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

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.