64 to 146.29)

reference 6.62 (6.36 to 6.89) 17.31 (16.60 to 18.05) 42.54 (40.55 to 44.62)

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From the 2005 Swedish Prescribed Drug Register; N = 732 228.

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Inappropriate Drug Use in the Elderly 2. Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med 2005;165: 68-74. DOI 10.1001/archinte.165.1.68 3. Perri M III, Menon AM, Deshpande AD, et al. Adverse outcomes associated with inappropriate drug use in nursing homes. Ann Pharmacother 2005;39:405-11. Epub 25 Jan 2005. DOI 10.1345/aph.1E230 4. Klarin I, Wimo A, Fastbom J. The association of inappropriate drug use with hospitalisation and mortality: a population-based study of the very old. Drugs Aging 2005;22:69-82. 5. Aparasu RR, Mort JR. Inappropriate prescribing for the elderly: beers criteria-based review. Ann Pharmacother 2000;34:338- 46. DOI 10.1345/aph.19006 6. National Board of Health and Welfare (Socialstyrelsen). Indikatorer för utvärdering av kvaliteten i äldres läkemedelsterapi—Socialstyrelsens förslag [Indicators for evaluation of the quality of drug use in the elderly] Swedish. 2003. 7. Landi F, Russo A, Liperoti R, et al. Anticholinergic drugs and physical function among frail elderly population. Clin Pharmacol Ther 2007;81: 235-41. DOI 10.1038/sj.clpt.6100035 8. Chutka DS, Takahashi PY, Hoel RW. Inappropriate medications for elderly patients. Mayo Clin Proc 2004;79:122-39. 9. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003;163:2716-24. DOI 10.1001/archinte.163.22.2716 10. De las Cuevas C, Sanz EJ. Polypharmacy in psychiatric practice in the Canary Islands. BMC Psychiatry 2004;4:18. DOI 0.1186/471-244X-4-18 11. Wettermark B, Hammar N, Michaelfored C, et al. The new Swedish Prescribed Drug Register—opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf. In press. 12. Lau HS, de Boer A, Beuning KS, Porsius A. Validation of pharmacy records in drug exposure assessment. J Clin Epidemiol 1997;50:619-25. 13. About the ATC/DDD system. WHO Collaborating Centre for Drug Statistics Methodology, Oslo, Norway. www.whocc.no/atcddd/ (accessed 2007 Apr 19). 14. Sjöqvist F. Interaktion mellan läkemedel [Drug interactions] Swedish. In: FASS (the Swedish Physicians’ Desk Reference). www.fass.se (accessed 2007 Apr 19). 15. Statistics Sweden. Sveriges befolkning efter kön och ålder 31/12/2005) [The population in Sweden according to sex and age, Dec. 31, 2005] Swedish. www.scb.se/templates/tableOrChart_78315.asp (accessed 2007 Apr 19). 16. Hallas J, Stovring H. Templates for analysis of individual-level prescription data. Basic Clin Pharmacol Toxicol 2006;98:260-5. DOI 10.1111/j.742-7843.2006.pto_257.x 17. Giron MS, Wang HX, Bernsten C, Thorslund M, Winblad B, Fastbom J. The appropriateness of drug use in an older nondemented and demented population. J Am Geriatr Soc 2001;49:277-83. 18. National Board of Health and Welfare (Socialstyrelsen). Kvaliteten på läkemedelsanvändningen hos äldre [The quality of drug use in the elderly] Swedish. Socialstyrelsen följer upp och utvärderar. 2000:8.2000. 19. Bergendal L, Friberg A, Schaffrath A. Potential drug– drug interactions in 5,125 mostly elderly out-patients in Gothenburg, Sweden. Pharm World Sci 1995;17:152-7. 20. Lechevallier-Michel N, Gautier-Bertrand M, Alperovitch A, et al. Frequency and risk factors of potentially inappropriate medication use in a community-dwelling elderly population: results from the 3C Study. Eur J Clin Pharmacol 2005;60:813-9. DOI 10.1007/s00228-004-0851-z 21. Zhan C, Sangl J, Bierman AS, et al. Potentially inappropriate medication use in the community-dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. JAMA 2001;286:2823-9. 22. Merlo J, Liedholm H, Lindblad U, et al. Prescriptions with potential drug interactions dispensed at Swedish pharmacies in January 1999: cross sectional study. BMJ 2001;323:427-8. 23. Stuart B, Kamal-Bahl S, Briesacher B, et al. Trends in the prescription of inappropriate drugs for the elderly between 1995 and 1999. Am J Geriatr Pharmacother 2003;1:61-74.

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24. Jyrkka J, Vartiainen L, Hartikainen S, Sulkava R, Enlund H. Increasing use of medicines in elderly persons: a five-year follow-up of the Kuopio 75+ Study. Eur J Clin Pharmacol 2006;62:151-8. DOI 10.1007/s00228005-0079-6 25. WHO (World Health Organization). Drugs for the elderly. Copenhagen, Denmark: WHO Regional Publications, European Series, no. 17, 1997.

