Polypharmacy among elderly populations

2017 ◽  
Vol 41 (S1) ◽  
pp. S315-S315
Author(s):  
I. Leal ◽  
P. Ordás ◽  
R. Vicente ◽  
C. Avila
Keyword(s):  
Older Patients ◽  
Psychiatric Illness ◽  
Inappropriate Prescribing ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Screening Tools ◽  
University Hospital ◽  
Potentially Inappropriate Medications ◽  
Potentially Inappropriate Prescribing ◽  
Cross Sectional

IntroductionPotentially inappropriate prescribing, is highly prevalent among older patients hospitalized with major psychiatric illness. Inappropriate use of psychotropic medications in elderly patients has become a focus of concern.ObjectivesTo determine the prevalence of potentially inappropriate prescribing including potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs), according to STOPP-START, Beers and PRISCUS criteria applied by CheckTheMeds®.AimsTo identify potentially IP, PPo and the prevalence of contraindications, interactions and precautions in older patients hospitalized with major psychiatric illness.MethodsRetrospective cross-sectional study with patients over 65 discharged from the Psychiatric acute unit of the university hospital of La Princesa (Madrid) between January 2013 and October 2015 was conducted. The CheckTheMeds® program was used to identify IP.ResultsA total of 104 elders–74 females and 30 males–were included, with a mean age of 76 years (range: 65–91). An average of 5.73 (range: 1–16) was prescribed drugs at discharge. The Ip results STOPP 81.73% (n = 85), START 43.26% (n = 45), Beers 94.23% (n = 98) y PRISCUS 40.38% (n = 42). Contraindications were described in the 21.15% of the patients, precautions in 83.65% and interactions in 83.65%. Psychotropic drugs were the most often inappropriate prescribed medicaments.ConclusionPrescribing omissions are twice as prevalent as IP in the elderly. Currently, inappropriate prescription of psychotropic agents is very common for the elderly. Application of such screening tools to prescribing decisions may reduce unnecessary medication, related adverse events, healthcare utilization and cost and nonpharmacological interventions, should be thoroughly explored.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Potentially Inappropriate Prescribing and Potential Clinically Significant Drug–Drug Interactions in Older Outpatients: Is There Any Association?

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 332
Author(s):  
Zorica Cvetković ◽  
Aneta Perić ◽  
Silva Dobrić
Keyword(s):  
Drug Interactions ◽  
Inappropriate Prescribing ◽  
Cross Sectional Study ◽  
Potentially Inappropriate Medications ◽  
Potentially Inappropriate Prescribing ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
Inappropriate Drugs ◽  
Stopp Criteria ◽  
Clinically Significant

Background and Objectives: The purpose of the study was to determine the prevalence rate of potentially inappropriate prescribing (PIP), by using the Screening Tool of Older Person’s potentially inappropriate Prescriptions (STOPP) criteria in older outpatients, and its association with potential clinically significant drug–drug interactions (csDDIs). Materials and Methods: A cross-sectional study included 248 outpatients ≥65 years old divided into two groups depending on the presence of csDDIs. For estimating the clinical significance of csDDIs we used Medscape′s "Drug Interaction Checker". We applied the thirty PIP indicators from the STOPP criteria. Results: The presence of PIP (25.00%; all patients) was significantly higher in the group with potential csDDIs compared to the other group (43 vs. 19, respectively; Chi-square test, χ2 = 9.947; p < 0.01). The most common PIP included the inappropriate use of proton pump inhibitors, long acting benzodiazepines, usage of thiazide diuretic in patients with gout, and duplication of therapeutic class. Patients with potential csDDIs had 43 potentially inappropriate medications (PIMs) prescribed. Out of this number, 12 (27.91%) PIMs were identified to participate in potential csDDIs. There was a correlation between the number of medications prescribed and the number of PIMs (ρ = 0.297; p < 0.01) and between the number of PIPs and the number of potential csDDIs (ρ = 0.170; p < 0.01). Conclusions: Older outpatients with potential csDDIs in relation to those with no potential csDDIs had significantly more prescribed drugs in total as well as inappropriate drugs. Almost 30% of these PIMs were included in potential csDDIs.

