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Risk Factors for Initiation of Potentially Inappropriate Medications in Community-Dwelling Older Adults with and without Alzheimer’s Disease

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Abstract

Background

Various criteria have been created to define potentially inappropriate medications (PIMs) to help improve the quality and safety of medicine use in older patients. Individuals with Alzheimer’s disease (AD) may be at higher risk of adverse drug events associated with PIMs (such as falls).

Objective

Our objective was to determine the risk factors for PIM initiation in a nationwide cohort of community dwellers aged ≥65 years with and without AD.

Methods

The Finnish nationwide MEDALZ cohort includes all patients diagnosed with AD in 2005–2011 (n = 70,718) and two comparison individuals without AD (non-AD) matched for age, sex and region of residence for each person with AD. After a 1-year washout period for PIM use and exclusion of those aged <65 years, we included 50,494 patients with AD and 106,306 comparison subjects. PIM use was defined according to Finnish criteria.

Results

Subjects without AD initiated PIMs more frequently than those with AD (16.4 vs. 12.2%, respectively; p < 0.001). The most common PIMs were muscle relaxants and urinary antispasmodics. Older individuals (aged ≥75 years) were less likely to initiate PIMs. In the AD group, women were less likely to initiate PIMs than men. More comorbidities were associated with PIM initiation, especially in the non-AD group. The use of opioids or psychotropic medicines was associated with PIM initiation in both cohorts. Regional differences between university hospital districts were observed.

Conclusion

PIM initiation was dependent on patient characteristics and possibly also some healthcare system-related factors such as differing regional treatment practices. It is important that medicines prescribed to the older vulnerable population are assessed regularly to avoid adverse effects and ensure safe pharmacotherapy, especially in those with multiple comorbidities.

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Authors and Affiliations

  1. Department of Health and Social Management, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland

    Virva Hyttinen & Hannu Valtonen

  2. Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland

    Heidi Taipale & Sirpa Hartikainen

  3. School of Pharmacy, University of Eastern Finland, Kuopio, Finland

    Heidi Taipale, Anna-Maija Tolppanen & Sirpa Hartikainen

  4. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

    Antti Tanskanen & Jari Tiihonen

  5. Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland

    Antti Tanskanen & Jari Tiihonen

  6. National Institute for Health and Welfare, Helsinki, Finland

    Antti Tanskanen

  7. Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland

    Sirpa Hartikainen

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  1. Virva Hyttinen
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  2. Heidi Taipale
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Correspondence to Virva Hyttinen.

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No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Virva Hyttinen, Heidi Taipale, Antti Tanskanen, Jari Tiihonen, Anna-Maija Tolppanen, Sirpa Hartikainen and Hannu Valtonen have no conflicts of interest relevant to the content of this study.

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Hyttinen, V., Taipale, H., Tanskanen, A. et al. Risk Factors for Initiation of Potentially Inappropriate Medications in Community-Dwelling Older Adults with and without Alzheimer’s Disease. Drugs Aging 34, 67–77 (2017). https://doi.org/10.1007/s40266-016-0415-9

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  • DOI: https://doi.org/10.1007/s40266-016-0415-9

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