Potentially inappropriate medication use among Finnish non-institutionalized people aged ≥65 years: a register-based, cross-sectional, national study

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.