gms | German Medical Science

Introduction: Since publication of the first compilation of potentially inappropriate medication (PIM) for the elderly in the United States in the late 1990s – the Beers list – there was an ongoing discussion about the need for a country specific list in Germany. With the recently published PRISCUS list [1], this information is now available. Aim of the study is the assessment of PIM prescribing according to PRISCUS in Germany for the year 2008.

Methods: Database: Health Insurance (SHI) sample AOK Hesse/KV Hesse, an 18.75% random sample of insurants from the AOK Hesse. Study population: 76,479 insurants above 64 years of age either continuously insured or deceased in 2008. Mean age of men and women was 73,9y (SD: 6,6y) and 76,7y (SD:7,8y) respectively. Treatment prevalence with PIM was defined as at least one prescription of a drug on the PRISCUS list reimbursed by the sickness fund. The results are standardized to the population of Germany (31.12.2008).

Results: 23.9% (men: 19.8%, women: 26.9%) of the elderly received at least one PIM prescription in 2008. The prevalence steeply increased with age (65–69y: 19.8%; 90–94y: 29.0%). With 34.7%, a higher percentage of insurants with nursing care (outpatient nursing care: 35.8%, inpatient nursing care: 32.6%) received PIM compared to 21.8% of persons without nursing care. One third of all persons with PIM were men. 30% received just one PIM of the list; 15% received two, three and four drugs respectively. The highest PIM prevalence was observed for psychoanaleptics (N06) with 7.4%, followed by psycholeptics (N05: 4.1%) and cardiac therapy (C01: 3.1%). The three most frequently prescribed PIM were amitriptyline, acetyldigoxin and doxepin with 11.9%, 10.1% and 9.9% of all patients with PIM, respectively (i.e. 2.9%, 2.3% and 2.4% of the study population). Of all defined daily doses (DDD) prescribed for PIM 25.9% fell upon psychoanaleptics, 17.8% on antihypertensive drugs (C02) and 12.0% on cardiac therapy (C01).

Discussion and conclusion: The analysis provides for the first time prevalence data of an unselected insured population and allows assessing the relevance of the drugs specified on the PRISCUS list. Educational programs should focus on drugs with high treatment prevalence and call attention of physicians to groups of elderly who are at special risk for inappropriate medication.