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Use of prescription drugs in the older adult population—a nationwide pharmacoepidemiological study

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

Multi-morbidity and polypharmacy are common among older people. It is essential to provide a better understanding of the complexity of prescription drug use among older adults to optimise rational pharmacotherapy. Population-based utilisation data in this age group is limited. Using the Danish nationwide health registries, we aimed to characterise drug use among Danish individuals ≥ 60 years.

Methods

This is a descriptive population-based study assessing drug prescription patterns in 2015 in the full Danish population aged ≥ 60 years. The use of specific therapeutic subgroups and chemical subgroups and its dependence on age were described using descriptive statistics. Profiles of drug combination patterns were evaluated using latent class analysis.

Results

We included 1,424,775 residents (median age 70 years, 53% women). Of all the older adults, 89% filled at least one prescription during 2015. The median number of drug groups used was five per person. The most used single drug groups were paracetamol and analogues (34%), statins (33%) and platelet aggregation inhibitors (24%). Eighteen drug profiles with different drug combination patterns were identified. One drug profile with expected use of zero drugs and 11 drug profiles expected to receive more than five different therapeutic subgroup drugs were identified.

Conclusion

The use of drugs is extensive both at the population level and increasing with age at an individual level. Separating the population into different homogenous groups related to drug use resulted in 18 different drug profiles, of which 11 drug profiles received on average more than five different therapeutic subgroup drugs.

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References

  1. Vass M, Hendriksen C (2005) Polypharmacy and older people - the GP perspective. Z Für Gerontol Geriatr 38:i14–i17. https://doi.org/10.1007/s00391-005-1104-1

    Article  Google Scholar 

  2. Schöttker B, Saum K-U, Muhlack DC, Hoppe LK, Holleczek B, Brenner H (2017) Polypharmacy and mortality: new insights from a large cohort of older adults by detection of effect modification by multi-morbidity and comprehensive correction of confounding by indication. Eur J Clin Pharmacol 73:1041–1048. https://doi.org/10.1007/s00228-017-2266-7

    Article  CAS  PubMed  Google Scholar 

  3. Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivelä SL, Isoaho R (2002) Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol 55:809–817. https://doi.org/10.1016/S0895-4356(02)00411-0

    Article  PubMed  Google Scholar 

  4. Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL (2015) Trends in prescription drug use among adults in the United States from 1999-2012. JAMA 314:1818–1831. https://doi.org/10.1001/jama.2015.13766

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Welker KL, Mycyk MB (2016) Pharmacology in the geriatric patient. Emerg Med Clin North Am 34:469–481. https://doi.org/10.1016/j.emc.2016.04.003

    Article  PubMed  Google Scholar 

  6. Mair A, Fernandez-Llimos F, Alonso A et al (2017) Polypharmacy management by 2030: a patient safety challenge. Coimbra SIMPATHY Consort 64

  7. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE (2017) What is polypharmacy? A systematic review of definitions. BMC Geriatr 17:230. https://doi.org/10.1186/s12877-017-0621-2

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fournaise A, Espensen N, Jakobsen S, Andersen-Ranberg K (2017) Increasing primary health-care services are associated with acute short-term hospitalization of Danes aged 70 years and older. Eur Geriatr Med 8:435–439. https://doi.org/10.1016/j.eurger.2017.07.018

    Article  Google Scholar 

  9. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380:37–43. https://doi.org/10.1016/S0140-6736(12)60240-2

    Article  PubMed  Google Scholar 

  10. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW (2005) Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases implications for pay for performance. JAMA J Am Med Assoc 294:716–724. https://doi.org/10.1001/jama.294.6.716

    Article  CAS  Google Scholar 

  11. Mangoni AA, Jackson SHD (2003) Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 57:6–14. https://doi.org/10.1046/j.1365-2125.2003.02007.x

    Article  CAS  Google Scholar 

  12. Alhawassi TM, Krass I, Bajorek BV, Pont LG (2014) A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting. Clin Interv Aging. https://doi.org/10.2147/CIA.S71178

  13. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Breckenridge AM (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 329:15–19. https://doi.org/10.1136/bmj.329.7456.15

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ma J, Wang Y, Gao M, Meng Q, Liu J (2012) Adverse drug reactions as the cause of emergency department admission of patients aged 80 years and older. Eur J Intern Med 23:e162–e163. https://doi.org/10.1016/j.ejim.2012.05.004

