title: Advanced Age and Medication Prescription: More Years, Less Medications? A Nationwide Report From the Italian Medicines Agency.
abstract: BACKGROUND
  In older adults co-occurrence of multiple diseases often leads to use of multiple medications (polypharmacy). The aim of the present study is to describe how prescription of medications varies across age groups, with specific focus on the oldest old.
  
  
  METHODS
  We performed a cross-sectional study using 2013 data from the OsMed Health-DB database (mean number of medicines and defined daily doses prescribed in 15,931,642 individuals). There were 3,378,725 individuals age 65 years or older (21.2% of the study sample).
  
  
  RESULTS
  The mean number of prescribed medications progressively rose from 1.9 in the age group <65 years to 7.4 in the age group 80-84 years and then declined, with a more marked reduction in the age group 95 years or older with a mean number of 2.8 medications. A similar pattern was observed for the mean number of defined daily doses. Among participants age ≥65 years, proton pump inhibitors were the most commonly prescribed medication (40.9% of individuals ≥65 years), followed by platelet aggregation inhibitors (32.8%) and hydroxy-methylglutaryl-coenzyme A reductase inhibitors (26.1%). A decline in prescription was observed among individuals age 90 years or older, but this reduction was less consistent for medications used to treat acute conditions (ie, antibiotics and glucocorticoids) rather than preventive medicines commonly used to treat chronic diseases (ie, antihypertensive medications and hydroxy-methylglutaryl-coenzyme A reductase inhibitors).
  
  
  CONCLUSIONS
  The burden of medication treatment progressively increases till age 85 and substantially declines after age of 90 years. Patterns of medication prescription widely vary across age groups.
authors.affiliation: Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: graziano.onder@rm.unicatt.it.
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
authors.affiliation: Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marengoni
authors.affiliation: Agenzia Italiana del Farmaco (AIFA), Rome, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Russo
authors.affiliation: CliCon Srl Health, Economics and Outcomes Research, Ravenna, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Degli Esposti
authors.affiliation: Scientific Direction, IRCCS San Raffaele Pisana, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Fini
authors.affiliation: Agenzia Italiana del Farmaco (AIFA), Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Monaco
authors.affiliation: Scientific Direction, IRCCS San Raffaele Pisana, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonassi
authors.affiliation: Agenzia Italiana del Farmaco (AIFA), Rome, Italy.
authors.forename: Katie
authors.initials: K
authors.lastname: Palmer
authors.affiliation: Agenzia Italiana del Farmaco (AIFA), Rome, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Marrocco
authors.affiliation: Court of Justice for the Right to Health, FederAnziani, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pozzi
authors.affiliation: CliCon Srl Health, Economics and Outcomes Research, Ravenna, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Sangiorgi
authors.affiliation: CliCon Srl Health, Economics and Outcomes Research, Ravenna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Buda
authors.affiliation: Division of Geriatric Cardiology and Medicine, Department of Medicine and Geriatrics, University of Florence, Florence, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.affiliation: Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy; Agenzia Italiana del Farmaco (AIFA), Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Mammarella
authors.affiliation: Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
authors.affiliation: Agenzia Italiana del Farmaco (AIFA), Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pani
authors.affiliation: Agenzia Italiana del Farmaco (AIFA), Rome, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Pecorelli
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D019338:Polypharmacy; D013727:Terminal Care
keywords: Prescribing; end of life; polypharmacy