Health care personnel shortage associated with older adults’ pharmacotherapy whose risks exceed benefits

According to a new study, the use of potentially inappropriate medications is more common in hospital districts with a higher proportion of residents aged 75 and over living alone and with excessive polypharmacy.

The prevalence of potentially inappropriate medications (PIMS) that are reimbursable by the National Health Insurance varies among elderly Finns between hospital districts. In 2017–2019 the prevalence varied from 16.4 to 24.8 percent. PIMs are defined as medicines whose risk of potential harm typically exceeds the clinical benefit.

The use of PIMs was highest in the hospital districts of Kymenlaakso, and Helsinki and Uusimaa, whereas the prevalence was lowest in the Länsi-Pohja and Vaasa hospital districts.

The use of PIMs is more common in hospital districts with higher proportion of people aged 75 and over live alone, use ten or more medications and who have been evaluated using the Resident Assessment Instrument (RAI) system. RAI is a standardised system used for assessing the need for service of a client receiving services for the older adults or the developmentally disabled and for planning care, rehabilitation, and services.

Other factors associated with higher use of PIMs were shortage of doctors at health care centres and less personnel assigned to home care out of the total number of personnel in services for the older adults.

Factors associated with use of potentially inappropriate medications require attention

The shortage of doctors and the small number of home care personnel are related to the challenges of resources of health care. The shortage of doctors may lead to busy working environment where professionals do not have enough time to thoroughly consider the choice of medications. While it would increase the number of personnel, the share of posts filled by substitutes to fill doctors’ or nurses’ vacancies does not bring continuity of care.

“This kind of care relationship is especially problematic in cases of older adults with multiple illnesses and who take multiple medicines, since changes in chronic illnesses and treatment needs are left unnoticed. To improve medication safety, we must understand the cause-and-effect relationships behind the factors observed in the study. Further studies should focus on this topic”, says researcher Jasmin Paulamäki.

Waiting time in primary health care, or the share of older population with morbidity or weakened functional performance were not found to be associated with the use of PIMs.

The study by the Finnish Medicines Agency Fimea and the Tampere University is based on the Kanta prescription registers, which includes all purchasing events made by pharmacies. Purchases of reimbursed prescription medicines were applied in the study. PIMs were defined according to the Fimea's Meds75+ database. The study was supported by the Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital.

Read more about the study: Regional variation of potentially inappropriate medication use and associated factors among older adults: A nationwide register study, Research in Social and Administrative Pharmacy.

Further information

Jasmin Paulamäki
Pharmacist
Doctoral researcher, University of Tampere
Researcher, Finnish Medicines Agency Fimea
jasmin.paulamaki@tuni.fi
+358 29 522 3604