Background: Proton pump inhibitors (PPIs) are used to decrease stomach acid. However, prolonged use >12 weeks is generally discouraged due to safety concerns, unless necessitated by specific clinical circumstances such as the chronic use of bleeding-risk-increasing drugs (BRIDs). We aimed to determine the prevalence and associated factors of inappropriate PPI overuse in residential aged care facilities (RACFs).
Method: A longitudinal cohort study using 8 years of electronic data from 34 RACFs managed by two aged care providers in NSW, Australia. The study included 6439 permanent residents aged ≥65 years, each with a length of stay >100 days. Continuous PPI use for more than 12 weeks, in the absence of BRIDs (>30 days) use was classified as ‘potentially inappropriate’. Logistic regression was used to determine factors associated with inappropriate PPI overuse.
Results: Over half of the residents (54.0%, n=3478) received a PPI, with a median duration of 46 weeks. Four out of five PPI users (83.6%, n=2,906) utilised PPIs for >12 weeks, although 67.5% (n=1962/2906) of them were concomitant chronic BRID users. After accounting for chronic BRID use, the prevalence of inappropriate PPI overuse was 27.1% (n=944). Residents in facilities in one provider group were four times more likely to experience PPI overuse compared to other provider group (OR 4.08; 95% CI 2.73-6.09).
Conclusion: Our study revealed that over a quarter of PPI users exceeded the recommended duration outlined in clinical guidelines. This highlights the need for tailored interventions such as medication reviews and deprescribing initiatives to reduce inappropriate PPI use.