Trends in Inappropriate Drug Therapy Prescription in the Elderly in Sweden from 2006 to 2013: Assessment Using National Indicators

Abstract

BackgroundMedication for elderly patients is often complex and problematic. Several criteria for classifying inappropriate prescribing exist. In 2010, the Swedish National Board of Health and Welfare published the document “Indicators of appropriate drug therapy in the elderly” as a guideline for improving prescribing for the elderly.ObjectiveThe aim of this study was to assess trends in the prescription of inappropriate drug therapy in the elderly in Sweden from 2006 to 2013 using national quality indicators for drug treatment.MethodsIndividual-based data on dispensed prescription drugs for the entire Swedish population aged ≥65 years during eight 3-month periods from 2006 to 2013 were accumulated. The data were extracted from the Swedish Prescribed Drug Register. Eight drug-specific quality indicators were monitored.ResultsFor the entire population studied (n = 1,828,283 in 2013), six of the eight indicators showed an improvement according to the guidelines; the remaining two indicators (drugs with anticholinergic effects and excessive polypharmacy) remained relatively unchanged. For the subgroup aged 65–74 years, three indicators showed an improvement, four indicators remained relatively unchanged (e.g. propiomazine, and oxazepam) and one showed an undesirable trend (anticholinergic drugs) according to guidelines. For the older group (aged ≥75 years), all indicators except excessive polypharmacy showed improvement.ConclusionAccording to the quality indicators used, the extent of inappropriate drug therapy in the elderly decreased from 2006 to 2013 in Sweden. Thus, prescribers appear to be more likely to change their prescribing patterns for the elderly than previously assumed.

Reduction in the use of potentially inappropriate drugs among old people living in geriatric care units between 2007 and 2013

“…In our study, 44 % of the study population used one or more potentially inappropriate medications in 2007 and 26 % in 2013, according to six of the quality indicators developed by the Swedish National Board of Health and Welfare [1]. This result agrees with the results of another study where six out of eight indicators showed an improvement according to the national quality indicators [15]. This study included the entire Swedish population aged 65 years or older, and four of the quality indicators were the same as in our study.…”

“…However, there is some evidence that the use of potentially inappropriate medication is decreasing among old people. In a newly published study, the extent of inappropriate drug use decreased between 2006 and 2013 in Sweden [15].…”

Potentially inappropriate medications use in community-based aged patients: a cross-sectional study using 2012 Beers criteria

“…As such, a Swedish study found that the extent of inappropriate drug prescriptions for the aged (≥65 years of age) improved over the period 2006–2013 due to improved/safer prescribing practices adopted by physicians when dealing with elderly patients 46. Additionally, pharmacists play a major role in reducing suboptimal prescribing as disclosed in a review that evaluated the impact of pharmacists’ interventions to improve the appropriateness of prescribing in the aged 47.…”

Effect of Potentially Inappropriate Use of Antimuscarinic Medications on Healthcare Use and Cost in Individuals with Overactive Bladder

“…Older adults generally have a greater risk of medication‐related adverse events than younger individuals because they use more medications and because of age‐related physiological changes. Inappropriate prescribing of medication in elderly adults is common and can lead to higher healthcare costs, adverse drug reactions, hospitalization, and mortality . The economic burden of potentially inappropriate medication (PIM) use is substantial, estimated at $7.2 billion in 2001 .…”