    Article  PubMed  Google Scholar 

  15. Olivier P, Bertrand L, Tubery M, Lauque D, Montastruc JL, Lapeyre-Mestre M (2009) Hospitalizations because of adverse drug reactions in elderly patients admitted through the emergency department: a prospective survey. Drugs Aging 26:475–482. https://doi.org/10.2165/00002512-200926060-00004

    Article  PubMed  Google Scholar 

  16. De Paepe P, Petrovic M, Outtier L et al (2013) Drug interactions and adverse drug reactions in the older patients admitted to the emergency department. Acta Clin Belg 68:15–21. https://doi.org/10.2143/ACB.68.1.2062714

    Article  PubMed  Google Scholar 

  17. Pottegård A, Schmidt SAJ, Wallach-Kildemoes H, Sørensen HT, Hallas J, Schmidt M (2017) Data resource profile: the Danish National Prescription Registry. Int J Epidemiol 46:798–798f. https://doi.org/10.1093/ije/dyw213

    Article  PubMed  Google Scholar 

  18. WHO Collaborating Centre for Drug Statistics Methodology (2012) Guidelines for ATC classification and DDD assignment 2013. Norwegian Institute of Public Health

  19. Norredam M, Kastrup M, Helweg-Larsen K (2011) Register-based studies on migration, ethnicity, and health. Scand J Public Health 39:201–205. https://doi.org/10.1177/1403494810396561

    Article  PubMed  Google Scholar 

  20. Helweg-Larsen K (2011) The Danish register of causes of death. Scand J Public Health 39:26–29. https://doi.org/10.1177/1403494811399958

    Article  PubMed  Google Scholar 

  21. Schmidt M, Pedersen L, Sørensen HT (2014) The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol 29:541–549. https://doi.org/10.1007/s10654-014-9930-3

    Article  PubMed  Google Scholar 

  22. McCutcheon AL (1987) Latent class analysis. Sage, Newcastle upon Tyne

    Book  Google Scholar 

  23. Nylund KL, Asparouhov T, Muthén BO (2007) Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Model Multidiscip J 14:535–569. https://doi.org/10.1080/10705510701575396

    Article  Google Scholar 

  24. Schwarz G (1978) Estimating the dimension of a model. Ann Stat 6:461–464

    Article  Google Scholar 

  25. Bakk Z, Kuha J (2017) Two-step estimation of models between latent classes and external variables. Psychometrika 83:1–22. https://doi.org/10.1007/s11336-017-9592-7

    Article  Google Scholar 

  26. Morin L, Johnell K, Laroche M-L, Fastbom J, Wastesson JW (2018) The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol 10:289–298. https://doi.org/10.2147/CLEP.S153458

    Article  PubMed  PubMed Central  Google Scholar 

  27. Øymoen A, Pottegård A, Almarsdóttir AB (2015) Characteristics and drug utilization patterns for heavy users of prescription drugs among the elderly: a Danish register-based drug utilization study. Eur J Clin Pharmacol 71:751–758. https://doi.org/10.1007/s00228-015-1849-4

    Article  PubMed  Google Scholar 

  28. Lagerin A, Törnkvist L, Nilsson G, Johnell K, Fastbom J (2017) Extent and quality of drug use in community-dwelling people aged ≥75 years: a Swedish nationwide register-based study. Scand J Public Health. https://doi.org/10.1177/1403494817744101

  29. Marengoni A, Angleman S, Meinow B, Santoni G, Mangialasche F, Rizzuto D, Fastbom J, Melis R, Parker M, Johnell K, Fratiglioni L (2016) Coexisting chronic conditions in the older population: variation by health indicators. Eur J Intern Med 31:29–34. https://doi.org/10.1016/j.ejim.2016.02.014

    Article  PubMed  Google Scholar 

  30. Craftman ÅG, Johnell K, Fastbom J, Westerbotn M, von Strauss E (2016) Time trends in 20 years of medication use in older adults: findings from three elderly cohorts in Stockholm, Sweden. Arch Gerontol Geriatr 63:28–35. https://doi.org/10.1016/j.archger.2015.11.010

