Pharmacoepidemiology reports
Use of medications and polypharmacy are increasing among the elderly

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Abstract

To assess changes in medicine use and polypharmacy, two cross-sectional surveys were carried out among community-dwelling persons aged 64 years or over in 1990–91 (n = 1,131) and 1998–99 (n = 1,197) in the municipality of Lieto in southwestern Finland. In addition to drug use, the questionnaire included items on social background, quality of life, and home nursing services. Among those surveyed, 78% in 1990–1991 and 88% in 1998–1999 (P = .001) used prescription drugs during 7 days prior to the interview. The most commonly used medications were for the cardiovascular and central nervous systems. The number of medications per person increased from 3.1 (SD 2.8) to 3.8 (SD 3.1) (P = .0001), and polypharmacy (concominant use of over five medications) increased from 19 to 25% (P = .006). These changes were most prominent among persons aged 85 years or over, especially among women. Polypharmacy is a complex and worrying phenomenon that merits more research.

Introduction

Many studies show that elderly people are the largest per capita consumers of medicines. Most of them, up to 80%, suffer from chronic diseases [1]. The prevalence of chronic morbidity among community-dwelling persons aged 75 years or over grew from 79% in 1976 [2] to 90% in 1995–1996 in Finland [3]. Especially among the oldest persons, multiple chronic diseases require long-term medical treatment and lead to use of several medications.

People over 64 years old represent 15% of the Finnish population [4], but their medication costs comprise 40% of the expenditures of the total Finnish population [5]. The same phenomenon has been noticed in other countries [6].

The definitions for polypharmacy are numerous, and the criteria vary from study to study 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. According to a review of literature, polypharmacy is usually defined in two ways: by a simple count of medications, or by the administration of more medications than are clinically indicated [8]. In the literature, no specific number of medications has been established with which to define polypharmacy. Some researchers have defined polypharmacy as the long-term use of two or more medications, others as the daily intake of two to three or at least three medications, or four to five medications. In other studies the limit for polypharmacy has been at least five medications, over five medications, at least seven, or at least 10 medications. Use of over five medications has been defined to be polypharmacy in previous studies 9, 17, 18, and it has been found to be associated with poor outcomes, i.e., poor physical and psychic health [18].

Polypharmacy increases with higher age 13, 19, 20, 21, 22. It causes a risk of interactions, adverse effects, and toxic reactions 23, 24. Clinically significant interactions have been found in up to 15% of the elderly with polypharmacy [12].

Prescription cardiovascular drugs were the most commonly used medications among the community-dwelling elderly in Denmark 12, 25. In the United States, cardiovascular and analgesic medications were the most common prescription and nonprescription drugs [13].

Only a few studies have described changes in medicine use and polypharmacy among the community-dwelling elderly during the past decades. The aim of this study was to investigate changes in the use of prescription drugs and polypharmacy among elderly people from 1990–1991 to 1998–1999 in Finland.

Section snippets

Material and methods

This study is part of a larger epidemiologic study of the elderly in Lieto, consisting of two cross-sectional surveys comprising an interview followed by a health examination. The first survey was carried out in 1990–1991 [26] and the latter in 1998–1999.

Lieto is a typical semirural southwestern municipality near the city Turku. The population in Lieto was 12,255 in 1990 and 13,845 in 1999, with about 12% of the people aged 65 years or over in 1999, compared to 15% in all of Finland 4, 27, 28.

Prevalence of medicine use

Medicine use was significantly more common among the community-dwelling elderly in 1998–1999 (88%) than in 1990–1991 (78%) (P = .001). Growth occurred among both sexes and in all age groups (Fig. 1). The proportion of medication users grew most among those aged 64–74, from 72 to 85% (P = .001), and much among persons aged 75–84, from 86 to 93% (P = .004). Medicine use was most frequent among the oldest old (over 84 years), having grown from 93 to 97% (P = .200) between the surveys.

