One in two older people is receiving potentially inappropriate medication
07.09.2023 15:36
In 2022, 8.3 million older people in Germany were prescribed a potentially inappropriate medication (PIM) at least once, which can lead to undesirable interactions or side effects. This is shown by a current analysis by the WIdO, which means that more than every second person over the age of 65 (50.3 percent) was affected. The basis for the evaluation is the medicines prescribed to the 16.4 million older people insured by statutory health insurance that are listed on the PRICUS 2.0 list.
“We don't have a knowledge problem with this topic, but an implementation problem. The transfer into practice can be supported through work aids for the medical practice, patient information and the free provision of the PRISCUS 2.0 list,” says WIdO managing director Helmut Schröder.
In 2022, an updated PRISCUS 2.0 list of potentially unsuitable drugs for older people aged 65 and over was published. Based on this list and on the basis of the age- and gender-adjusted drug prescriptions for over 65-year-olds with statutory health insurance in 2022, the WIdO determined that 12.3 percent of all daily doses prescribed to older people are potentially unsuitable. At 50.3 percent, more than every second older person insured by statutory health insurance is affected. According to the evaluation, the proportion of potentially inappropriate medication is significantly higher for women than for men.
Prescription share of potentially inadequate medication has decreased over the past ten years
“The supply of medicines to people over 65 is characterized by the increasing number of illnesses in old age and the treatment of multiple, parallel illnesses,” says Helmut Schröder. The number of medications prescribed at the same time increases significantly with increasing age. Overall, in 2022, those with statutory health insurance (GKV) aged 65 and over accounted for 56 percent of the total GKV prescription volume in terms of daily doses. 43 percent of the insured over the age of 65 were treated with more than five different active ingredients
treated at the same time. Older patients are therefore particularly at risk of suffering from adverse drug events. “Medication side effects such as fatigue, drop in blood pressure or visual disturbances can lead to falls or cognitive loss and in some cases can even be life-threatening,” says Schröder. It is therefore encouraging that the proportion of prescriptions for potentially inappropriate medication has decreased over the past ten years: while the proportion of prescriptions for these medications among older people was 14.6 percent in 2013, it was 12.3 percent in 2022.
Clear regional differences in the prescription rates of PIM drugs
However, an evaluation by region shows clear differences in the prescription rates of PIM drugs: The lowest PIM shares are achieved with 48.2 percent at the Association of Statutory Health Insurance Physicians in Bremen. “The range of regional differences is 6.6 percentage points and indicates that there is still room for improvement in many CT regions,” says Helmut Schröder. In order to promote the transfer of knowledge into practice, the WIdO has created a compact summary of the PRISCUS 2.0 active ingredients as a working aid for doctors. It is available for download from the AOK health partner portal. Schröder also referred to the free provision of the complete PRISCUS 2.0 list by the WIdO and current patient information from the Federal Ministry of Education and Research on the subject.
More than half of the prescriptions for potentially inappropriate medication relate to gastric protective preparations
The PRISCUS 2.0 project aims to optimize drug therapy in older people and reduce adverse drug events. PRISCUS 2.0 builds on the first version of the PRISCUS list created in Germany in 2010. In 2022, an interdisciplinary team from science and practice expanded this list to reflect the current state of knowledge. More than half of the prescriptions for potentially inappropriate medications relate to gastroprotective drugs, the so-called proton pump inhibitors. These medications are prescribed for symptoms such as acid reflux or a manifest gastrointestinal ulcer. But they are also used to prevent stomach bleeding when taking painkillers or anticoagulants at the same time. Only PIMs for which long-term therapy of more than eight weeks was evident in the prescription data were included in the analysis. Treatment with anticoagulants is usually permanent, so prolonged use of proton pump inhibitors can be justified. Nonetheless, long-term use of these drugs is associated with an increased risk of osteoporosis, fractures, and certain infections, especially in the elderly. Proton pump inhibitors are the medications that can most often be discontinued after critical indications.
Other commonly prescribed potentially inappropriate medications include some active ingredients for pain, antidepressants and medications for bladder and prostate problems.