Polypharmacy in the elderly: A deeper analysis of drug utilization in Sweden and Germany

Abstract:

Introduction:  If a person uses many different drugs at the same time it can be termed “polypharmacy”. Polypharmacy is mostly seen in the elderly and often associated with negative aspects of drug treatment. Some negative consequences of using many drugs are a higher risk of drug-drug interactions and side effects and a lower patient compliance. The number of drugs defining polypharmacy can vary. But what does the number really tell?

Aim:  The aim of this work is to get a better picture of the medication of the elderly in Sweden and Germany. Which are the most common drugs used by the elderly with excessive polypharmacy (use of 10 or more drugs) in Sweden and Germany?

Materials and Methods: A cross-sectional observational study was done using individual based drug dispensing data on elderly 65 years and older from the Swedish Prescribed Drug Register (1,4 million elderly) and Germany’s (AOK) drug register (5,3 million elderly). Period prevalence for the time interval October to December 2010 was calculated.

Results:  Many interesting differences were found comparing the drug treatment of the elderly with excessive polypharmacy in Sweden and Germany. In Sweden the most common drugs for this population were paracetamol (56%), acetylsalicylic acid (52%) and furosemide (42%), in Germany the use of torasemide (35%), simvastatin (35%) and pantoprazole (33%) dominated. Differences between the countries can partly depend on how common a disease is in a country, but also which drugs are available as OTC-drugs, the availability of guidelines/formularies and how physicians in a country follow them and differences in the availability of drugs in the market.

Conclusions:  When assessing drug use in terms of polypharmacy, the focus should not lie on the amount of drugs; the importance is which drugs are administered. Through international comparisons strengths and weaknesses of different countries’ drug treatment of the elderly can be found. The countries should support each other and make interventions. Hopefully a better drug treatment will be reached.