Burden of Potentially Harmful Medications and the Association With Quality of Life and Mortality Among Institutionalized Older People

J Am Med Dir Assoc. 2016 Mar 1;17(3):276.e9-14. doi: 10.1016/j.jamda.2015.12.011. Epub 2016 Jan 21.


Objectives: This study investigated the overlap among 3 different definitions of potentially harmful medication (PHM) use and the corresponding associations with resident quality of life and mortality.

Design: Cross-sectional study with 3-year follow-up for mortality.

Setting: Assisted living facilities and nursing homes in Helsinki and Kouvola, Finland.

Participants: A total of 326 residents.

Measurements: PHM use was defined as (1) use of medications with anticholinergic properties, (2) use of Beers Criteria medications, and (3) concomitant use 3 or more psychotropic medications. Health-related quality of life (HRQoL) was assessed using the 15D and psychological well-being (PWB) scale. Residents self-rated their own health using a 4-point scale. Mortality data were obtained from central registers.

Results: There were 38.0%, 28.2%, and 12.6% of residents who used PHMs according to 1 (G1), 2 (G2), and 3 definitions (G3), respectively. Overall, 21.2% of residents did not use PHMs according to any of the 3 definitions (G0). There were no significant differences in comorbidity, cognition, or functioning among groups. In adjusted analyses, there was a stepwise association between use of multiple PHMs and poorer self-rated health, poorer PWB, and poorer HRQoL. There was no association in adjusted analyses between PHM use and 3-year mortality (47.8%-63.8%).

Conclusion: PHM use is highly prevalent in institutional settings, regardless of the definition of inappropriateness. Residents who used multiple categories of PHMs were at greatest risk of poor HRQoL, poor PWB, and poor self-rated health. However, there was no apparent association with increased mortality. Given the importance of quality of life as an outcome to older people, further efforts are needed to minimize PHM use in this setting.

Keywords: Inappropriate prescribing; assisted living facilities; nursing home; psychological well-being; quality of life.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Assisted Living Facilities*
  • Cholinergic Antagonists*
  • Contraindications
  • Cross-Sectional Studies
  • Female
  • Finland / epidemiology
  • Humans
  • Inappropriate Prescribing*
  • Male
  • Mortality / trends*
  • Nursing Homes*
  • Polypharmacology
  • Psychotropic Drugs*
  • Quality of Life / psychology*
  • Registries


  • Cholinergic Antagonists
  • Psychotropic Drugs