[Sex differences in drug use by over 75-year-old persons at home: an epidemiologic study in Bern]

The purpose of this study was to explore gender differences of medication use in a random sample of community-dwelling elderly subjects (N = 791). The average number of different medications in women (N = 578) was higher than in men (N = 213) (4.0 vs. 3.5, age corrected ratio 1.2, 95% confidence interval, 1.0-1.3). However, despite this relatively small difference in number of medications there was a major gender difference in the pattern of medications used. Compared to men, women had a higher use of benzodiazepines (risk ratio 1.7, 95% confidence interval, 1.3-2.3), diuretics (1.5, 1.1-2.0), nonsteroidal antiinflammatory agents (1.7, 1.2-2.3), and anti-depressants (2.5, 1.1-5.5), but a lower use of pulmonary (0.5, 0.3-0.9) and gout medications (0.2, 0.1-0.6). These gender differences in medication use can be explained by the fact that compared to men, women have a higher prevalence of non-lethal chronic conditions such as degenerative joint disease and hypertension. However, additional factors such as gender-specific differences in patient or physician behavior are likely to contribute to the observed differences in medication use as well. Overall, 36% of all women and 21% of all men were using benzodiazepines, with 42% of these subjects using long-acting compounds. Furthermore, 24% of all women and 15% of all men reported use of nonsteroidal antiinflammatory agents for which safer medication and non-medication alternatives would be available in many cases. Thus, women had a higher risk of inappropriate medication use than men. On the other hand, the finding that antidepressant use was 3% in men and 7% in women indicates that compared to women, men might be at increased risk for undertreatment of depression. Further causal evaluation of gender differences in both medication use and patient-physician interaction might contribute to detection and reduction of inappropriate drug use in older persons.