Still Too Many Inappropriate Prescriptions Among the Elderly

In elderly patients, who often have multiple conditions, polypharmacy is often appropriate but entails a risk for adverse events and, sometimes, an increased risk for morbidity and mortality. This risk is particularly apparent when polypharmacy includes potentially inappropriate medications: Those for which the benefit/risk ratio is unfavorable for older adults.

The definition of polypharmacy remains variable by country, and studies aiming to assess its frequency in different countries are difficult to compare because of the heterogeneity of methodologies implemented (relating to, eg, data sources, patient profiles, and study duration). Researchers conducted a study on the subject across six European countries, and this transnational comparison could help identify principles to apply from one country to another.

The retrospective cohort study was conducted using databases hosted by IQVIA. Each database included as many as several hundreds of thousands of anonymized electronic medical records from a panel of general practitioners. The data were representative of primary care in each respective country. Included in this analysis were patients aged ≥ 65 years who had been followed for ≥ 12 months by their physicians and had at least two consultations during 2018. The study period extended throughout 2018.

The prevalence of polypharmacy was determined by the prescription of at least five medications over a period of 6 months, excluding treatments for acute conditions, topical treatments, medical devices, and specialist prescriptions. An analysis was conducted to assess the weight of potentially inappropriate medications among prescriptions for opioids, antipsychotics, benzodiazepines, and proton pump inhibitors (PPIs).

The study populations generally were comparable between countries (average age, 75-76 years; 54%-56% women). The prevalence of polypharmacy varied from 22.8% in the United Kingdom to 58.3% in Germany and that of the prescription of ≥ 10 medications ranged from 11.3% in the United Kingdom to 28.5% in Germany. In France, the prevalence of these two levels of polypharmacy was 58.0% and 22.9%, respectively. The Charlson Comorbidity Index was zero for 33.7% (Germany) to 68.7% (United Kingdom) of included patients (58.8% in France).

The percentage of potentially inappropriate medication prescriptions was highest for PPIs, ranging from 42.3% to 65.5% (48.4% in France). The inappropriate use of benzodiazepines affected between 2.7% and 34.9% of patients (20.7% in France). The inappropriate prescription of opioids ranged from 11.1% (in France) to 27.5% and that of antipsychotics ranged from 2.1% (in France) to 10.8%.

Diabetes and chronic respiratory diseases were the most frequently represented comorbidities in patients with polypharmacy. The most commonly prescribed treatment groups were gastrointestinal and cardiovascular medications (eg, antiulcer, antithrombotic, beta blocking, and lipid-lowering agents).

The authors noted that Belgium and the United Kingdom have “a strikingly low prevalence of polypharmacy…compared to the other countries.” While these two countries have initiatives to manage medication use in the elderly, other countries do as well. “The differences and similarities in country health systems and general practitioner documentation practices…also do not provide an obvious explanation for our findings,” they wrote. Further comparative studies could shed light on these observations.

This story was translated from Univadis France, which is part of the Medscape Professional Network, using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.