scholarly journals Identification of inappropiate prescribing in a Geriatric outpatient clinic using the Criteria Stopp Start

2016 ◽  
Vol 19 (5) ◽  
pp. 871-879 ◽  
Author(s):  
Andressa Stella Kuhn Correia da Rosa ◽  
Bruna Polanski Costa ◽  
Cássia Pinheiro Kapper ◽  
Gabriela Graça Soder Dalmas ◽  
Lissiê Lunardi Sbroglio ◽  
...  
Keyword(s):  
Acetylsalicylic Acid ◽  
Cardiovascular System ◽  
Outpatient Clinic ◽  
Inappropriate Prescribing ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Potentially Inappropriate Medications ◽  
Cross Sectional ◽  
Start Criteria ◽  
Stopp Criteria

Abstract Identified the inappropriate prescription of drugs in elderly assisted geriatric outpatient clinic in the region of Vale do Rio Pardo in Rio Grande do Sul according to the criteria of STOPP and START. Cross-sectional study of 221 elderly, based on retrospective analysis of medical records using comprehensive geriatric assessment data held in the first visit. Descriptive variables were age, sex, number of pathologies and number of medications in use. And the study variables were potentially inappropriate medications (MPI) and potentially omitted medications (MPO), according to the STOPP and START criteria. Descriptive statistics were performed with frequencies, means and standard deviations where appropriate. It was observed 157 (71%) female patients. The average age was 75 (±8.26) years, 49.8% in the range of 75-84 years. The average number of drugs was 3 (±2.27), with 22.63% using 5 or more medications. The average pathologies was 3.45 (±2.02). They identified 194 prescriptions of MPI and observed 93 MPO. The most identified were the MPI for the cardiovascular system, especially β noncardioselective blockers and acetylsalicylic acid. Also MPO were found most of the cardiovascular system, with emphasis on acetylsalicylic acid and inhibitors of angiotensin converting enzyme. This is sample of elderly with significant prevalence of inappropriate prescribing of drugs. Studies using the STOPP criteria and START in different health care settings can qualify the care provided to the elderly.

scholarly journals Deprescribing: What are the views and factors influencing this concept among patients with chronic diseases in a developed Asian community?

2017 ◽  
Vol 26 (3) ◽  
pp. 172-179 ◽  
Author(s):  
Wei Ling Ng ◽  
Mark Zhong Wei Tan ◽  
Eileen Yi Ling Koh ◽  
Ngiap Chuan Tan
Keyword(s):  
Chronic Diseases ◽  
Primary Healthcare ◽  
Inappropriate Prescribing ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Adverse Outcomes ◽  
Potentially Inappropriate Medications ◽  
Prescription Medications ◽  
Cross Sectional ◽  
Physician Trust

Objective: Public primary healthcare clinics in Singapore manage a large proportion of elderly patients with chronic diseases. Inappropriate prescribing of medications and polypharmacy in the elderly are associated with adverse outcomes. It is hence important to stop potentially inappropriate medications in this vulnerable group. An approach coined ‘deprescribing’ has been used to describe a patient-centred process of optimising medication regimens. The study aimed to elucidate patients’ attitudes towards the number of medications they were taking and identify factors that might influence acceptance of deprescription. Method: A cross-sectional study using the validated Patients’ Attitudes Towards Deprescribing (PATD) questionnaire was performed at two public primary healthcare institutions in Singapore. Participants were on regular follow-up at the clinics for chronic disease management and had at least five regular prescription medications. Results: The study found that participants (with a mean age of 68) had an average of four medical conditions and six prescription medications, with the majority (60.3%) expressing that they were taking a large number of medications. Of note, 93.4% of participants were willing to stop one of their medications if advised by the doctor. This was associated with a younger age (<65 years old), not having a discount card for medications and having a higher physician trust score (Wake Forest Physician Trust Score). Conclusions: This study showed that majority of the participants were willing to cease a medication that their physician thought was no longer required. Factors were also identified which potentially may be targeted to facilitate deprescription.

