The prevalence of polypharmacy in older Europeans: A multi‐national database study of general practitioner prescribing

• Published in: British journal of clinical pharmacology 2024-09, Vol.90 (9), p.2124-2136
• Main Authors: Bennie, Marion, Santa‐Ana‐Tellez, Yared, Galistiani, Githa Fungie, Trehony, Julien, Despres, Johanna, Jouaville, Laurence Sophie, Poluzzi, Elisabetta, Morin, Lucas, Schubert, Ingrid, MacBride‐Stewart, Seán, Elseviers, Monique, Nasuti, Paola, Taxis, Katja
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cohort Studies; crossnational comparison; Databases, Factual - statistics & numerical data; Drug Prescriptions - statistics & numerical data; elderly; Europe; European People; Female; General Practitioners - statistics & numerical data; Humans; Inappropriate Prescribing - statistics & numerical data; Life Sciences; Male; Pharmaceutical sciences; Polypharmacy; potentially inappropriate medication; Practice Patterns, Physicians' - statistics & numerical data; Practice Patterns, Physicians' - trends; Prevalence; primary care; Primary Health Care - statistics & numerical data; Retrospective Studies
• ISSN: 0306-5251; 1365-2125; 1365-2125
• DOI: 10.1111/bcp.16113

Aims The aims of this study were to measure the prevalence of polypharmacy and describe the prescribing of selected medications known for overuse in older people with polypharmacy in primary care. Methods This was a multinational retrospective cohort study across six countries: Belgium, France, Germany, Italy, Spain and the UK. We used anonymized longitudinal patient‐level information from general practice databases hosted by IQVIA. Patients ≥65 years were included. Polypharmacy was defined as having 5–9 and ≥10 distinct drug classes (ATC Level 3) prescribed during a 6‐month period. Selected medications were: opioids, antipsychotics, proton pump inhibitors (PPI), benzodiazepines (ATC Level 5). We included country experts on the healthcare context to interpret findings. Results Age and gender distribution was similar across the six countries (mean age 75–76 years; 54–56% female). The prevalence of polypharmacy of 5–9 drugs was 22.8% (UK) to 58.3% (Germany); ≥10 drugs from 11.3% (UK) to 28.5% (Germany). In the polypharmacy population prescribed ≥5 drugs, opioid prescribing ranged from 11.5% (France) to 27.5% (Spain). Prescribing of PPI was highest with almost half of patients receiving a PPI, 42.3% (Germany) to 65.5% (Spain). Benzodiazepine prescribing showed a marked variation between countries, 2.7% (UK) to 34.9% (Spain). The healthcare context information explained possible underreporting for selected medications. Conclusions We have found a high prevalence of polypharmacy with more than half of the older population being prescribed ≥5 drugs in four of the six countries. Whilst polypharmacy may be appropriate in many patients, worryingly high usage of PPIs and benzodiazepines supports current efforts to improve polypharmacy management across Europe.