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22 The extent of pharmacological overtreatment in frail older people. Are all prescribed medications indicated?
  1. Dmitri Zintchouk
  1. Department of Geriatrics, Aarhus University Hospital, Aarhus N, Denmark


Objectives Medication is the most frequently used form of therapy in older people. Between 1988 and 2010, the proportion of non-institutionalized Americans aged ≥65 years taking ≥5 medications tripled from 13% to 39%. The aim of this cross-sectional study was to explore the indications for prescribing for the most prevalent drugs used regularly by older people referred to a Danish non-hospital based community rehabilitation unit.

Methods This study involved a secondary analysis of our previously published randomized controlled trial. The prevalence of use of at least one drug within Anatomical Therapeutic Chemical (ATC) classes was assessed. The data on regular medication and diagnoses was complete and obtained through the Electronic Patient Records at baseline prior to randomization.

Results 368 people were included (mean age: 78.6±8.1 years, women: 50%). 38% of people were taking ≥10 drugs daily. 91% used the Gastrointestinal System ATC class drugs, which was most prevalent within the all 14 ATC classes. Within this ATC class, proton-pump inhibitors (PPI) were the most prevalent drugs (45%). Among persons taking PPI, six persons (4%) had diagnosis of gastrointestinal reflux, ulceration or bleeding and 93 persons (56%) were taking some type of anticoagulant medication. The remaining 73 persons (44%) had no indication for PPI use. The second most prevalent ATC class was the Central Nervous System (79%) with antidepressants (35%) as the most prevalent drugs. Among persons taking antidepressants, 23 persons (19%) had diagnosis of depression, bipolar disorder or anxiety. The remaining 100 persons (81%) had no indication for antidepressants use. The indications for antidepressant might be uncertain due to validity of the registration of depression diagnoses.

Conclusions There was an alarmingly high prevalence of hyperpolypharmacy in older people referred to a non-hospital based community rehabilitation unit. Doctors should pay more attention to potentially reversible iatrogenic functional deterioration and reconsider valid indication for using PPI and antidepressants in a growing population of frail older people often suffering from malnutrition and loneliness.

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