scholarly journals The Prevalence of Potentially Inappropriate Prescribing in Geriatric Patients with Psychiatric Disorders in Iraq

2020 ◽  
Vol 29 (1) ◽  
pp. 166-173
Author(s):  
Mustafa K. Mahmood ◽  
Zinah M. Anwer
Keyword(s):  
Geriatric Patients ◽  
Assessment Tool ◽  
Psychiatric Patients ◽  
Inappropriate Medication ◽  
Inappropriate Prescribing ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Beers Criteria ◽  
Potentially Inappropriate Prescribing ◽  
Cross Sectional

Potentially inappropriate prescribing is the prescribing of a medication that may cause more harm than benefit, the elderly population aged 65 years or older is more prone to potentially inappropriate prescribing because of alterations in their physiology, pharmacokinetics, and pharmacodynamics as well as polypharmacy and comorbidities, Beers list is a screening tool that help doctors to detect potentially inappropriate prescribing in geriatric patients and is designed to solve this problem, the aim of this study is to measure the prevalence of potentially inappropriate prescribing among psychiatric patients using the Beers criteria as an assessment tool and find the relationship between duration of hospitalization, comorbidities and polypharmacy with potentially inappropriate prescribing in elderly. This cross-sectional study was carried out using electronic medical records in Ibn Rushud psychiatry and addiction hospital in Baghdad and 369 patients were included. The mean age of the patients was (68.59 ± 3.75 years) and 177 (48%) of them had comorbidities, 100 (27.1%) of them had polypharmacy and 17 (4.6%) stayed in the hospital for more than 3 weeks, the most used drug classes were antipsychotics in (39.9%) of patients and benzodiazepines in (17.6%) of patients. The prevalence of potentially inappropriate prescribing according to Beers criteria was found to be 74.3% among study patients, the most prevalent inappropriately used drug class was benzodiazepines, and there was a significant association between the prescribing of a potentially inappropriate medication with gender (p=0.018), with comorbidities (p=0.022), and a very significant association with polypharmacy (p<0.001)

scholarly journals Identification of inappropriate prescribing in a Brazilian nursing home using STOPP/START screening tools and the Beers' Criteria

2014 ◽  
Vol 50 (4) ◽  
pp. 911-918 ◽  
Author(s):  
Mariana Martins Gonzaga Nascimento ◽  
Andréia Queiroz Ribeiro ◽  
Mariana Linhares Pereira ◽  
Adriana Cristina Soares ◽  
Antônio Ignácio de Loyola Filho ◽  
...  
Keyword(s):  
Nursing Home ◽  
Medical Records ◽  
Inappropriate Medication ◽  
Inappropriate Prescribing ◽  
Cross Sectional Study ◽  
Screening Tools ◽  
Beers Criteria ◽  
Cross Sectional ◽  
The Past ◽  
Prescribing Omissions

The objective of this study was to determine the prevalence of Potentially Inappropriate Medication (PIM) use and associated factors, as well as the prevalence of Prescribing Omissions (PO). A cross-sectional study was conducted in a philanthropic Brazilian nursing home involving 46 individuals aged 60 years or older. The following information was collected from medical records and drug prescriptions: gender, age, health conditions and drugs used in the past thirty days. PIM and PO were identified according to the Beers' Criteria and the STOPP/START screening tools. Over one third (37%) of the population used at least one PIM according to the Beers' Criteria (n=17) and 60.9% according to the STOPP tool. A significant association was found between polypharmacy (use of five or more drugs) and use of PIM according to the Beers' Criteria, but not according to the STOPP. Eight residents (17.4%) were exposed to eight PO. This study allowed the diagnosis of a concerning drug utilization profile with use of a high number of PIMs. Thus, there is an evident need to implement strategies for improving geriatric prescription.

