title: Burden of Potentially Harmful Medications and the Association With Quality of Life and Mortality Among Institutionalized Older People.
abstract: OBJECTIVE
  This study investigated the overlap among 3 different definitions of potentially harmful medication (PHM) use and the corresponding associations with resident quality of life and mortality.
  
  
  METHODS
  Cross-sectional study with 3-year follow-up for mortality.
  
  
  METHODS
  Assisted living facilities and nursing homes in Helsinki and Kouvola, Finland.
  
  
  METHODS
  A total of 326 residents.
  
  
  METHODS
  PHM use was defined as (1) use of medications with anticholinergic properties, (2) use of Beers Criteria medications, and (3) concomitant use 3 or more psychotropic medications. Health-related quality of life (HRQoL) was assessed using the 15D and psychological well-being (PWB) scale. Residents self-rated their own health using a 4-point scale. Mortality data were obtained from central registers.
  
  
  RESULTS
  There were 38.0%, 28.2%, and 12.6% of residents who used PHMs according to 1 (G1), 2 (G2), and 3 definitions (G3), respectively. Overall, 21.2% of residents did not use PHMs according to any of the 3 definitions (G0). There were no significant differences in comorbidity, cognition, or functioning among groups. In adjusted analyses, there was a stepwise association between use of multiple PHMs and poorer self-rated health, poorer PWB, and poorer HRQoL. There was no association in adjusted analyses between PHM use and 3-year mortality (47.8%-63.8%).
  
  
  CONCLUSIONS
  PHM use is highly prevalent in institutional settings, regardless of the definition of inappropriateness. Residents who used multiple categories of PHMs were at greatest risk of poor HRQoL, poor PWB, and poor self-rated health. However, there was no apparent association with increased mortality. Given the importance of quality of life as an outcome to older people, further efforts are needed to minimize PHM use in this setting.
authors.affiliation: City of Porvoo, Health Services, Porvoo, Finland; Department of General Practice, and Helsinki University Hospital, Unit of Primary Health Care, University of Helsinki, Finland. Electronic address: anna-liisa.juola@fimnet.fi.
authors.forename: Anna-Liisa
authors.initials: AL
authors.lastname: Juola
authors.affiliation: Faculty of Pharmacy, Division of Social Pharmacy, University of Helsinki, Carea Central Hospital Pharmacy, Kotka, Finland.
authors.forename: Sarita
authors.initials: S
authors.lastname: Pylkkanen
authors.affiliation: Department of General Practice, and Helsinki University Hospital, Unit of Primary Health Care, University of Helsinki, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia, Adelaide, Australia; and Kuopio Research Centre of Geriatric Care, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
authors.affiliation: Department of General Practice, and Helsinki University Hospital, Unit of Primary Health Care, University of Helsinki, Finland.
authors.forename: Mikko P
authors.initials: MP
authors.lastname: Bjorkman
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Harriet
authors.initials: H
authors.lastname: Finne-Soveri
authors.affiliation: City of Helsinki, Department of Social Services and Health Care, Developmental and Operational Support, Helsinki, Finland.
authors.forename: Helena
authors.initials: H
authors.lastname: Soini
authors.affiliation: Department of General Practice, and Helsinki University Hospital, Unit of Primary Health Care, University of Helsinki, Finland.
authors.forename: Kaisu H
authors.initials: KH
authors.lastname: Pitkälä
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D018680:Cholinergic Antagonists; D000075202:Contraindications; D003430:Cross-Sectional Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D057970:Inappropriate Prescribing; D008297:Male; D009026:Mortality / Q000639:trends*; D009735:Nursing Homes; D064798:Polypharmacology; D011619:Psychotropic Drugs; D011788:Quality of Life / Q000523:psychology*; D012042:Registries
chemical_list: D018680:Cholinergic Antagonists; D011619:Psychotropic Drugs
keywords: Inappropriate prescribing; assisted living facilities; nursing home; psychological well-being; quality of life