Comparison of FORTA, PRISCUS and EU(7)-PIM lists on identifying potentially inappropriate medication and its impact on cognitive function in multimorbid elderly German people in primary care: a multicentre observational study
Hans-Helmut König,
Tobias Dreischulte,
Claudia Langebrake,
Steffi G Riedel-Heller,
Martin Scherer,
Gerhard Schön,
Ingmar Schäfer,
Wolfgang von Renteln-Kruse,
Birgitt Wiese,
Caroline Krüger,
Hendrik van den Bussche,
Horst Bickel,
Angela Fuchs,
Wolfgang Maier,
Karola Mergenthal,
Siegfried Weyerer
Affiliations
Hans-Helmut König
Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Tobias Dreischulte
Department of General Practice and Family Medicine, LMU Hospital, Munich, Germany
Claudia Langebrake
Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Steffi G Riedel-Heller
Institute of Social Medicine, Occupational Health and Public Health, Leipzig University, Leipzig, Sachsen, Germany
Martin Scherer
professor of health services research
Gerhard Schön
Department of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
Ingmar Schäfer
Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Wolfgang von Renteln-Kruse
Research Department, Albertinen-Haus Zentrum für Geriatrie und Gerontologie Medizinisch-Geriatrische Klinik, Hamburg, Germany
Birgitt Wiese
Institute for General Practice, Hannover Medical School, Hannover, Germany
Caroline Krüger
Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Hendrik van den Bussche
Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Horst Bickel
Department of Psychiatry, Technical University of Munich, Munchen, Germany
Angela Fuchs
Institute of General Practice, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
Wolfgang Maier
Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
Karola Mergenthal
3Goethe-University Frankfurt, Institute for General Practice, Frankfurt, Germany
Siegfried Weyerer
Medical Faculty, Central Institute of Mental Health, Mannheim, Germany
Objectives Our study aimed to assess the frequency of potentially inappropriate medication (PIM) use (according to three PIM lists) and to examine the association between PIM use and cognitive function among participants in the MultiCare cohort.Design MultiCare is conducted as a longitudinal, multicentre, observational cohort study.Setting The MultiCare study is located in eight different study centres in Germany.Participants 3189 patients (59.3% female).Primary and secondary outcome measures The study had a cross-sectional design using baseline data from the German MultiCare study. Prescribed and over-the-counter drugs were classified using FORTA (Fit fOR The Aged), PRISCUS (Latin for ‘time-honoured’) and EU(7)-PIM lists. A mixed-effect multivariate linear regression was performed to calculate the association between PIM use patients’ cognitive function (measured with (LDST)).Results Patients (3189) used 2152 FORTA PIM (mean 0.9±1.03 per patient), 936 PRISCUS PIM (0.3±0.58) and 4311 EU(7)-PIM (1.4±1.29). The most common FORTA PIM was phenprocoumon (13.8%); the most prevalent PRISCUS PIM was amitriptyline (2.8%); the most common EU(7)-PIM was omeprazole (14.0%). The lists rate PIM differently, with an overall overlap of 6.6%. Increasing use of PIM is significantly associated with reduced cognitive function that was detected with a correlation coefficient of −0.60 for FORTA PIM (p=0.002), −0.72 for PRISCUS PIM (p=0.025) and −0.44 for EU(7)-PIM (p=0.005).Conclusion We identified PIM using FORTA, PRISCUS and EU(7)-PIM lists differently and found that PIM use is associated with cognitive impairment according to LDST, whereby the FORTA list best explained cognitive decline for the German population. These findings are consistent with a negative impact of PIM use on multimorbid elderly patient outcomes.Trial registration number ISRCTN89818205.