scholarly journals Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e031483 ◽  
Author(s):  
Socheat Cheng ◽  
Tahreem Ghazal Siddiqui ◽  
Michael Gossop ◽  
Espen Saxhaug Kristoffersen ◽  
Christofer Lundqvist
Keyword(s):  
Pain Intensity ◽  
Older Patients ◽  
Adverse Drug Events ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medication Misuse ◽  
Factors Associated ◽  
Concurrent Use

ObjectivesTimely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics.DesignA prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.SettingSomatic departments of the Akershus University Hospital, Norway.Participants246 patients aged 65–90 were included.Outcome measuresProlonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients’ characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence.ResultsForty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75–84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs <75 years, for pain intensity (OR=1.02, 95% CI 1.01 to 1.04), and polypharmacy versus no polypharmacy (OR=5.16, 95% CI 2.13 to 12.55). The odds were lower for patients who completed secondary education (OR=0.33, 95% CI 0.13 to 0.83) compared with those with only basic education. Factors associated with misuse or dependence were pain intensity (OR=1.02, 95% CI 1.01 to 1.04) and concurrent use of ≥2 CNSDs (OR=3.99, 95% CI 1.34 to 11.88).ConclusionCNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs.Trial registration numberNCT03162081.

scholarly journals Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

Medicina ◽  
2018 ◽  
Vol 54 (4) ◽  
pp. 57 ◽  
Author(s):  
Muhammad Sarwar ◽  
Sadia Iftikhar ◽  
Muhammad Sarfraz
Keyword(s):  
Older People ◽  
Older Patients ◽  
Formal Education ◽  
Cross Sectional Study ◽  
Education Level ◽  
P Value ◽  
Potentially Inappropriate Medications ◽  
Sectional Study ◽  
Cross Sectional ◽  
Inappropriate Medications

Objective: To evaluate influence of education level of older patients on polypharmacy, potentially inappropriate medications (PIMs) listed in Beer’s Criteria, and unplanned hospitalization. Methods: A cross-sectional study was conducted among older people aged ≥65 years between 1 December 2017 and 28 February 2018. For data analysis, descriptive statistics and logistic regression analysis were employed. Results: Among 385 older patients, 88.8% were prescribed PIMs and 56.4% underwent PIMs associated unplanned hospitalization. Older people were less exposed to polypharmacy or excessive polypharmacy as their education levels increased (no formal education vs. primary vs. secondary vs. tertiary, 74% vs. 69.8% vs. 60.5% vs. 58.1%). Patients having higher education were also accompanied by significantly lower prescription of PIMs (no formal education vs. primary vs. secondary vs. tertiary, 96% vs. 87.3% vs. 84.5% vs. 79.1%) as well as unplanned hospitalization (no formal education vs. primary vs. secondary vs. tertiary, 64.7% vs. 76.2% vs. 40.3% vs. 46.5%). Results of regression analysis revealed that no formal education (OR = 1.202, 95% CI = 1.032–2.146, p-value = 0.003) and primary education level (OR = 1.175, 95% CI = 1.014–1.538, p-value = 0.039) were significantly associated with the use of polypharmacy among older people. On the other hand, no formal education was significantly associated with the prescription of PIMs (OR = 1.898, 95% CI = 1.151–2.786, p-value = 0.007). Furthermore, older people with no formal education (OR = 1.402, 95% CI = 1.123–1.994, p-value = 0.010) and primary education level (OR = 1.775, 95% CI = 1.281–3.018, p-value = <0.001) were significantly more likely to undergo unplanned hospitalization. Conclusions: Patients having low literacy level are more likely to receive PIMs, polypharmacy, and undergo unplanned hospitalization in comparison to highly educated patients. Hence, promotion of health literacy for patients is crucial to overcome these problems.

