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Epidemiology of Suboptimal Prescribing in Older, Community Dwellers

A Two-Wave, Population-Based Survey in Dicomano, Italy

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Abstract

Background

Because of co-morbidity, older persons are often exposed to use of an excessive number of drugs, which per se implies also use of inappropriate drugs or of potentially interacting drugs (‘suboptimal prescribing’). Time trends of suboptimal prescribing in older, community dwellers have been poorly investigated, particularly in Italy.

Objective

To evaluate the time-course modification of suboptimal prescribing in older, community dwellers.

Methods

We conducted a study on an Italian cohort of older (aged ≥65 years), community dwellers for whom data were collected in a two-wave (1995 and 1999), population-based survey. Suboptimal prescribing was defined as occurrence of polypharmacy (≥5 medications), prescription of inappropriate medications (according to 1991 Beers’ criteria) and prescription of potentially interacting drugs (as identified by the Micromedex® Drug-Reax® system). All outcome variables were modelled as continuous and dichotomous.

Results

In 568 participants (59.9% women, mean±standard error age 72.7±0.2 years), polypharmacy and potentially interacting drugs were more prevalent in 1999 than in 1995, while prevalence of inappropriate drugs was lower in 1999. The proportion of participants receiving polypharmacy was nearly 3-fold greater in 1999 than in 1995 (21.6% vs 8.8%; p<0.001). After adjustment for disability, coronary artery disease/stroke, heart failure and other co-morbidities, polypharmacy was twice as prevalent in 1999 as in 1995, with a mean increase of 0.5 drugs per participant. In contrast, in models adjusted for the same variables and also for polypharmacy, inappropriate prescribing was reduced (60% lower prevalence, 0.06 mean reduction in prescriptions per participant) in 1999 compared with 1995. In multivariable models, no change was observed in the number of potentially interacting prescriptions.

Conclusions

Between 1995 and 1999, the number of prescriptions received by a cohort of older, community dwellers increased substantially, even after controlling for co-morbidity. On the other hand, when controlling for polypharmacy, other indicators of suboptimal prescribing remained unaffected or even decreased, suggesting that even increasing levels of polypharmacy do not necessarily imply other forms of suboptimal prescribing among older persons.

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Acknowledgements

No sources of funding were used to assist in the preparation of this study. The authors are very grateful to all geriatricians and general practitioners who took part in the study planning and data collection. The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Tuscan Regional Centre of Pharmacovigilance, Department of Pharmacology, University of Florence, Viale G. Pieraccini no. 6, 50139, Florence, Italy

    Francesco Lapi, Pierangelo Geppetti & Alessandro Mugelli

  2. Department of Pharmacology, University of Florence, Florence, Italy

    Francesco Lapi & Alessandro Mugelli

  3. Epidemiology Unit, Regional Agency for Healthcare Services of Tuscany, Florence, Italy

    Francesco Lapi & Giampiero Mazzaglia

  4. Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence, Florence, Italy

    Claudia Pozzi, Andrea Ungar, Stefano Fumagalli, Niccolò Marchionni & Mauro Di Bari

  5. Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Claudia Pozzi, Andrea Ungar, Stefano Fumagalli, Niccolò Marchionni & Mauro Di Bari

Authors
  1. Francesco Lapi
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  2. Claudia Pozzi
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  3. Giampiero Mazzaglia
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  4. Andrea Ungar
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  5. Stefano Fumagalli
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  6. Niccolò Marchionni
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  7. Pierangelo Geppetti
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  8. Alessandro Mugelli
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  9. Mauro Di Bari
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Correspondence to Francesco Lapi.

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Lapi, F., Pozzi, C., Mazzaglia, G. et al. Epidemiology of Suboptimal Prescribing in Older, Community Dwellers. Drugs Aging 26, 1029–1038 (2009). https://doi.org/10.2165/11319390-000000000-00000

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