PURPOSE: The aim of this study was to explore patterns and long-term development in prescribing potentially inappropriate medication (PIM) according to the EU(7)-PIM list to elderly patients in Germany. METHODS: We analysed anonymized German claims data. The study population comprised 6.0 million insured individuals at least 65 years old, including all their prescriptions reimbursed in 2019. For the analysis of long-term development, we used data for the years 2009-2019. Factors associated with PIM prescribing were considered from two perspectives: patient-oriented analysis was performed with logistic regression and prescriber-oriented analysis was performed with multiple linear regression. RESULTS: EU(7)-PIM prevalence was reduced from 56.9% in 2009 to 45.1% in 2019. Average annual volume (DDDs/insured) decreased from 145 in 2009 to 121 in 2019. These figures are substantially greater than those for the older PRISCUS list. The majority of investigated ATC level 2 groups with the highest EU(7)-PIM DDD volume exhibited substantial decreases; moderate increases were found for antihypertensive and urological drugs. Antithrombotics increased strongly with the introduction of direct oral anticoagulants. The most prevalent EU(7)-PIM medication was diclofenac; however, in the age group 85+ years, apixaban was twice as prevalent as diclofenac. Polypharmacy, female sex, age < 90 years, need for nursing care and living in Eastern regions were identified as risk factors. Prescriber specialty was the most marked factor in the prescriber-oriented analysis. CONCLUSION: Although the use of EU(7)-PIMs has been declining, regional differences indicate considerable room for improvement. The comparison with PRISCUS highlights the necessity of regular updates of PIM lists.

AOK Research Institute Berlin Germany

Department of Clinical Pharmacology University of Witten Herdecke Witten North Rhine Westphalia Germany

Department of Medical Biophysics Faculty of Medicine in Hradec Králové Charles University Hradec Králové Czech Republic

Philipp Klee Institute of Clinical Pharmacology HELIOS University Clinic Wuppertal Wuppertal Germany

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Statistisches Bundesamt (Destatis) (2019) Bevölkerungspyramide: Altersstruktur Deutschlands von 1950 - 2060. https://service.destatis.de/bevoelkerungspyramide/index.html#!y=2029&a=20,65&l=en&g . Accessed 24 Nov 2020

Schmiedl S, Rottenkolber M, Szymanski J et al (2018) Preventable ADRs leading to hospitalization - results of a long-term prospective safety study with 6,427 ADR cases focusing on elderly patients. Expert Opin Drug Saf 17:125–137. https://doi.org/10.1080/14740338.2018.1415322 PubMed DOI

Bates DW, Cullen DJ, Laird N et al (1995) Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group JAMA 274:29–34

Morimoto T, Gandhi TK, Seger AC et al (2004) Adverse drug events and medication errors: detection and classification methods. Qual Saf Health Care 13:306–314. https://doi.org/10.1136/qhc.13.4.306 PubMed DOI PMC

Reeve E, Wiese MD, Mangoni AA (2015) Alterations in drug disposition in older adults. Expert Opin Drug Metab Toxicol 11:491–508. https://doi.org/10.1517/17425255.2015.1004310 PubMed DOI

Thürmann PA (2020) Clinical studies in geriatric population. Drug Discov Eval Methods Clin Pharmacol 417–424.  https://doi.org/10.1007/978-3-319-68864-0_43

Gallagher P, Barry P, O’Mahony D (2007) Inappropriate prescribing in the elderly. J Clin Pharm Ther 32:113–121. https://doi.org/10.1111/j.1365-2710.2007.00793.x PubMed DOI

Beers MH, Ouslander JG, Rollingher I et al (1991) Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med 151:1825–1832 DOI

Motter FR, Fritzen JS, Hilmer SN et al (2018) Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria. Eur J Clin Pharmacol 74:679–700. https://doi.org/10.1007/s00228-018-2446-0 PubMed DOI

Fialová D, Brkić J, Laffon B et al (2019) Applicability of EU(7)-PIM criteria in cross-national studies in European countries. Ther Adv Drug Saf 10:2042098619854014. https://doi.org/10.1177/2042098619854014 PubMed DOI PMC

Wamil N, Mattsson S, Gustafsson M (2019) Assessment of potentially inappropriate medications using the EU (7)-PIM list and the Swedish quality indicators. Int J Clin Pharm 41:903–912. https://doi.org/10.1007/s11096-019-00847-x PubMed DOI PMC

Grina D, Briedis V (2017) The use of potentially inappropriate medications among the Lithuanian elderly according to Beers and EU(7)-PIM list - a nationwide cross-sectional study on reimbursement claims data. J Clin Pharm Ther 42:195–200. https://doi.org/10.1111/jcpt.12494 PubMed DOI

Toepfer S, Bolbrinker J, König M et al (2019) Potentially inappropriate medication in older participants of the Berlin Aging Study II (BASE-II) - sex differences and associations with morbidity and medication use. PLoS One 14:e0226511. https://doi.org/10.1371/journal.pone.0226511 PubMed DOI PMC

Holt S, Schmiedl S, Thürmann PA (2010) Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arzteblatt Int 107:543–551. https://doi.org/10.3238/arztebl.2010.0543 DOI

Beers MH (1997) Explicit criteria for determining potentially inappropriate medication use by the elderly. An update Arch Intern Med 157:1531–1536 DOI

Fick DM, Cooper JW, Wade WE et al (2003) Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 163:2716–2724. https://doi.org/10.1001/archinte.163.22.2716 PubMed DOI

McLeod PJ, Huang AR, Tamblyn RM, Gayton DC (1997) Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ 156:385–391 PubMed PMC

