Background and Objective
Risk factors (RFs) for potentially inappropriate medication (PIM) use in older adults have been extensively studied, but with a higher emphasis on patient-related and clinical-related RFs (1,2). However, other RFs, like social, economic and healthcare-related, could also contribute to PIM use in older patients in different settings of care (3). Thus, the objective of our study was to conduct a systematic literature review on social, economic and healthcare-provision related RFs for PIM use in older patients. This study is a part of the Horizon 2020 EuroAgeism FIP7 project.
Methods
MEDLINE and SCOPUS databases were searched in October 2017, and electronic database search was supplemented by a manual search of reference lists of included studies, review articles, and PhD thesis. We included only original studies published in English as full-texts. We did not perform a meta-analysis due to differences between the studies in: designs, settings, metrics of the outcome, and clinical heterogeneity.
Results
Out of 2740 records identified, 69 studies were included in the review (refer to the PRISMA diagram, Figure 1). In total, 72 RFs were examined in the included studies. Of those, social related RFs were examined in 39 studies, and economic and healthcare-provision related RFs in 19 and 46 studies, respectively. As an example, we present in Figure 2 odds ratios and 95% confidence intervals for RFs related to the prescriber.) Among economic RFs patients’ low income reached the highest odds ratio OR=2.48 (1.82-3.39), p<0.001 (3) and among social RFs “not having a partner” OR=1.50 (1.10-2.10), p<0.05 (17). Considering care-related RFs, residency in long-term care institutions and admission to acute care were the strongest associated with PIM use OR=2.29 (2.25-2.33), p<0.001 (18) and OR=3.35 (2.43-4.62), p<0.05 (10), respectively, as well as care provided by non-geriatricians OR=5.54 (1.62-18.89), p=0.01 (11) or by more prescribers OR=1.40 (1.29-1.51), p<0.001 (4).
Conclusions
In contrast to a considerably higher amount of literature on patient-related or clinical-related RFs of PIM use, less evidence is available on social, economic and healthcare-related RFs. The results of the studies could not be summarised meaningfully because heterogeneity among the analyzed studies was high. Therefore, further work is required to develop a consensus on identifying, defining, measuring, and analyzing RFs for PIM use. This would maximize the comparability of studies and enable meta-analysis. In light of the rapid population ageing, research on RFs for PIM use is becoming more important because it could inform decision-makers to design regulatory measures aimed to reduce PIM use and consequently improve economic, clinical and humanistic outcomes of the older population.
