REview of potentially inappropriate MEDIcation pr[e]scribing in Seniors (REMEDI[e]S): French implicit and explicit criteria

Background: The elderly people have high morbimortality associated with respiratory disorders, in addition to the presence of other safety risk factors, such as the use of potentially inappropriate medication and the occurrence of drug interactions. Objective: Considering the current pandemic scenario, it was intended to identify explicit criteria-based tools that reported drug interactions between potentially inappropriate medication and respiratory system disorders and possibly worse prognosis of COVID-19 infection. Methods: A systematic scoping review was conducted until February 2020. Study characteristics of explicit criteria-based tools, and potentially inappropriate medication, drug interactions, and therapeutic management, were extracted. Results: Nineteen explicit criteria-based tools were included. Nineteen drug interactions and 17 potentially inappropriate medications with concerns for three respiratory disorders (asthma, chronic pulmonary obstructive disease, and respiratory failure) were identified. The most frequent pharmacological classes reported were benzodiazepines and beta-blockers. For clinical management, the tools recommend using cardioselective beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II type I receptor blockers, and benzodiazepines with a short or intermediate half-life. Conclusion: Considering the increased risk of COVID-19 infection in the elderly, drug interactions and the use of potentially inappropriate medication associated with the occurrence of adverse drug events in the respiratory system may also worsening COVID-19 infection in patients with uncontrolled respiratory disorders. Thus, it is essential to assess drug therapy in use, to identify safety risks, and monitor the elderly in general and those with a worse prognosis concerning COVID-19, promoting patient safety.

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Explicit Criteria for Determining Potentially Inappropriate Medication Use by the Elderly

Archives of Internal Medicine ◽

10.1001/archinte.1997.00440350031003 ◽

1997 ◽

Vol 157 (14) ◽

pp. 1531 ◽

Cited By ~ 835

Author(s):

Mark H. Beers

Keyword(s):

Inappropriate Medication ◽

Medication Use ◽

The Elderly ◽

Potentially Inappropriate Medication ◽

Inappropriate Medication Use ◽

Explicit Criteria

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Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria

European Journal of Clinical Pharmacology ◽

10.1007/s00228-018-2446-0 ◽

2018 ◽

Vol 74 (6) ◽

pp. 679-700 ◽

Cited By ~ 48

Author(s):

Fabiane Raquel Motter ◽

Janaína Soder Fritzen ◽

Sarah Nicole Hilmer ◽

Érika Vieira Paniz ◽

Vera Maria Vieira Paniz

Keyword(s):

Systematic Review ◽

Inappropriate Medication ◽

The Elderly ◽

Potentially Inappropriate Medication ◽

Explicit Criteria

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Explicit criteria for determining potentially inappropriate medication use by the elderly. An update

Archives of Internal Medicine ◽

10.1001/archinte.157.14.1531 ◽

1997 ◽

Vol 157 (14) ◽

pp. 1531-1536 ◽

Cited By ~ 150

Author(s):

M. H. Beers

Keyword(s):

Inappropriate Medication ◽

Medication Use ◽

The Elderly ◽

Potentially Inappropriate Medication ◽

Inappropriate Medication Use ◽

Explicit Criteria

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Comparison of adaptive versions of the Hong Kong-specific criteria and 2015 Beers criteria for assessing potentially inappropriate medication use in Hong Kong older patients

BMC Geriatrics ◽

10.1186/s12877-021-02324-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Huanyu ZHANG ◽

Eliza L. Y. WONG ◽

Samuel Y. S. WONG ◽

Patsy Y. K. CHAU ◽

Benjamin H. K. YIP ◽

...

Keyword(s):

Older Adults ◽

Hong Kong ◽

Older Patients ◽

Inappropriate Medication ◽

Female Gender ◽

Potentially Inappropriate Medication ◽

Multivariable Logistic Regression Analysis ◽

Beers Criteria ◽

Medical Conditions ◽

Cross Sectional

Abstract Background The Hong Kong-specific criteria have been established in 2019 to assess potentially inappropriate medication (PIM) use in older adults and improve the local prescribing quality. The aim of this study was to compare the adaptive versions of the Hong Kong-specific criteria and 2015 Beers criteria for assessing the prevalence and correlates of PIM use in Hong Kong older patients. Methods A cross-sectional study was performed from January 1, 2014 to December 31, 2014 using the Hospital Authority (HA) database. A total of 489,301 older patients aged 65 years and older visiting general outpatient clinics (GOPCs) during the study period were included in the study. Two categories of PIM use included in the Hong Kong-specific criteria and 2015 Beers criteria, i.e. PIMs independent of diagnoses and PIMs considering specific medical conditions, were adapted to assess the prevalence of PIM use among the study sample. Characteristics of PIM users and the most frequently prescribed PIMs were investigated for each set of the criteria. Factors associated with PIM use were identified using the stepwise multivariable logistic regression analysis. Results The adaptive Hong Kong-specific criteria could detect a higher prevalence of patients exposed to at least one PIM than that assessed by the adaptive Beers criteria (49.5% vs 47.5%). Meanwhile, the adaptive Hong Kong-specific criteria could identify a higher rate of patients exposed to PIMs independent of diagnoses (48.1% vs 46.8%) and PIMs considering specific medical conditions (7.3% vs 4.9%) compared with that of the adaptive Beers criteria. The most frequently prescribed PIMs detected by the adaptive Beers criteria were all included in the adaptive Hong Kong-specific criteria. The strongest factor associated with PIM use was number of different medications prescribed. Patients with female gender, aged 65 ~ 74 years, a larger number of GOPC visits, and more than six diagnoses were associated with greater risk of PIM use, whereas advancing age was associated with lower risk of PIM use. Conclusions The adaptive Hong Kong-specific criteria could detect a higher prevalence of PIM use than the adaptive Beers criteria in older adults visiting GOPCs in Hong Kong. It is necessary to update the prevalence and correlates of PIM use regularly in older adults to monitor the burden of PIM use and identify vulnerable patients who need further interventions.

