In Finland, there are not many studies concerning drug use, polypharmacy, and sedative use among the home-dwelling elderly and the oldest old between two time windows. In other countries, such studies have been carried out, but most of them also include institutionalized persons. This study aimed to illustrate the drug use policy in Finland from 1990–91 to 1998–99.
According to the findings and in view of the literature, the following conclusions and clinical implications can be made:
The use of prescription drugs and polypharmacy among home-dwelling elderly people in a Finnish municipality became more prevalent over a period of a decade. The mean number of drugs per user grew during the study period, most markedly in the oldest women. In this study cardiovascular and CNS drugs were used most commonly by the general elderly population and also by the persons with polypharmacy. The oldest old, aged over 84 years, used drugs most commonly, and polypharmacy grew most among them.
Overall assessments of medication should be made regularly, and the main target in the reduction of polypharmacy should be elderly women and the oldest old. Physicians should have a possibility to consult a geriatrician when necessary.
The persons with polypharmacy were typically the oldest ones and had many diseases and poor self-perceived health and used home nursing services. Difficulties or dependence in daily activities or mobility were typical of persons with polypharmacy.
Quality of life should be improved among persons with polypharmacy. Training of nurses to check medication use and to identify the adverse effects of drugs should be available for all patients in home care/nursing. Persons with polypharmacy should be trained to diminish physical functional disabilities. The importance of a critical and conservative approach toward drug therapy in elderly patients cannot be overemphasized.
Psychotropic use showed a slightly increasing trend. The oldest old, who are supposed to be at the highest risk of adverse drug reactions, use psychotropics most commonly.
Most psychotropic users were on regular medication. Hypnotic and antidepressant use grew most significantly. Anxiolytic use remained stable. Regular use of hypnotics/sedatives is against the recommendations. Treatment of depression may have improved among the elderly, though this study was unable to demonstrate whether or not the right persons, i.e. the persons with major depression, receive antidepressants. The prevalence of antipsychotic use dropped to a half, and they are probably not used so much in sleeping pills any longer. New atypical antipsychotics were not used. Concomitant use of psychotropics should be avoided without proper indications. The young elderly women have not diminished their psychotropic use, and they should be assessed very carefully, in order to avoid increasing their psychotropic use in the course of life.
Sedative drug use is very common, and the classification of drugs by their sedative properties was helpful. Development and updating of the classification will be the major challenge in the future after local elaboration of the national drug assortments. The pharmacokinetics and pharmacodynamics of drugs in the elderly should be presented in more detail in medical schools, to avoid polypharmacy and sedation, and the information should be easily available from Pharmaca Fennica.
The most frail persons aged 80 years or over, women, those with many diseases, smokers, those with poor self-perceived health/poor life satisfaction, and those with home nursing are most likely to have abundant sedative drug use. They should be assessed with particular care by physicians.