Background
Methods
Study population
Medication assessment
Definition and identification of PIMs
Variables
Statistical Analysis
Results
Main baseline characteristics of the study cohort by the number of drugs
Number of drugs | |||||
---|---|---|---|---|---|
Total | 0 | 1–4 | 5–9 | ≥10 | |
n (%) | 2069 (100) | 60 (3) | 635 (31) | 1044 (50) | 330 (16) |
Age (mean ± SD), years | 79.5 ± 6.6 | 76.4 ± 5.7 | 78.1 ± 6.3 | 80.2 ± 6.6 | 80.7 ± 6.6 |
Female, n (%) | 1307 (63) | 20 (34) | 384 (60) | 685 (66) | 218 (66) |
Education (CASMIN-short)a, n (%) | |||||
Low | 1285 (62) | 36 (59) | 397 (63) | 648 (62) | 205 (62) |
Middle | 434 (21) | 11 (18) | 118 (19) | 238 (23) | 67 (20) |
High | 340 (17) | 14 (23) | 118 (19) | 152 (15) | 57 (17) |
Income, € (%) | |||||
< 1000 € | 639 (36) | 17 (32) | 200 (37) | 321 (36) | 101 (36) |
1000–1999 € | 1021 (58) | 33 (61) | 306 (57) | 516 (58) | 166 (60) |
≥ 2000 € | 106 (6) | 4 (7) | 35 (7) | 56 (6) | 11 (4) |
Hypertensionb, n (%) | 1629 (79) | n.a. | 396 (62) | 916 (88) | 317 (96) |
Diabetes mellitusc, n (%) | 538 (26) | 2 (3) | 84 (13) | 299 (29) | 153 (47) |
Myocardial infarction, n (%) | 247 (12) | 0 | 32 (5) | 135 (13) | 80 (24) |
Stroke, n (%) | 172 (8) | 1 (1) | 35 (6) | 94 (9) | 42 (13) |
Cancer, n (%) | 435 (21) | 8 (13) | 118 (19) | 218 (21) | 92 (28) |
eGFRBIS2d < 60 ml/min/1.73m2, n (%) | 1041 (50) | 10 (17) | 234 (37) | 573 (55) | 223 (68) |
CCI (mean ± SD) | 6.9 ± 3.0 | 4.4 ± 2.1 | 5.6 ± 2.4 | 7.2 ± 2.8 | 9.0 ± 3.3 |
BMI ≥ 30 kg/m2, n (%) | 573 (28) | 3 (5) | 148 (23) | 300 (29) | 122 (37) |
Smoking (ever), n (%) | 934 (45) | 36 (59) | 253 (40) | 486 (47) | 159 (48) |
Alcohol intake (%) | |||||
< 1/month | 964 (47) | 19 (32) | 253 (40) | 505 (49) | 187 (57) |
≥ 1/month - 2/week | 712 (35) | 23 (38) | 249 (40) | 340 (33) | 100 (31) |
≥3/week – daily | 376 (18) | 19 (31) | 127 (20) | 190 (18) | 40 (12) |
Physical activity, n (%) | |||||
< 1/week | 528 (26) | 10 (16) | 96 (15) | 287 (28) | 135 (41) |
1–5/week | 947 (46) | 16 (26) | 310 (49) | 484 (47) | 138 (42) |
> 5/week | 588 (29) | 35 (58) | 229 (36) | 268 (26) | 57 (17) |
Subjective general state of health, n (%) | |||||
excellent | 86 (4) | 11 (18) | 44 (7) | 27 (3) | 4 (1) |
good | 966 (47) | 42 (69) | 392 (62) | 443 (43) | 89 (27) |
moderate | 796 (39) | 7 (12) | 176 (28) | 446 (43) | 166 (51) |
poor | 180 (9) | 1 (1) | 17 (3) | 106 (10) | 57 (17) |
very poor | 29 (1) | 0 | 1 (0.2) | 15 (1) | 12 (4) |
Drug categorye, n (%) | |||||
OTC only | 62 (3) | n.a. | 58 (9) | 4 (0.4) | 0 |
PD only | 407 (20) | n.a. | 241 (38) | 145 (14) | 21 (6) |
PD and OTC combined | 1539 (74) | n.a. | 336 (53) | 895 (86) | 308 (94) |
PIMf, n (%) | 311 (15) | n.a. | 36 (6) | 177 (17) | 98 (30) |
Medication distribution by age and gender
Polypharmacy
Age groups | ||||||
---|---|---|---|---|---|---|
Total | 70–74 | 75–79 | 80–84 | 85–89 | ≥90 | |
n | 2069 | 644 (31) | 541 (26) | 426 (21) | 273 (13) | 185 (9) |
Number of drugs (mean ± SD) | 6.2 ± 3.5 | 5.4 ± 3.5 | 6.3 ± 3.4 | 6.8 ± 3.5 | 6.7 ± 3.1 | 7.1 ± 3.4 |
Number of drugs [median (IQR)] | 6 (4;8) | 5 (3;7) | 6 (4;8) | 7 (4;9) | 6 (4;8) | 7 (5;9) |