Laroche M-L, Charmes J-P, Merle L (2007) Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol 63:725–731. https://doi.org/10.1007/s00228-007-0324-2 PubMed DOI

Renom-Guiteras A, Meyer G, Thürmann PA (2015) The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol 71:861–875. https://doi.org/10.1007/s00228-015-1860-9 PubMed DOI PMC

Bundesministerium der Justiz und für Verbraucherschutz (2020) Sozialgesetzbuch - Elftes Buch, § 15. https://www.gesetze-im-internet.de/sgb_11/__15.html . Accessed 24 Nov 2020

Gnjidic D, Tinetti M, Allore HG (2017) Assessing medication burden and polypharmacy: finding the perfect measure. Expert Rev Clin Pharmacol 10:345–347. https://doi.org/10.1080/17512433.2017.1301206 PubMed DOI PMC

Nishtala PS, Salahudeen MS (2015) Temporal trends in polypharmacy and hyperpolypharmacy in older New Zealanders over a 9-year period: 2005–2013. Gerontology 61:195–202. https://doi.org/10.1159/000368191 PubMed DOI

Statistisches Bundesamt (Destatis) (2020) - GENESIS-Online. https://www-genesis.destatis.de/genesis/online . Accessed 24 Nov 2020

Monteiro C, Canário C, Ribeiro MÂ et al (2020) Medication evaluation in Portuguese elderly patients according to beers, STOPP/START criteria and EU(7)-PIM List - an exploratory study. Patient Prefer Adherence 14:795–802. https://doi.org/10.2147/PPA.S247013 PubMed DOI PMC

Caldeira D, Nunes-Ferreira A, Rodrigues R et al (2019) Non-vitamin K antagonist oral anticoagulants in elderly patients with atrial fibrillation: a systematic review with meta-analysis and trial sequential analysis. Arch Gerontol Geriatr 81:209–214. https://doi.org/10.1016/j.archger.2018.12.013 PubMed DOI

Moudallel S, Steurbaut S, Cornu P, Dupont A (2018) Appropriateness of DOAC prescribing before and during hospital admission and analysis of determinants for inappropriate prescribing. Front Pharmacol 9:1220. https://doi.org/10.3389/fphar.2018.01220 PubMed DOI PMC

American Geriatrics Society Beers Criteria® Update Expert Panel (2019) American Geriatrics Society 2019 Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 67:674–694. https://doi.org/10.1111/jgs.15767 DOI

Mucalo I, Hadžiabdić MO, Brajković A et al (2017) Potentially inappropriate medicines in elderly hospitalised patients according to the EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol. Eur J Clin Pharmacol 73:991–999. https://doi.org/10.1007/s00228-017-2246-y PubMed DOI

Schubert I, Küpper-Nybelen J, Ihle P, Thürmann P (2013) Prescribing potentially inappropriate medication (PIM) in Germany’s elderly as indicated by the PRISCUS list. An analysis based on regional claims data. Pharmacoepidemiol Drug Saf 22:719–727. https://doi.org/10.1002/pds.3429 PubMed DOI

Stock S, Redaelli M, Simic D et al (2014) Risk factors for the prescription of potentially inappropriate medication (PIM) in the elderly: an analysis of sickness fund routine claims data from Germany. Wien Klin Wochenschr 126:604–612. https://doi.org/10.1007/s00508-014-0589-2 PubMed DOI

Roux B, Sirois C, Simard M et al (2020) Potentially inappropriate medications in older adults: a population-based cohort study. Fam Pract 37:173–179. https://doi.org/10.1093/fampra/cmz060 PubMed DOI

Sönnerstam E, Sjölander M, Gustafsson M (2017) An evaluation of the prevalence of potentially inappropriate medications in older people with cognitive impairment living in Northern Sweden using the EU(7)-PIM list. Eur J Clin Pharmacol 73:735–742. https://doi.org/10.1007/s00228-017-2218-2 PubMed DOI PMC

Nothelle SK, Sharma R, Oakes A et al (2019) Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review. Int J Pharm Pract 27:408–423. https://doi.org/10.1111/ijpp.12541 PubMed DOI PMC

Johnell K (2015) Inappropriate drug use in people with cognitive impairment and dementia: a systematic review. Curr Clin Pharmacol 10:178–184. https://doi.org/10.2174/1574884710666150609154741 PubMed DOI PMC

Thürmann PA (2017) Einsatz von Psychopharmaka bei Pflegebedürftigen. In: Jacobs K, Kuhlmey A, Greß S, Klauber J, Schwinger A (eds) Pflege-Report 2017. Schattauer, Stuttgart, pp 119–129

Hoffmann F, Bantel C, von Rosen FT, Jobski K (2020) Regional differences in prescribing patterns of metamizole in Germany based on data from 70 million persons. Int J Environ Res Public Health 17:3892. https://doi.org/10.3390/ijerph17113892 DOI PMC

Selke Krulichová I, Selke GW, Eichler U et al (2019) Impact of EU risk assessment process and administrative regulations for manufacturers of combined hormonal contraceptive prescribing. An analysis of developments in Germany and the implications. Curr Med Res Opin 35:697–704. https://doi.org/10.1080/03007995.2018.1541317 PubMed DOI

Gudd K, Meier F, Lindenthal J et al (2020) Potenziell inadäquate Medikation in einem deutschen Praxisnetz – Wer verordnet was an wen? Z Gerontol Geriat 53:647–654. https://doi.org/10.1007/s00391-019-01660-x DOI