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Inappropriate prescribing for the elderly—a modern epidemic?

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

Abstract

Purpose

The elderly often use several drugs on a regular basis and are especially at risk for drug-related harm from side effects and interactions. The aim of this study was to explore the overall prevalence of and predictors for potentially inappropriate medication use among Norwegian elderly outpatients.

Methods

A pharmaco-epidemiological retrospective cross-sectional survey was undertaken based on data from the Norwegian Prescription Database. Prescriptions from all doctors in Norway, dispensed by pharmacies to home-dwelling elderly ≥70 years in 2008, were included for a total of 11,491,065 prescriptions from 24,540 prescribers to 445,900 individuals (88.3% of the Norwegian population in this age group, 58.9% females). We applied a list of criteria for pharmacological inappropriateness for elderly people (the NORGEP criteria) to determine the prevalence of potentially inappropriate medications (PIMs) and applied a multiple logistic regression model to identify predictors.

Results

According to our criteria, 34.8% of the study population (28.5% of the men, 39.3% of the women) was exposed to at least one PIM. Of these, 59.9% represented psychoactive substances. The odds of receiving potentially harmful prescriptions increased with the number of prescribers (OR 3.52, 99% CI 3.44–3.60 for those with ≥5 compared to those with 1 or 2 prescribers). Twenty percent were prescribed more than 10 medications; among these two-thirds had at least one PIM. Adjusted for differences in age distribution and the number of prescribers involved, women were more frequently exposed to PIMs than men, with an odds ratio of 1.60 (99% CI 1.58–1.64).

Conclusions

About one-third of the elderly Norwegian population is exposed to potentially inappropriate medications, and elderly females are at particular risk.

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Acknowledgments

Dr. Nyborg has had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. MD Svein Gjelstad, Mediata AS, Tønsberg, Norway developed the computer software used in the analyses in this work and was compensated for this work from the project’s funds. Dr. Gjelstad is also a researcher at the Department of Family Medicine, Institute of Health and Society, University of Oslo, Norway but has not been a part of this project group. Contributions to the study were also made by statisticians Ingvild Dalen and Magne Thoresen, both at the Department of General Practice/Family Medicine, Institute of Health and Society, University of Oslo, Norway.

Funding

The project was funded by the Allmennmedisinsk forskningsfond (AMFF), a foundation founded and sponsored by the Norwegian Medical Association. The AMFF had no role in the design, conduct, analyses, or reporting of this study.

Conflicts of interest

The authors report no conflict of interest relevant to the topic of this article.

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Authors and Affiliations

  1. Department of General Practice/Family Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway

    Gunhild Nyborg, Jørund Straand & Mette Brekke

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  1. Gunhild Nyborg
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  3. Mette Brekke
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Correspondence to Gunhild Nyborg.

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Nyborg, G., Straand, J. & Brekke, M. Inappropriate prescribing for the elderly—a modern epidemic?. Eur J Clin Pharmacol 68, 1085–1094 (2012). https://doi.org/10.1007/s00228-012-1223-8

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  • DOI: https://doi.org/10.1007/s00228-012-1223-8

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