The epidemiology of polypharmacy in older adults: register-based prospective cohort study

Lucas Morin,1 Kristina Johnell,1 Marie-Laure Laroche,2,3 Johan Fastbom,1 Jonas W Wastesson1 1Aging Research Center, Karolinska Institutet, Stockholm, Sweden; 2University Hospital of Limoges, Service de Pharmacologie, Toxicologie et Pharmacovigilance, Limoges, France; 3Faculté de Médecine, Université de Limoges, Limoges, France Objective: Polypharmacy is the concomitant use of several drugs by a single person, and it increases the risk of adverse drug-related events in older adults. Little is known about the epidemiology of polypharmacy at the population level. We aimed to measure the prevalence and incidence of polypharmacy and to investigate the associated factors. Methods: A prospective cohort study was conducted using register data with national coverage in Sweden. A total of 1,742,336 individuals aged ≥65 years at baseline (November 1, 2010) were included and followed until death or the end of the study (December 20, 2013). Results: On average, individuals were exposed to 4.6 (SD =4.0) drugs at baseline. The prevalence of polypharmacy (5+ drugs) was 44.0%, and the prevalence of excessive polypharmacy (10+ drugs) was 11.7%. The incidence rate of polypharmacy among individuals without polypharmacy at baseline was 19.9 per 100 person-years, ranging from 16.8% in individuals aged 65–74 years to 33.2% in those aged ≥95 years (adjusted hazard ratio [HR] =1.49, 95% confidence interval [CI] 1.42–1.56). The incidence rate of excessive polypharmacy was 8.0 per 100 person-years. Older adults using multi-dose dispensing were at significantly higher risk of developing incident polypharmacy compared with those receiving ordinary prescriptions (HR =1.51, 95% CI 1.47–1.55). When adjusting for confounders, living in nursing home was found to be associated with lower risks of incident polypharmacy and incident excessive polypharmacy (HR =0.79 and HR =0.86, p<0.001, respectively). Conclusion: The prevalence and incidence of polypharmacy are high among older adults in Sweden. Interventions aimed at reducing the prevalence of polypharmacy should also target potential incident polypharmacy users as they are the ones who fuel future polypharmacy. Keywords: drugs, older adults, polypharmacy, prescribing, medication, elderl

Response to "Deprescription during last year of life in patients with pancreatic cancer: optimization or nihilism?"

Abstract Preventive drugs are often continued until the final weeks before death. Although these drugs are not necessarily clinically inappropriate at the end of life because some may have important palliative indications, deprescribing strategies are warranted to avoid unnecessary and potentially harmful treatments

Gender differences in the use of anti-infective medications before and after widowhood: a register-based study

Background:&nbsp;Recent findings suggest that bereavement&nbsp;due to spousal loss is associated with a decline in&nbsp;general immune functions, and thus to increased&nbsp;susceptibility to infections among widowed individuals.&nbsp;The present study aims to investigate whether spousal&nbsp;loss weakens immune refences more among men than&nbsp;among women using a 5% random sample of the total&nbsp;Danish population, and anti-infective medication use as&nbsp;a proxy for immune response. Methods:&nbsp;We followed 6076 Danish individuals (67%&nbsp;women) aged &ge;50 from 5 years before and up to 5 years&nbsp;after widowhood to examine changes in prescriptions of&nbsp;anti-infectives for systemic use. Results:&nbsp;Women used more anti-infective drugs both&nbsp;before and after spousal loss (women: OR= 1.31; 95%&nbsp;CI 1.21 to 1.42). The age-related changes in the&nbsp;use of anti-infective medications in the period before&nbsp;widowhood were similar to that in the period after&nbsp;widowhood among both men and women. Also, age-related changes in the use of anti-infective medications&nbsp;were similar in both genders. Conclusions: The present study shows that individuals&nbsp;are more likely to use anti-infective medication after&nbsp;being widowed than before being widowed, but this&nbsp;change is likely to be related to increasing age and it is&nbsp;similar in both genders.</p

Research Priorities for Optimizing Geriatric Pharmacotherapy: An International Consensus

Medication management is becoming increasingly challenging for older people, and there is limited evidence to guide medication prescribing and administration for people with multimorbidity, frailty, or at the end of life. Currently, there is a lack of clear research priorities in the field of geriatric pharmacotherapy. To address this issue, international experts from 5 research groups in geriatric pharmacotherapy and pharmacoepidemiology research were invited to attend the inaugural Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network workshop. A modified nominal group technique was used to explore and consolidate the priorities for conducting research in this field. Eight research priorities were elucidated: quality of medication use; vulnerable patient groups; polypharmacy and multimorbidity; person-centered practice and research; deprescribing; methodological development; variability in medication use; and national and international comparative research. The research priorities are discussed in detail in this article with examples of current gaps and future actions presented. These priorities highlight areas for future research in geriatric pharmacotherapy to improve medication outcomes in older people

Heterogeneity of the pharmacologic treatment of allergic rhinitis in Europe based on MIDAS and OTCims platforms

International audienceBackground: The practice of allergology varies widely between countries, and the costs and sales for the treatment of rhinitis differ depending on practices and health systems. To understand these differences and their implications, the rhinitis market was studied in some of the EU countries.Methods: We conducted a pharmaco-epidemiological database analysis to assess the medications that were being prescribed for allergic rhinitis in the years 2016, 2017 and 2018. We used the IQVIA platforms for prescribed medicines (MIDAS®- Meaningful Integration of Data, Analytics and Services) and for OTC medicines (OTC International Market Tracking-OTCims). We selected the five most important markets in the EU (France, Germany, Italy, Poland and Spain).Results: Intranasal decongestants were excluded from the analyses because they are rarely prescribed for allergic rhinitis. For both Standard Units (SU) and costs, France is leading the other countries. In terms of SU, the four other countries are similar. For costs, Poland is lower than the three others. However, medication use differs largely. For 2018, in SU, intranasal corticosteroid is the first treatment in Poland (70.0%), France (51.3%), Spain (51.1%) and Germany (50.3%), whereas the Italian market is dominated by systemic antihistamines (41.4%) followed by intranasal corticosteroids (30.1%). Results of other years were similar.Discussion: There are major differences between countries in terms of rhinoconjunctivitis medication usage