Trends in inappropriate drug therapy prescription in the elderly in Sweden from 2006 to 2013: assessment using national indicators

Abstract

Background: Medication for elderly patients is often complex and problematic. Several criteria for classifying inappropriate prescribing exist. In 2010, the Swedish National Board of Health and Welfare published the document "Indicators of appropriate drug therapy in the elderly" as a guideline for improving prescribing for the elderly.

Objective: The aim of this study was to assess trends in the prescription of inappropriate drug therapy in the elderly in Sweden from 2006 to 2013 using national quality indicators for drug treatment.

Methods: Individual-based data on dispensed prescription drugs for the entire Swedish population aged ≥65 years during eight 3-month periods from 2006 to 2013 were accumulated. The data were extracted from the Swedish Prescribed Drug Register. Eight drug-specific quality indicators were monitored.

Results: For the entire population studied (n = 1,828,283 in 2013), six of the eight indicators showed an improvement according to the guidelines; the remaining two indicators (drugs with anticholinergic effects and excessive polypharmacy) remained relatively unchanged. For the subgroup aged 65-74 years, three indicators showed an improvement, four indicators remained relatively unchanged (e.g. propiomazine, and oxazepam) and one showed an undesirable trend (anticholinergic drugs) according to guidelines. For the older group (aged ≥75 years), all indicators except excessive polypharmacy showed improvement.

Conclusion: According to the quality indicators used, the extent of inappropriate drug therapy in the elderly decreased from 2006 to 2013 in Sweden. Thus, prescribers appear to be more likely to change their prescribing patterns for the elderly than previously assumed.

Fig. 1

The proportion of elderly individuals in Sweden (aged ≥65 years), in 5-year age groups, for whom long-acting benzodiazepines were dispensed over the period Q1 2006 to Q1 2013. Q1 Quarter 1

Fig. 2

The proportion of elderly individuals in Sweden (aged ≥65 years), in 5-year age groups, for whom drugs with anticholinergic effects were dispensed over the period Q1 2006 to Q1 2013. Q1 Quarter 1

Fig. 3

The proportion of elderly individuals in Sweden (aged ≥65 years) for whom propiomazine and tramadol was dispensed over the period Q1 2006 to Q1 2013. Q1 Quarter 1

Fig. 4

The proportion of elderly individuals in Sweden (aged ≥65 years) for whom ten or more prescription drugs, or three or more concurrent psychotropic drugs, were dispensed concurrently over the period Q1 2006 to Q1 2013. Q1 Quarter 1

Fig. 5

The proportion of elderly individuals in Sweden (aged ≥65 years) receiving tranquilizers for whom oxazepam was dispensed, and the proportion of elderly individuals in Sweden (aged ≥65 years) receiving hypnotics or sedatives for whom zopiclone was dispensed, over the period Q1 2006 to Q1 2013. Q1 Quarter 1