    Article  PubMed  Google Scholar 

  31. Barat I, Andreasen F, Damsgaard EMS (2000) The consumption of drugs by 75-year-old individuals living in their own homes. Eur J Clin Pharmacol 56:501–509

    Article  CAS  PubMed  Google Scholar 

  32. Wastesson JW, Cedazo Minguez A, Fastbom J, Maioli S, Johnell K (2018) The composition of polypharmacy: a register-based study of Swedes aged 75 years and older. PLoS One 13. https://doi.org/10.1371/journal.pone.0194892

  33. Voigt K, Gottschall M, Köberlein-Neu J, Schübel J, Quint N, Bergmann A (2016) Why do family doctors prescribe potentially inappropriate medication to elderly patients? BMC Fam Pract 17:93. https://doi.org/10.1186/s12875-016-0482-3

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kendler KS, Ohlsson H, Sundquist K, Sundquist J (2013) A latent class analysis of drug abuse in a national Swedish sample. Psychol Med 43:2169–2178. https://doi.org/10.1017/S0033291713000081

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Woodman RJ, Wood KM, Kunnel A, Dedigama M, Pegoli MA, Soiza RL, Mangoni AA (2016) Patterns of drug use and serum sodium concentrations in older hospitalized patients: a latent class analysis approach. Drugs - Real World Outcomes 3:383–391. https://doi.org/10.1007/s40801-016-0094-1

    Article  PubMed  PubMed Central  Google Scholar 

  36. Henriksen DP, Rasmussen L, Hansen MR, Hallas J, Pottegård A (2015) Comparison of the five Danish regions regarding demographic characteristics, healthcare utilization, and medication use—a descriptive cross-sectional study. PLoS One 10:e0140197. https://doi.org/10.1371/journal.pone.0140197

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Olesen C, Harbig P, Barat I, Damsgaard EM (2013) Absence of ‘over-the-counter’ medicinal products in on-line prescription records: a risk factor of overlooking interactions in the elderly. Pharmacoepidemiol Drug Saf 22:145–150. https://doi.org/10.1002/pds.3362

    Article  CAS  PubMed  Google Scholar 

  38. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, for the STROBE Initiative (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147:573–577. https://doi.org/10.7326/0003-4819-147-8-200710160-00010

    Article  Google Scholar 

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Acknowledgements

This study is a part of the Optimized Senior Patient Program (Optimed) at the Clinical Research Center, Hvidovre Hospital. We want to thank the Statistics Denmark for providing the data, Mikkel Ankarfeldt for the SAS support, Thomas Kallemose for the R support and Morten Baltzer Houlind for the support with the renal risk drug list.

Author information

Authors and Affiliations

  1. Clinical Research Center, Copenhagen University Hospital Hvidovre, Kettegaard Allé 30, 2650, Hvidovre, Denmark

    Line Due Christensen, Helle Gybel Juul-Larsen, Lillian Mørch Jørgensen, Ove Andersen & Janne Petersen

  2. Hospital Pharmacy, Odense University Hospital, Odense, Denmark

    Line Due Christensen & Anton Pottegård

  3. The Capital Region Pharmacy, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

    Line Due Christensen

  4. The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark

    Mette Reilev

  5. Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark

    Mette Reilev & Anton Pottegård

  6. Section for Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark

    Susanne Kaae

  7. Emergency Department, Copenhagen University Hospital Hvidore, Hvidovre, Denmark

    Ove Andersen

  8. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Ove Andersen

  9. Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Janne Petersen

  10. Center for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg and Frederiksberg, Frederiksberg, Denmark

    Janne Petersen

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  1. Line Due Christensen
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Corresponding author

Correspondence to Line Due Christensen.

Ethics declarations

The study was approved by the Scientific Board of Statistics Denmark and the Danish Data Protection Agency (Ref. 00003115). An approval from an ethics committee is not required for registry-based studies in Denmark. No identifiable patient data could be retrieved. The study was conducted by following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations [38].

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The authors declare that they have no conflicts of interest.

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Christensen, L.D., Reilev, M., Juul-Larsen, H.G. et al. Use of prescription drugs in the older adult population—a nationwide pharmacoepidemiological study. Eur J Clin Pharmacol 75, 1125–1133 (2019). https://doi.org/10.1007/s00228-019-02669-2

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  • DOI: https://doi.org/10.1007/s00228-019-02669-2

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