Drug utilization and polypharmacy in an Italian elderly population: the EPIFARM-elderly project.
OBJECTIVE
To investigate the prescribing patterns and the prevalence of polypharmacy in community-dwelling elderly people, and to analyze the association of chronic medications and number of drug prescriptions with age and sex.


METHODS
All prescriptions for people aged 65 years or older reimbursed by the Italian National Health Service (NHS) and dispensed by retail pharmacies of the 15 local health units (LHU) in the Lombardy Region during 2005 were analyzed. Logistic regression analysis was used to assess the association between drug prescription (overall, chronic drugs, and polypharmacy) and age, sex, and LHU of residence.


RESULTS
Eighty-eight percent of the 1 ,767 ,239 analyzed elderly received at least one drug prescription. The overall prescription rate was slightly higher for women than men (odds ratio [OR] 1.20; 95%CI 1.19-1.21). Seventy-six percent of the elderly received at least one chronic drug, 46% were exposed to polypharmacy, and 20% to chronic polypharmacy. At multivariate analysis, age and LHU residence of the elderly were the main determinants of drug exposure. A significant correlation was found between the overall prescription prevalence rate and exposure to chronic drugs and to chronic polypharmacy (r(s)  = 0.79, p < 0.0005 and r(s)  = 0.84, p < 0.0001, respectively).


CONCLUSIONS
Our findings indicate that age and LHU residence of the elderly are the main determinants of drug prescribing, and there is evidence of a significant correlation between the overall prescription prevalence rate and exposure to chronic drugs and to chronic polypharmacy.
Laboratory of Quality Assessment of Geriatric Therapies and Services, Mario Negri Institute for Pharmacological Research, Milan, Italy. nobili@marionegri.it
Alessandro
A
Nobili
Carlotta
C
Franchi
Luca
L
Pasina
Mauro
M
Tettamanti
Marta
M
Baviera
Lara
L
Monesi
Carla
C
Roncaglioni
Emma
E
Riva
Ugo
U
Lucca
Angela
A
Bortolotti
Ida
I
Fortino
Luca
L
Merlino
D000367:Age Factors; D000368:Aged; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D017723:Drug Utilization Review / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D012737:Sex Factors