A population-based study of drug use in the very old living in a rural district of Sweden, with focus on cardiovascular drug consumption: comparison with an urban cohort

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Abstract
To describe drug use among the elderly, with focus on cardiovascular drugs and regional differences. Cross-sectional data from a Swedish population-based study on ageing and dementia were used. In rural Nordanstig, drug-use data for 918 participants, 75 years and older (N1), were collected during the period 1995-1998. The data for 335 participants, 84 years and older (N84+), were compared with 418 subjects of the same age group in urban Kungsholmen (K5), data collected 1997-1998. Over 90% of the participants were using drugs regularly or 'as needed'. The most common were cardiovascular drugs, nervous system drugs and drugs for the alimentary tract and metabolism. Polypharmacy (five drugs or more) was common, especially among the oldest, 46% (N84+) and 50% (K5). ACE-inhibitors were used by only 24% of the N1 participants with heart failure. Significantly fewer of cognitively impaired participants were treated with ACE-inhibitors (OR: 0.44) and beta-blockers (OR: 0.50). Significant regional differences among the oldest old were found, with more cardiovascular (OR: 2.72) and less antithrombotic drugs (OR: 0.43) in the rural 84+ group. The extensive drug consumption, high prevalence of polypharmacy and regional differences stress the need for rigorous monitoring of drug use in the elderly. The data also indicate undertreatment of some cardiovascular diseases in the elderly with cognitive impairment.

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