A greater

Discussion

The populations are representative samples of southwestern Finnish elderly persons in the early and late 1990s. The questionnaires and health examination procedures were similar in both Lieto surveys, so the results are comparable with each other. The age distributions were similar. Interviewed persons may over-report or under-report their use of medications [35]. In Lieto medication use was asked by a trained nurse. She also confirmed the respondents' medication use with a close relative or a

Conclusions

The use of prescription drugs is increasing among the community-dwelling elderly. The mean number of medications being used is growing, most rapidly among the oldest old, and especially among women. Several factors can cause these changes, like longer life, increasing use of health services and development of new medications.

The use of medications is in part necessary, but polypharmacy, in particular, increases the safety problems of the medications. Polypharmacy is a complex phenomenon and

Acknowledgements

This work was supported in part by grants from the Uulo Arhio Foundation, Lundbeck Company, the Research Foundation of Orion Corporation, and the Paulo Foundation.

References (46)

  • A Bardel et al.

    Reported current use of prescription drugs and some of its determinants among 35 to 65-year-old women in mid- Swedena population based study

    J Clin Epidemiol

    (2000)
  • P.P Lamy

    The health status of the elderly

  • Klaukka T. Health and need of health services of adults. In: Kalimo E, Nyman K, Klaukka T, Tuomikoski H, Savolainen E,...
  • S Arinen et al.

    Health and the use of health services in Finland. Main findings of the Finnish Health Care surveys 1995/96 and changes from 1987

    (1998)
  • Population projection by municipalities 1998–2030. Helsinki: Statistics Finland;...
  • T Klaukka et al.

    Nearly forty percent of drug reimbursements are paid to the elderly

    TABU—drug information from the National Agency for Medicines in Finland

    (1996)
  • B Mehl et al.

    Projecting future drug expenditures 1999

    Am J Health Syst Pharm

    (1999)
  • R.D Lee

    Polypharmacya case report and new protocol for management

    J Am Board Fam Pract

    (1998)
  • J.T Hanlon et al.

    Suboptimal prescribing in older inpatients and outpatients

    J Am Geriatr Soc

    (2001)
  • L Veehof et al.

    The development of polypharmacy. A longitudinal study

    Fam Pract

    (2000)
  • L.J Veehof et al.

    Chronic polypharmacy in one-third of the elderly in family practice

    Ned Tijdschr Geneeskd

    (1999)
  • S Iliffe et al.

    Assessment of elderly people in general practice. 2. Functional abilities and medical problems

    Br J Gen Pract

    (1991)
  • I Barat et al.

    The consumption of drugs by 75-year-old individuals living in their own homes

    Eur J Clin Pharmacol

    (2000)
  • E.A Chrischilles et al.

    Use of medications by persons 65 and overdata from established populations for epidemiologic studies of the elderly

    J Gerontol

    (1992)
  • H.M Fillit et al.

    Polypharmacy management in Medicare managed carechanges in prescribing by primary care physicians resulting from a program promoting medication reviews

    Am J Manag Care

    (1999)
  • J.H Flaherty et al.

    Polypharmacy and hospitalization among older home care patients

    J Gerontol

    (2000)
  • T Klaukka et al.

    Multiuse of medicines in Finland

    Med Care

    (1993)
  • T.M Jörgensen et al.

    Presciption drug use among ambulatory elderly in a Swedish municipality

    Ann Pharmacother

    (1993)
  • T Linjakumpu et al.

    Polypharmacy and the use of psychotropics and analgesic drugs among the community-dwelling elderly

    Gerontologia

    (2001)
  • P Laukkanen et al.

    Use of drugs by non- institutionalized urban Finns born in 1904–1923 and the association of drug use with mood and self-rated health

    Age Ageing

    (1992)
  • I Purves et al.

    The quality of general practice repeat prescribing

    (1994)
  • L Bjerrum et al.

    Polypharmacycorrelations with sex, age and drug regimen. A prescription database study

    Eur J Clin Pharmacol

    (1998)
  • L Tune et al.

    Anticholinergic effects of drugs commonly prescribed for the elderlypotential means for assessing risk of delirium

    Am J Psychiatry

    (1992)
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