Number of drugs [n (%)] | ||||||
0 | 60 (3) | 33 (5) | 13 (2) | 11 (3) | 1 (1) | 3 (2) |
1–4 | 635 (31) | 264 (41) | 161 (30) | 98 (23) | 73 (27) | 40 (22) |
5–9 | 1044 (50) | 273 (42) | 283 (52) | 230 (54) | 153 (56) | 104 (56) |
> =10 | 330 (16) | 75 (12) | 84 (16) | 87 (21) | 46 (17) | 37 (20) |
OTC | ||||||
0 | 468 (23) | 189 (29) | 115 (21) | 84 (20) | 56 (20) | 24 (13) |
1–4 | 1491 (72) | 433 (67) | 402 (74) | 312 (73) | 197 (72) | 147 (79) |
> =5 | 110 (5) | 22 (3) | 23 (4) | 30 (7) | 20 (7) | 15 (8) |
PD | ||||||
0 | 123 (6) | 58 (9) | 31 (6) | 18 (4) | 9 (3) | 7 (4) |
1–4 | 1022 (49) | 359 (56) | 263 (49) | 189 (44) | 131 (48) | 80 (43) |
> =5 | 924 (45) | 227 (35) | 247 (46) | 218 (51) | 133 (49) | 98 (53) |
Polypharmacy only regular PDs | 829 (40) | 204 (32) | 223 (41) | 198 (47) | 122 (45) | 81 (44) |
Top ten ATC anatomical main groups and their subgroups
total N = 2069 | 70–79 N = 1186 | ≥80 N = 883 | p-value | |
---|---|---|---|---|
ATC anatomical main group and subgroup | ||||
cardiovascular system (C) | 1748 (85) | 954 (80) | 795 (90) | < 0.001 |
agents acting on the renin-angiotensin system (C09) | 1283 (62) | 690 (58) | 593 (67) | < 0.001 |
beta blocking agents (C07) | 951 (46) | 514 (43) | 437 (50) | 0.006 |
lipid modifying agents (C10) | 756 (37) | 431 (36) | 325 (37) | 0.84 |
diuretics (C03) | 569 (28) | 258 (22) | 311 (35) | < 0.001 |
calcium channel blockers (C08) | 525 (25) | 281 (24) | 243 (28) | 0.050 |
cardiac therapy (C01) | 398 (19) | 155 (13) | 243 (28) | < 0.001 |
alimentary tract and metabolism (A) | 1329 (64) | 743 (63) | 586 (66) | 0.090 |
mineral supplements (A12) | 677 (33) | 360 (30) | 317 (36) | 0.009 |
drugs for acid related disorders (A02) | 459 (22) | 257 (22) | 202 (23) | 0.54 |
drugs used in diabetes (A10) | 409 (20) | 251 (21) | 158 (18) | 0.061 |
vitamins (A11) | 250 (12) | 129 (11) | 122 (14) | 0.043 |
blood and blood forming organs (B) | 1013 (49) | 507 (43) | 506 (57) | < 0.001 |
antithrombotic agents (B01) | 949 (46) | 470 (40) | 480 (54) | < 0.001 |
antianemic preparations (B03) | 123 (6) | 61 (5) | 61 (7) | 0.094 |
nervous system (N) | 783 (38) | 388 (33) | 396 (45) | < 0.001 |
analgesics (N02) | 364 (18) | 170 (14) | 194 (22) | < 0.001 |
psychoanaleptics (N06) | 277 (13) | 119 (10) | 157 (18) | < 0.001 |
psycholeptics (N05) | 192 (9) | 102 (9) | 90 (10) | 0.22 |
musculo-skeletal system (M) | 704 (34) | 402 (34) | 302 (34) | 0.89 |
antiinflammatory and antirheumatic products (M01) | 386 (19) | 237 (20) | 150 (17) | 0.080 |
antigout preparations (M04) | 202 (10) | 112 (10) | 90 (10) | 0.60 |
drugs for treatment of bone diseases (M05) | 127 (6) | 55 (5) | 72 (8) | 0.001 |
systemic hormonal preparations, excl. Sex hormones and insulins (H) | 503 (24) | 275 (23) | 228 (26) | 0.17 |
thyroid therapy (H03) | 453 (22) | 253 (21) | 200 (23) | 0.50 |
genitourinary system and sex hormones (G) | 338 (16) | 203 (17) | 135(15) | 0.28 |
urologicals (G04) | 286 (14) | 169 (14) | 118 (13) | 0.55 |
various (V) | 307 (15) | 152 (13) | 155 (18) | 0.011 |
