As the population ages, morbidity and medication use increase, which increases the use and costs of social and health services. Now when the pressure for savings is increasing, attention should be focused on the quality of medication management and the prevention of harmful outcomes of medications.
In her doctoral thesis, MSc (Pharmacy) Jasmin Paulamäki investigated prevalence of potentially inappropriate medication (PIM) use and factors associated with prescribing these medications in Finland. PIMs are medications which risk of harm usually outweigh the clinical benefits in older adults. The Finnish Meds75+ database supports clinical decision-making on prescribing safer medications for older adults and includes approximately 90 medications classified as PIMs. Previous studies have shown that the use of PIMs is associated with adverse drug events, such as confusion and falls, which increase the need for health care services and, consequently, health care costs.
A key finding of Paulamäki’s thesis is that the identification of PIMs varies between Finnish and international criteria. Using data from the Social Insurance Institution’s (SII’s) nationwide Prescription Centre on prescription medicines purchases of older adults aged 75 and over in years 2017–2019, the study found that the prevalence of PIMs varies annually from 11% to 57%, depending on the applied criteria. The results show that there are major development needs in pharmacotherapy for older adults in Finland. The most commonly used Meds75+ PIMs reimbursed by SII's national health insurance are opioids, muscle relaxants, and hypnotics.
Paulamäki found that regional differences in the use of reimbursed PIMs and higher PIM prevalence are associated with personnel shortages in health centers and home care.
“An interesting finding was that a longer interval between RAI assessments, i.e. service needs assessment and planning, for home care clients was associated with an increased risk of initiating PIMs. Based on these results, poor continuity of social and health services is associated with the prescription of medications whose harms outweigh the clinical benefits among older adults”, Paulamäki says.
The harms related to PIM use are highlighted in older home care clients who need support for independent living. By utilizing regularly conducted comprehensive RAI assessments, Paulamäki demonstrated that the characteristics of home care clients, such as impaired cognition, higher education level, and independent outdoor activity, were also associated with higher risk to initiate PIMs.
According to Paulamäki, the demonstrated association between PIM initiation and impaired cognition is particularly concerning given the growing number of older adults with memory disorders and their increasing service needs. Choosing safer pharmacotherapies for the older adults would support their functional capacity and ensure safe living in their own homes, which is in line with national goals.
“What goes around comes around, meaning that our choices in how we meet the needs of older adults in medication management, have consequences. By reducing the prescription of PIMs, for example, through training of health care professionals and improving continuity of care, would help to prevent negative outcomes of PIM use and save our overburdened and under-resourced health care system”, Paulamäki concludes.
Jasmin Paulamäki works at the Finnish Medicines Agency Fimea in Tampere.
Public defence on Friday 28 March
Master of Science Jasmin Paulamäki’s doctoral dissertation” Potentially Inappropriate Medication Among Older Adults: Prevalence, regional variation and risk of initiation” will be publicly examined at the Faculty of Medicine and Health Technology at Tampere University on Friday 28 March 2025 at 12 o’clock at Kauppi campus, Arvo building, auditorium F115 (Arvo Ylpön katu 34, Tampere). The opponent will be Professor Anne Gerd Granås from University of Oslo. The Custos will be Professor Tuomas Koskela from the Faculty of Medicine and Health Technology, Tampere University.