Uso Inapropiado de Medicamentos en Ancianos: Un Estudio Basado en Registros de Ámbito Nacional K Johnell, J Fastbom, M Rosén, y A Leimanis Ann Pharmacother 2007;41:1243-8. EXTRACTO

El uso potencialmente inadecuado de medicamentos (IDU) es un problema de seguridad importante y prevenible en la atención a pacientes ancianos, ya que el IDU se asocia a reacciones adversas a medicamentos, hospitalización, y mortalidad. OBJETIVOS: Estimar la prevalencia del IDU potencial entre los ancianos en Suecia, e investigar el grado de asociación de la edad, el sexo, y el número de medicamentos con el IDU. MÉTODOS: Analizamos los datos de edad, sexo, y medicamentos dispensados de persona de 75 o más años de edad registrados en el Registro de Medicamentos Prescritos en Suecia durante octubre– diciembre 2005 (n = 732 228). Para determinar el IDU potencial midieron 4 indicadores: la prescripción de anticolinérgicos y benzodiazepinas de larga duración, el uso concomitante de 3 o más psicótropos y una indicación de interacciones entre medicamentos potencialmente graves, definiendo el IDU como la exposición al menos a uno de esos indicadores. RESULTADOS: La prevalencia de IDU fue del 17%: prescripción de anticolinérgicos 6%, de benzodiazepinas de larga duración 5%, uso concomitante de 3 o más psicótropos 5% e interacciones entre medicamentos potencialmente graves 4%. Después de ajustar por edad y sexo se encontró una fuerte asociación entre el número de medicamentos dispensados y las 4 medidas de IDU. Existe una moderada asociación entre el aumento de la edad y una mayor probabilidad de IDU, prescripción de benzodiazepinas de larga duración y uso concomitante de 3 o más psicótropos, después de ajustar por sexo y número de medicamentos dispensados. Las mujeres mostraron un ligero incremento de probabilidad de IDU, prescripción de anticolinérgicos y benzodiazepinas de larga duración y uso concomitante de 3 o más psicótropos, después de ajustar por edad y número de medicamentos dispensados. CONCLUSIONES: El IDU fue bastante común entre los ancianos en Suecia en 2005. La edad avanzada y el sexo femenino se relacionaron con el uso inapropiado de psicótropos, mientras que se encontró una relación inversa con las reacciones adversas a medicamentos. Se precisan futuras investigaciones para determinar hasta que punto el IDU va a ser más común debido al aumento del uso de medicamentos entre los ancianos. El reto está en afrontar los problemas relacionados con el IDU sin privar a los ancianos de una terapéutica farmacológica potencialmente valiosa. INTRODUCCIÓN:

Traducido por Juan del Arco

Utilisation de Médicaments non Appropriés chez les Personnes Âgées: Une Étude Nationale en Suède K Johnell, J Fastbom, M Rosén, et A Leimanis Ann Pharmacother 2007;41:1243-8. RÉSUMÉ

Évaluer la prévalence de l’utilisation des médicaments potentiellement non appropriés chez les personnes âgées demeurant en Suède et examiner si l’âge, le sexe et le nombre de médicaments dispensés contribuent à l’utilisation de médicaments potentiellement non appropriés.

OBJECTIFS:

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K Johnell et al. MÉTHODES: Les auteurs ont analysé les données concernant l’âge, le sexe, et les médicaments dispensés chez une population de plus de 75 ans enregistrés avec le registre des médicaments prescrits pour la Suède durant la période de octobre–décembre 2005 (n = 732 228). Le critère d’évaluation primaire des médicaments potentiellement non appropriés comprenait la prescription de médicaments anticholinergiques, de benzodiazépines à longue durée d’action, de l’utilisation de 3 ou plus antipsychotiques et de la présence d’interactions médicamenteuses potentiellement graves. RÉSULTATS: La prévalence de médicaments potentiellement non appropriés était de 17%; de 6% pour les médicaments anticholinergiques; de 5% pour les benzodiazépines à longue durée d’action; de 5% pour l’utilisation de 3 ou plus d’antipsychotiques et de 4% pour les interactions médicamenteuses potentiellement graves. Le nombre de médicaments dispensés était fortement associé avec les 4 critères d’évaluation primaire pour l’utilisation de médicaments potentiellement non appropriés après ajustement pour l’âge et le sexe. L’augmentation en âge était modérément associée avec la prise de médicaments potentiellement non appropriés, la présence de benzodiazépines à longue demi-vie et la présence de 3 ou plus

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d’antipsychotiques, après ajustement pour le sexe et le nombre de médicaments dispensés. Les femmes avaient un risque légèrement augmenté de recevoir des médicaments potentiellement non appropriés, des médicaments anticholinergiques, des benzodiazépines à longue durée d’action et de 3 ou plus antipsychotiques après ajustement pour l’âge et le nombre de médicaments. CONCLUSIONS: L’utilisation de médicaments potentiellement non appropriés représente un problème commun chez les patients âgés demeurant en Suède et ce, durant l’année 2005. Ceci est fortement associé au nombre de médicaments dispensés. L’âge avancé et le sexe féminin sont associés à une utilisation non appropriée d’antipsychotiques tandis qu’une relation opposée prévaut pour les interactions médicamenteuses potentiellement graves. D’autres études sont nécessaires pour déterminer si l’utilisation des médicaments potentiellement non appropriés deviendra plus importante compte tenu de l’augmentation de l’utilisation des médicaments chez les personnes âgées.

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Traduit par Louise Mallet

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