The initiation of potentially inappropriate medication (PIM) is associated with a higher risk of fracture-specific hospitalisations and mortality, a new study has found.

Additionally, initiation of a PIM is also associated with higher hospital costs, the study – a collaboration between the University of Eastern Finland, Fimea and The Social Insurance Institution of Finland - found.

PIMs are defined as medications whose potential risks are higher than their clinical benefits. In this study, PIMs were defined according to the Meds75+ database maintained by the Finnish Medicines Agency (Fimea). Medications are divided into four categories:

  • A - Suitable for the older persons
  • B - There is little evidence, practical evidence or efficacy in older persons
  • C - Suitable for older persons, with specific cautions, and
  • D - Avoid use in older persons.

The most commonly used international criteria (Beers, STOPP/START and Laroche) were taken into account when creating the database.

Nationwide registers were used to follow more than 20,000 community-dwelling people aged ≥65 years between the years 2002 and 2013. Matching persons were identified from the non-users group for those persons who purchased PIMs during the 12-year follow-up.

The study indicates that the risk of fracture-specific hospitalisation and mortality is higher when initiating PIMs. Previous studies conducted in Europe have not investigated hospital costs associated with PIM use with as long a follow-up as this study.

PIM prescription always requires clinical grounds, which take account of the risks related to medication treatments. The purpose of the Meds75+ database is to support clinical decision-making on the pharmacotherapy of patients over 75 years of age and to improve the safety of medication in primary health care. Meds75+ is available free of charge at Fimea’s website.

The study was published in the European Journal of Health Economics.