general nutrients (V06) | 261 (13) | 126 (11) | 135 (15) | 0.001 |
respiratory system (R) | 289 (14) | 172 (15) | 117 (13) | 0.41 |
drugs for obstructive airway diseases (R03) | 219 (11) | 131 (11) | 88 (10) | 0.41 |
sensory organs (S) | 154 (8) | 87 (7) | 67 (8) | 0.85 |
ophthalmologicals (S01) | 154 (8) | 87 (7) | 67 (8) | 0.85 |
ATC code on chemical substance level
total N = 2069 | 70–79 N = 1186 | ≥80 N = 883 | p-value | |
---|---|---|---|---|
Prescription medication | ||||
simvastatin | 577 (28) | 329 (28) | 248 (28) | 0.87 |
metoprolol | 440 (21) | 231 (20) | 209 (24) | 0.021 |
levothyroxine sodium | 386 (19) | 213 (18) | 173 (20) | 0.35 |
amlodipine | 281 (14) | 164 (14) | 118 (13) | 0.75 |
bisoprolol | 274 (13) | 150 (13) | 124 (14) | 0.35 |
torasemide | 253 (12) | 105 (9) | 147 (17) | < 0.001 |
ramipril and hydrochlorothiazid | 218 (11) | 130 (11) | 88 (10) | 0.46 |
ramipril | 216 (10) | 119 (10) | 97 (11) | 0.48 |
metformin | 213 (10) | 144 (12) | 69 (7) | 0.001 |
omeprazole | 208 (10) | 115 (10) | 93 (11) | 0.54 |
OTC including herbal products and supplements | ||||
acetylsalicylic acid | 731 (35) | 365 (31) | 366 (42) | < 0.001 |
magnesiuma | 344 (17) | 189 (16) | 155 (18) | 0.060 |
dietary supplement | 226 (11) | 109 (9) | 116 (13) | 0.004 |
calcium | 160 (8) | 85 (7) | 75 (9) | 0.068 |
ibuprofen | 145 (7) | 95 (8) | 50 (6) | 0.039 |
Ginkgo biloba | 136 (7) | 51 (4) | 84 (10) | < 0.001 |
omega-3-triglycerides incl. other esters and acids | 65 (3) | 38 (3) | 27 (3) | 0.85 |
tocopherol (vit E) | 52 (3) | 31 (3) | 20 (2) | 0.61 |
paracetamol | 52 (3) | 27 (2) | 25 (3) | 0.43 |
Hawthorn flower | 50 (2) | 14 (1) | 36 (4) | < 0.001 |
Frequency of PIMs by age and gender
total N = 2069 | 70–79 N = 1186 | ≥80 N = 883 | p-value | |
---|---|---|---|---|
PIMs total | 311 (15) | 173 (15) | 139 (16) | 0.47 |
PIM: ATC subgroup (n = 311) | ||||
psychoanaleptics (N06) | 63 (20) | 37 (22) | 26 (19) | 0.54 |
psycholeptics (N05) | 59 (19) | 30 (17) | 30 (21) | 0.35 |
antihypertensives (C02) | 44 (14) | 22 (13) | 22 (16) | 0.42 |
calcium channel blockers (C08) | 34 (11) | 16 (9) | 18 (13) | 0.30 |
drugs for obstructive airway diseases (R03) | 33 (10) | 23 (13) | 9 (7) | 0.049 |
urologicals (G04) | 30 (10) | 16 (9) | 14 (10) | 0.81 |
antiinflammatory and antirheumatic products (M01) | 24 (8) | 14 (8) | 10 (7) | 0.77 |
cardiac therapy (C01) | 20 (7) | 11 (6) | 9 (7) | 0.95 |
total N = 2069 | male N = 762 | female N = 1307 | p-value | |
PIMs total | 311 (15) | 104 (14) | 208 (16) | 0.17 |
PIM: ATC subgroup (n = 311) | ||||
psychoanaleptics (N06) | 63 (20) | 19 (18) | 44 (21) | 0.55 |
psycholeptics (N05) | 59 (19) | 13 (12) | 46 (22) | 0.039 |
antihypertensives (C02) | 44 (14) | 20 (20) | 24 (11) | 0.061 |
calcium channel blockers (C08) | 34 (11) | 12 (12) | 21 (10) | 0.69 |
drugs for obstructive airway diseases (R03) | 33 (10) | 11 (10) | 22 (11) | 1.0 |
urologicals (G04) | 30 (10) | 9 (9) | 20 (10) | 0.79 |
antiinflammatory and antirheumatic products (M01) | 24 (8) | 9 (9) | 15 (7) | 0.65 |
cardiac therapy (C01) | 20 (7) | 7 (7) | 13 (6) | 0.85 |