One‐year persistence of potentially inappropriate medication use in older adults: A population‐based study

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%), longduration 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.

Physician and patient-related factors associated with inappropriate prescribing to older patients within primary care: a cross-sectional study in Brazil

“…23 The prevalence of PIM prescription within primary care varied between countries and according to the criteria used: totals of 41% in the United 36 These data show that, in several countries, the criteria specified and local prescription habits influenced the prevalence of PIM prescription. Like in several other studies, it was found in the present study that the pharmacological classes of PIM that were most prescribed were benzodiazepines, 2,5,10,14,15,18,33,34,37 nonsteroidal anti-inflammatory drugs (NSAIDs), 2,5,11,14,17,18,21,34 proton pump inhibitors, 11,14,18 first-generation antihistamines, 2,5,11,14,18,21,33 muscle relaxants, 2,5,15,18,33 tricyclic antidepressants, 2,5,11,14,15,33 antihypertensives, 2,14,18,33 and oral antihyperglycemics. 5,14,15,18,33,34 However, in cont...…”

“…2,3,17 In 2013, 37% of non-hospitalized older people in Canada received ≥ 1 prescription of PIM, equivalent to an estimated cost of US$ 75 per older person or a total cost of US$ 419 million in that year. 15 Similarly, after starting to use at least one PIM, a quarter of older adults continued to use them beyond one year, 18 thereby potentially increasing the risk of adverse events and raising healthcare costs.…”

Low Persistence of Antipsychotic Therapy in Parkinson Disease – Intolerance, Ineffectiveness, or Inertia?

“…Time to discontinuation of AP treatment was calculated from the initial AP prescription claim date until the end date for the last AP prescription, allowing a standard 14-day grace period (i.e., prescription ll gap) between AP prescription lls. [24,[31][32][33] Individuals with no additional AP medication ll after the end of this grace period were categorized as discontinuing AP therapy.…”

“…[54] Our methods for eligibility, exposure, and outcome measures are standard for pharmacoepidemiologic studies of treatment adherence and persistence. [24,[31][32][33] Finally, our study provides comparative real-world data on all used medications, including the recently approved pimavanserin; such multi-drug comparisons are only possible using real-world observational data.…”

Efficacy and safety of glucokinase activators for type 2 diabetes mellitus therapy: A meta-analysis of double-blind randomized controlled trials

“…Complications caused by poor blood glucose control are the main hazards. Increasing studies show that high-risk diseases such as heart and cerebrovascular diseases are closely related to poor blood glucose control [2][3][4] . More than 400 million adults worldwide live with diabetes, which causes excess mortality, morbidity, and substantial economic cost.…”