Factors associated with potentially inappropriate medication use, medication underuse and overuse in older adults in the German National Cohort.

Abstract

Background: Effectively identifying individuals exposed to drug underuse, overuse and potentially inappropriate medication (PIM) in older adults is essential for minimizing preventable drug-related harms.

Methods: We analysed data from 54,296 individuals aged 60-74 years from the German National Cohort (NAKO). We assessed the frequency of PIM, untreated conditions (medication and vaccination underuse) and medications without indication (overuse) utilizing the Fit fOR The Aged (FORTA) list. Factors associated with PIM, medication overuse and underuse were identified by multivariable logistic regression models.

Results: The frequency of PIM, underuse and overuse of medications was 26.1%, 19.1% and 23.6%, respectively. In participants with available vaccination information, 90.6% and 62.7% did not have the recommended pneumococcal and annual influenza virus vaccinations, respectively. Parkinson's disease, arterial hypertension, epilepsy and depression were strongly associated with PIM use, with 16.2-, 4.5-, 4.3- and 2.1-fold increased odds, respectively. Osteoporosis, atrial fibrillation, Parkinson's disease and chronic obstructive pulmonary disease were identified as particularly strongly associated with underuse, with 9.5-, 6.1-, 2.6- and 2.0-fold increased odds, respectively. Depression and epilepsy were the most prominent factors associated with overuse (1.6- and 1.5-fold increased odds).

Conclusion: PIM and medication overuse, as well as drug and vaccine underuse, are very common among older German individuals. Comprehensive medication reviews are needed to improve medication quality. This work identifies people with specific characteristics who would benefit the most and could be prioritized for medication reviews.