OBJECTIVES : The American Geriatrics Society list of Potentially Inappropriate Medication (Beers Criteria) use in older adults (>64-years) includes Proton Pump Inhibitors (PPIs), and specifically cautions against their long-term (>8 weeks) use. PPIs are prescribed to reduce the production of stomach acid, however there is strong evidence older adults are at risk of extreme adverse events (AE), such as infection and bone loss from prolonged exposure. This study seeks to identify characteristics of older adults who nevertheless receive long-term prescriptions of PPIs and their most commonly reported adverse events.

METHODS : Older adults (>64-years) were identified in the 2017 Medical Expenditure Panel Survey (MEPS) and the FDA Adverse Event Report System (FAERS, as of June 30, 2019). With the MEPS data, a generalized linear model using a quasi-binomial link function was used to identify characteristics associated with long-term PPI use. The FAERS data was categorized by patient demographics and System Organ Class (SOC).

RESULTS : 4,288 patients older adults were included in MEPS, weighted to represent over 46 million Americans. Of these, 19.6% had been prescribed a PPI in 2017, and 10.05% had a long-term (>8 week) prescription. Patients with arthritis (adjusted-OR: 1.52, 95% CI: 1.17-1.98) and asthma (adjusted-OR: 1.73, 95% CI: 1.24-2.41) were more likely to report long-term PPI use, as were patients with 5+ prescriptions (adjusted-OR: 4.31, 95% CI: 2.71-6.85). The adjusted odds ratios (ORs) were not different by age, gender, income, or education-level. For all PPIs, 28,031 (age>64) AE cases were found in FAERS. The most commonly reported AEs were gastrointestinal disorders, and renal or urinary disorders, which appeared in 50% of included cases.

CONCLUSIONS : Contrary to the American Geriatrics Society's recommendations, our study found long-term PPI use is common among older US adults. This study has identified risks from and patient characteristics associated with long-term PPI use among older adults.