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Potentially Inappropriate Medication Use Among Finnish Non-Institutionalized People Aged ≥65 Years

A Register-Based, Cross-Sectional, National Study

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Abstract

Background

The Beers criteria and their modifications are the most frequently used tools for measuring potentially inappropriate medication (PIM) use among older people. The prevalence of such use in various settings has been high, but no data have been reported for an entire national non-institutionalized elderly population, nor is there information on the reimbursement costs for those medications.

Objective

To determine the prevalence of PIM use according to the Beers 2003 criteria, independent of diagnoses, among Finnish non-institutionalized people aged ≥65 years, and the reimbursement costs for these medications.

Methods

A register-based cross-sectional national study used drug reimbursement data from Finland’s Social Insurance Institution (SII). These data cover the entire non-institutionalized population aged ≥65 years in 2007. The number of persons who received reimbursements for each PIM according to the Beers 2003 criteria and the total annual reimbursement costs for PIMs were calculated. Indirect costs were excluded.

Results

Of the non-institutionalized population aged ≥65 years in Finland (n = 841 509), 14.7% (n = 123 545) had received PIMs according to the Beers 2003 criteria. Temazepam >15 mg/day was clearly the most commonly reimbursed PIM (4.4% of the population aged ≥65 years), followed by amitriptyline (2.0%) and diazepam (1.8%). The SII paid drug reimbursements of €2.9 million for PIMs, which was 0.7% of the total drug reimbursements (€421 million) for people aged ≥65 years in Finland in 2007.

Conclusions

The use of PIMs among outpatients aged ≥65 years in Finland (14.7%) was less than in several earlier large-scale studies in other countries (17–42%) and reimbursement costs were modest, mainly as a result of the limited availability in Finland of medicines identified as PIMs by the Beers 2003 criteria. However, benzodiazepines were commonly used and actions to improve medication safety should target reducing their use.

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Acknowledgements

No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

The authors are indebted to Professor Timo Klaukka, MD, late Chief of Health Research at the Social Insurance Institution, who enabled the authors’ access to the research data. The authors also thank Dr Leena Saastamoinen, PhD, Social Insurance Institution, Helsinki, Finland, for her contributions in the acquisition of the Social Insurance Institution data.

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Authors and Affiliations

  1. Division of Social Pharmacy, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014 University of Helsinki, Helsinki, Finland

    Saija Leikola MSc, Maarit Dimitrow, Alan Lyles & Marja Airaksinen

  2. School of Health and Human Services, University of Baltimore, Baltimore, Maryland, USA

    Alan Lyles

  3. Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland

    Kaisu Pitkälä

  4. Department of General Practice and Primary Health Care, Faculty of Medicine, University of Helsinki, Helsinki, Finland

    Kaisu Pitkälä

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  1. Saija Leikola MSc
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  2. Maarit Dimitrow
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Correspondence to Saija Leikola MSc.

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Leikola, S., Dimitrow, M., Lyles, A. et al. Potentially Inappropriate Medication Use Among Finnish Non-Institutionalized People Aged ≥65 Years. Drugs Aging 28, 227–236 (2011). https://doi.org/10.2165/11586890-000000000-00000

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