Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.
Assessment of Pharmacotherapies, Finnish Medicines Agency, Kuopio, Finland.
Basic Clin Pharmacol Toxicol. 2019 Jan;124(1):74-83. doi: 10.1111/bcpt.13096. Epub 2018 Aug 9.
Potentially inappropriate medications (PIMs) in older persons are defined as medications of which the potential harms outweigh their benefits. The purpose of this study was to determine how initiation of PIMs accumulate in community-dwelling persons aged 65-74 and ≥75 years, and which patient- and health care-related factors are associated with PIM initiation over time. Data of this study were gathered from population-based registers by a 10% random sample of persons (n = 28 497) aged ≥65 years with no prior PIMs within a 2-year period preceding the index date (1 January 2002), and the study individuals were followed until 2013. The Finnish Prescription Register was linked using a personal identity code to register on inpatient care and causes of deaths and socio-economic data. In this study, 10 698 (37.5%) persons initiated PIMs during the study period. Female gender was associated with PIM initiation in 65-74-year-olds, but not in ≥75-year-olds. In 65-74-year-olds, the risk of PIM initiation increased with the higher income, whereas in ≥75-year-olds, the association between PIM initiation and the high income was not significant. The prescribing physician explained 9%-16% of the variation in the probability of PIM initiation. In conclusion, there were age-related differences in the factors associated with PIM initiation in relation to gender and socio-economic status. Overall, patient-related factors explained a large proportion of variation of PIM initiation, but there were also differences in PIM prescribing among physicians. However, physician-related variance of PIM initiations decreased during the 12-year follow-up.
潜在不适当药物（PIMs）在老年人中被定义为潜在危害大于益处的药物。本研究的目的是确定在 65-74 岁和≥75 岁的社区居住人群中，PIM 的起始如何积累，以及哪些患者和医疗保健相关因素与随时间推移的 PIM 起始相关。本研究的数据来自基于人群的登记处，通过对 10%的年龄≥65 岁且在指数日期（2002 年 1 月 1 日）前 2 年内无既往 PIM 的人群进行随机抽样（n=28497）获得，研究对象随访至 2013 年。使用个人身份代码将芬兰处方登记处与住院护理和死亡原因以及社会经济数据相关联。在这项研究中，10698 人（37.5%）在研究期间开始使用 PIM。女性在 65-74 岁人群中与 PIM 起始相关，但在≥75 岁人群中不相关。在 65-74 岁人群中，PIM 起始的风险随着收入的增加而增加，而在≥75 岁人群中，PIM 起始与高收入之间的关联不显著。开处方的医生解释了 PIM 起始概率变化的 9%-16%。总之，与性别和社会经济地位相关，PIM 起始的相关因素在年龄上存在差异。总体而言，患者相关因素解释了 PIM 起始变化的很大一部分，但医生之间的 PIM 处方也存在差异。然而，PIM 起始的医生相关方差在 12 年的随访期间有所下降。
