title: Any versus long-term prescribing of high risk medications in older people using 2012 Beers Criteria: results from three cross-sectional samples of primary care records for 2003/4, 2007/8 and 2011/12.
abstract: BACKGROUND
  High risk medications are commonly prescribed to older US patients. Currently, less is known about high risk medication prescribing in other Western Countries, including the UK. We measured trends and correlates of high risk medication prescribing in a subset of the older UK population (community/institutionalized) to inform harm minimization efforts.
  
  
  METHODS
  Three cross-sectional samples from primary care electronic clinical records (UK Clinical Practice Research Datalink, CPRD) in fiscal years 2003/04, 2007/08 and 2011/12 were taken. This yielded a sample of 13,900 people aged 65 years or over from 504 UK general practices. High risk medications were defined by 2012 Beers Criteria adapted for the UK. Using descriptive statistical methods and regression modelling, prevalence of 'any' (drugs prescribed at least once per year) and 'long-term' (drugs prescribed all quarters of year) high risk medication prescribing and correlates were determined.
  
  
  RESULTS
  While polypharmacy rates have risen sharply, high risk medication prevalence has remained stable across a decade. A third of older (65+) people are exposed to high risk medications, but only half of the total prevalence was long-term (any = 38.4 % [95 % CI: 36.3, 40.5]; long-term = 17.4 % [15.9, 19.9] in 2011/12). Long-term but not any high risk medication exposure was associated with older ages (85 years or over). Women and people with higher polypharmacy burden were at greater risk of exposure; lower socio-economic status was not associated. Ten drugs/drug classes accounted for most of high risk medication prescribing in 2011/12.
  
  
  CONCLUSIONS
  High risk medication prescribing has not increased over time against a background of increasing polypharmacy in the UK. Half of patients receiving high risk medications do so for less than a year. Reducing or optimising the use of a limited number of drugs could dramatically reduce high risk medications in older people. Further research is needed to investigate why the oldest old and women are at greater risk. Interventions to reduce high risk medications may need to target shorter and long-term use separately.
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Barrack Road, Exeter, EX2 5DW, UK. A.Ble@exeter.ac.uk.|National Institute for Health Research (NIHR)'School for Public Health Research, ᅟ, UK. A.Ble@exeter.ac.uk.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ble
authors.affiliation: Healthcare for Older People, Royal Devon and Exeter NHS Foundation Trust, Barrack Rd, Exeter, EX2 5DW, UK. J.Masoli@exeter.ac.uk.
authors.forename: Jane A H
authors.initials: JA
authors.lastname: Masoli
authors.affiliation: Primary Care, Institute of Health Research, University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter, EX1 2LU, UK. H.E.Barry@exeter.ac.uk.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Barry
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter, EX1 2LU, UK. R.E.Winder@exeter.ac.uk.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Winder
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Barrack Road, Exeter, EX2 5DW, UK. beh26uk@gmail.com.
authors.forename: Behrooz
authors.initials: B
authors.lastname: Tavakoly
authors.affiliation: Health Statistics, Institute of Health Research, University of Exeter Medical School, College House, St Luke's Campus, Exeter, EX1 2LU, UK. W.E.Henley@exeter.ac.uk.
authors.forename: William E
authors.initials: WE
authors.lastname: Henley
authors.affiliation: UConn Center on Aging, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030-5215, USA. Kuchel@uchc.edu.
authors.forename: George A
authors.initials: GA
authors.lastname: Kuchel
authors.affiliation: Health Services & Policy Research, Institute of Health Research, University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter, EX1 2LU, UK. J.M.Valderas@exeter.ac.uk.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Valderas
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Barrack Road, Exeter, EX2 5DW, UK. D.Melzer@exeter.ac.uk.|National Institute for Health Research (NIHR)'School for Public Health Research, ᅟ, UK. D.Melzer@exeter.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Melzer
authors.affiliation: Primary Care Research Group, Institute of Health Research, University of Exeter Medical School, Smeall Building, St Luke's Campus, Exeter, EX1 2LU, UK. s.h.richards@exeter.ac.uk.
authors.forename: Suzanne H
authors.initials: SH
authors.lastname: Richards
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008297:Male; D008501:Medical Records, Problem-Oriented; D019338:Polypharmacy; D000067561:Potentially Inappropriate Medication List / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D013995:Time; D006113:United Kingdom