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Development of an explicit tool assessing potentially inappropriate medication use in Hong Kong elder patients

BMC Geriatrics ◽

10.1186/s12877-021-02024-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Huanyu Zhang ◽

Eliza LY Wong ◽

Eng-kiong Yeoh ◽

Bosco HM Ma

Keyword(s):

Hong Kong ◽

Inappropriate Medication ◽

Delphi Process ◽

Potentially Inappropriate Medication ◽

Medical Conditions ◽

Modified Delphi ◽

Adverse Health Outcomes ◽

Elder Patients ◽

Prescribing Quality ◽

Prescribing Practice

Abstract Background Potentially inappropriate medication (PIM) use has adverse effects on health, particularly in elder patients. Various country-specific explicit criteria have been developed to measure the appropriateness of prescribing worldwide. However, it is difficult to apply the criteria developed from other regions to measure and guide the local prescribing practice in Hong Kong. This study aims to develop a Hong Kong-specific PIM assessing tool from previously published criteria and validate this tool using the modified Delphi method. Methods A disease-oriented Hong Kong-specific preliminary PIM list was developed based on nine sets of reference criteria selected from a literature review. Any medication or medication class appeared in at least two sets of the reference criteria as well as its related medical conditions were selected as PIM candidates. After examining the availability of PIM candidates by the Hong Kong Hospital Authority drug formulary, the Hong Kong-specific preliminary PIM list was validated by a two-round of modified Delphi process. Eight experts from different specialties were invited to rate the degree of inappropriateness of each PIM candidate using a five-point Likert scale. The experts were also encouraged to propose therapeutic alternatives and new PIM candidates not covered by the preliminary PIM list. The PIM candidates that the expert panel didn’t reach consensus on were excluded from the final Hong Kong-specific PIM list. Results After two rounds of the Delphi process, eight PIM candidates remained questionable and thus were excluded from the PIM list. The final Hong Kong-specific PIM list included a total of 164 statements applicable to older adults aged 65 years or above, among which 77 were under PIMs independent of diagnoses, and 87 were under PIMs considering specific medical conditions. Conclusions The Hong Kong-specific PIM list can be used as a quality measure and an educational tool to improve the local prescribing quality. Further studies should validate its association with adverse health outcomes in clinical and research settings.

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Prevalence of Polypharmacy and Risks of Potentially Inappropriate Medication Use in the Older Population in a Developing Country: A Systematic Review and Meta-Analysis

Gerontology ◽

10.1159/000516075 ◽

2021 ◽

pp. 1-10

Author(s):

Akshaya Srikanth Bhagavathula ◽

Eyob Alemayehu Gebreyohannes ◽

Daniela Fialova

Keyword(s):

Risk Factors ◽

Developing Countries ◽

Literature Review ◽

Developing Country ◽

Systematic Literature Review ◽

Meta Analysis ◽

Inappropriate Medication ◽

Older Age ◽

Potentially Inappropriate Medication ◽

Older Population

Background and Aim: Polypharmacy and potentially inappropriate medication (PIM) use in older populations (65+ years) have not yet been investigated by meta-analyses in developing countries. This systematic literature review and meta-analysis aimed to investigate the prevalence of polypharmacy and PIM use and major risk factors associated with PIM prescribing in older adults in Ethiopia. Methods: We searched PubMed/MEDLINE, Scopus, Embase, and Google Scholar databases to identify relevant studies published between January 1990 and October 2020. Observational studies reporting the prevalence and association of risk factors with polypharmacy and PIM use in the older population were meta-analyzed. A multilevel meta-analysis was conducted to pool the prevalence estimates, and the risk of PIM use was reported as a relative risk (RR) with a 95% confidence interval (CI). Results: We identified by systematic literature review 404 articles. Of those, 8 studies fulfilled inclusion criteria, comprising a total sample of 2,608 participants. The overall prevalence of polypharmacy and PIM use pooled by meta-analysis in the Ethiopian older population was 33 and 37%, respectively. The risk factors of PIM use were analyzed in the meta-analysis (particularly polymorbidity, polypharmacy, gender, and older age), and only older age of 65+ (RR: 1.71, 95% CI: 1.16–2.51) was significantly associated with PIM use. Conclusion: This first meta-analysis from a developing country revealed a high prevalence of polypharmacy and PIM use in the Ethiopian older population. There was no awareness about the risk of PIMs in patients with polypharmacy and polymorbidity, and older age significantly predicted PIM use. Interventions ensuring rational geriatric pharmacotherapy are essential in developing countries in order to reduce the expected burden of PIM-related geriatric morbidity, higher costs, and mortality.

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