(AM) Comparison of Potentially Inappropriate Medications in Nursing Homes and The Community: A Nationwide Cross-Sectional Study in Older Persons

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall E South

Publication Number: 655

Presenting Author(s)

Solene Drusch
– French National Agency for the Safety of Medicines and Health Products, Saint-Denis, Seine-Saint-Denis, France

Co-Author(s)

Thien Le Tri
– EPI-PHARE, epidemiology of health products (French National Agency for the Safety of Medicines and Health Products, and French National Health Insurance), Saint-Denis, France, Saint-Denis, Ile-de-France, France
Joel Ankri
– Professor, University of Paris-Saclay, UVSQ, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, Montigny-Le-Bretonneux, France, Montigny-Le-Bretonneux, Ile-de-France, France
Hugues Michelon
– Pharmacist, Pharmacy department, Sainte-Périne Hospital, AP-HP. University of Paris-Saclay, Paris, France, Paris, Ile-de-France, France
Mahmoud Zureik
– Director, EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products, and French National Health Insurance), Saint-Denis, France, Saint-Denis, Ile-de-France, France
Marie Herr
– Professor, University of Paris-Saclay, UVSQ, Inserm, Anti-Infective Evasion and Pharmacoepidemiology, Montigny-Le-Bretonneux, France, Montigny-Le-Bretonneux, Ile-de-France, France

Background: Potentially Inappropriate Medications (PIMs) have become a major issue in improving prescribing practices and reducing the risk of adverse drug events in older people. Literature suggests that PIMs exposure is higher among Nursing Home Residents (NHRs) than among Community-Dwelling Older Adults (CDOAs). However, very few studies have compared exposure to PIMs controlling for demographic and health status differences between these two populations.

Objectives: The aim of this study was to compare the prevalence of PIMs between NHRs and CDOAs from French health insurance data.

Methods: A cross-sectional study was conducted over a 3-month period in 2019 using the French National Healthcare Database (SNDS). The study population included 274,971 NHRs and 4,893,721 CDOAs aged between 75 and 110 years. We described the prevalence of seventeen PIM indicators, based on the Beers and STOPP 2015 lists. The Prevalence Ratio (PR) of PIMs between NHRs and CDOAs was assessed using robust Poisson regression models adjusted for age, sex, diseases, and polypharmacy.

Results: NHRs were older (89.2±5.9 versus 82.5±5.4 years) and more frequently female (79.1% versus 59.9%) than CDOAs. During the study period, 54% of NHRs and 29% of CDOAs received at least one PIM. After adjustment for confounders, the prevalence of PIMs was 33% higher among NHRs compared to CDOAs (aPR [95%CI]=1.33 [1.33-1.34]). Compared to CDOAs, NHRs received PIMs related to benzodiazepines (aPR [95%CI]=1.43 [1.42-1.43]), anticholinergic drugs (aPR [95%CI]=1.29 [1.27-1.31]), and at least three central nervous system-active drugs (aPR [95%CI]=1.94 [1.92-1.96]) more frequently. Prevalence of PIMs related to non-steroidal anti-inflammatory drugs (aPR [95%CI]=0.50 [0.48-0.52]) and long-acting benzodiazepines (aPR [95%CI]=0.84 [0.82-0.85]) was lower among NHRs.

Conclusions: This large study from the French National Healthcare Database confirms that NHRs are at greater risk for PIM overall than CDOAs, although this is not true for a few PIM indicators. As the population is aging, it is essential to promote and evaluate interventions in NHs and in the community to enhance medication optimization.