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Patterns of Drug Use and Factors Associated with Polypharmacy and Excessive Polypharmacy in Elderly Persons

Results of the Kuopio 75+ Study: A Cross-Sectional Analysis

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Abstract

Background

Although the increasing use of drugs in elderly persons has raised many concerns in recent years, the process leading to polypharmacy (PP) and excessive polypharmacy (EPP) remains largely unknown.

Objective

To describe the number and type of drugs used and to evaluate the role of different factors associated with PP (i.e. 6–9 drugs) and EPP (i.e. ≥10 drugs), with special reference to the number and type of medical diagnoses and symptoms, in a population of home-dwelling elderly persons aged ≥75 years.

Methods

The study was a cross-sectional analysis of a population-based cohort in 1998. The population consisted of home-dwelling elderly persons aged ≥75 years in the city of Kuopio, Finland. The data for the analysis were obtained from the Kuopio 75+ Study, which drew a random sample of 700 elderly residents aged ≥75 years living in the city of Kuopio from the population register. Of these, 601 attended a structured clinical examination and an interview carried out by a geriatrician and a trained nurse in 1998. For this analysis, all home-dwelling elderly participants (n = 523) were included. Study data were expressed as proportions and means with standard deviations. The factors associated with PP and EPP were examined by multinomial logistic regression.

Results

The most commonly used drugs were cardiovascular drugs (97% in EPP, 94% in PP and 59% in non-PP group) and analgesics (89%, 76% and 54%), respectively. Use of psychotropics was markedly higher in the EPP group (77%) than in the PP (42%) and non-PP groups (20%). The mean number of drugs per diagnosis was 3.6 in the EPP group, 2.6 in the PP group and 1.6 in the non-PP group. Factors associated only with EPP were moderate self-reported health (odds ratio [OR] 2.05; 95% CI 1.08, 3.89), female gender (OR 2.43; 95% CI 1.27, 4.65) and age ≥85 years (OR 2.84; 95% CI 1.41, 5.72). Factors that were associated with both PP and EPP included poor self-reported health (PP: OR 2.15; 95% CI 1.01, 4.59 and EPP: OR 6.02; 95% CI 2.55, 14.20), diabetes mellitus (PP: OR 2.28; 95% CI 1.26, 4.15 and EPP: OR 2.07; 95% CI 1.03, 4.18), depression (PP: OR 2.13; 95% CI 1.16, 3.90 and EPP: OR 2.93; 95% CI 1.51, 5.66), pain (PP: OR 2.69; 95% CI 1.68, 4.30 and EPP: OR 2.74; 95% CI 1.56, 4.82), heart disease (PP: OR 2.51; 95% CI 1.54, 4.08 and EPP: OR 4.63; 95% CI 2.45, 8.74) and obstructive pulmonary disease (including asthma or chronic obstructive pulmonary disease) [PP: OR 2.79; 95% CI 1.24, 6.25 and EPP: OR 6.82; 95% CI 2.87, 16.20].

Conclusions

The study indicates that the factors associated with PP and EPP are not uniform. Age ≥85 years, female gender and moderate self-reported health were factors associated only with EPP, while poor self-reported health and several specific disease states were associated with both PP and EPP. The high number of drugs per diagnosis observed in this study calls for a thorough assessment of the need for and outcomes associated with use of these drugs.

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Acknowledgements

The Kuopio 75+ Study was funded by the Nordic Red Feather of the Lions. Subsequent financial support for data analysis was obtained from the Kuopio University Pharmacy Fund and the Social Insurance of Finland. In addition, the study was supported by grants from the Jenny and Antti Wihuri Foundation, and the Orion-Farmos Research Foundation. The funders had no role in the design of the Kuopio 75+ Study or the preparation of this article.

The authors would like to thank the dedicated research staff who collected and saved the data. The authors are also grateful to Ms Päivi Heikura for her role in maintaining and updating the Kuopio 75+ database. In addition, the authors would like to thank statistician Piia Lavikainen for her advice regarding the statistical analysis.

The authors have no conflicts of interest that are directly relevant to the content of this study.

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Correspondence to Johanna Jyrkkä M.Sc. (Pharm).

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Jyrkkä, J., Enlund, H., Korhonen, M.J. et al. Patterns of Drug Use and Factors Associated with Polypharmacy and Excessive Polypharmacy in Elderly Persons. Drugs Aging 26, 493–503 (2009). https://doi.org/10.2165/00002512-200926060-00006

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