Profile of the cases of violence reported in university hospital

2010 ◽  
Vol 4 (3) ◽  
pp. 1457
Author(s):  
Aline Do Nascimento Silva ◽  
Eduardo Tavares Gomes ◽  
Renata Livia Alves de Souza Melo ◽  
Rutheanne Melo de Siqueira ◽  
Lucileide Silva Fonteles
Keyword(s):  
The Elderly ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Sectional Study ◽  
Specific Training ◽  
Recording Instrument ◽  
Cross Sectional ◽  
Ethics Research ◽  
The Social ◽  
Lack Of Commitment

ABSTRACTObjective: to elucidate the situation of the notification of cases of violence in a university in a university hospital in Recife at the beginning of training actions and professional awareness of this issue. Method: an observational cross-sectional study as conducted. Data collection was done through referrals made to the Social Service of Clinics Hospital of the Federal University of Pernambuco (HC/UFPE), by reports of professional by itself, a recording instrument from the hospital and copies of the notification form of cases. The project was approved by the Ethics Research Center of Health Sciences of the Federal University of Pernambuco/UFPE with protocol number 13/10. All cases were considered of September 2006, when began using the Notification Form from the Ministry of Health until December 2008. Results: the most notification was cases against the child (n=20, 46,51%), while there isn’t registration of cases against the elderly. Professionals who often made the notification were doctors (n=22, 51.16%) and psychologists (n=12, 27,91%). The Notification Form was used in only 41,86% of cases. Conclusion: the data underscore the under-reporting. Further research should verify the cause of poor service (lack of commitment, lack of specific training, among others) so that they can perform actions to make better situation. Descriptors: violence; epidemiology; public health; mandatory reporting.RESUMOObjetivo: elucidar a situação da notificação dos casos de violência em um hospital universitário do Recife no inicio das ações de capacitação e sensibilização dos profissionais para essa questão. Método: foi realizado um estudo observacional do tipo corte transversal. A coleta de dados foi realizada a partir dos encaminhamentos realizados para o Serviço Social do Hospital das Clínicas da Universidade Federal de Pernambuco/HC/UFPE por meio de relatórios dos profissionais, instrumento de registro próprio do hospital e cópias das Fichas de Notificação dos casos. O projeto foi aprovado pelo Comitê de Ética em Pesquisa do Centro de Ciências da Saúde/UFPE com número de protocolo 13/10. Foram considerados todos os casos de setembro de 2006, quando iniciou o uso da Ficha de Notificação do Ministério da Saúde até dezembro 2008. Resultados: a maior notificação foi de casos contra à criança (n=20, 46,51%), ao passo que não consta registro de casos contra idosos. Os profissionais que mais notificaram foram os médicos (n=22, 51,16%) e os psicólogos (n=12, 27,91%). A Ficha de Notificação foi usada em apenas 41,86% dos casos. Conclusão: os dados ressaltam a sub-notificação. Pesquisas posteriores devem verificar a causa da pouca notificação (falta de compromisso, falta de formação específica, entre outras), para que se possam realizar medidas para melhorar o quadro. Descritores: violência; epidemiologia; saúde pública; notificação de abuso.RESUMENObjetivo: conocer la situación de la notificación de casos de violencia en un hospital universitario en Recife al inicio de las acciones de formación y sensibilización del profesional de esta cuestión. Método: se realizó un estudio observacional, transversal. Recolección de datos se realiza através de consultas que el Servicio Social del Hospital de Clínicas, Universidad Federal de Pernambuco/HC/UFPE por los informes de profesionales de por sí, un instrumento de registro del hospital y copia del Formulario de Notificación de los casos. El proyecto fue aprobado por el Centro de Ética de la Investigación de las Ciencias de la Salud/UFPE com el número de protocolo 13/10.  Se consideraron todos los casos de septiembre de 2006, cuando comenzó a usar el Formulario de Notificación del Ministerio de Salud hasta diciembre de 2008. Resultados: la mayoría de los casos de notificación fue contra el niño (n=20, 46,51%), mientras que no hay registro de casos en contra de los ancianos. Los profesionales que a menudo hace la notificación eran médicos (n=22, 51,16%) y los psicólogos (n=12, 27,91%).  El Formulario de Notificación se utilizó en sólo 41,86% de los casos. Conclusión: los datos ponen de relieve la subnotificación. Las investigations futuras deberían verificar la causa de la notificación de baja (falta de compromiso, la falta de formación específica, entre otros) de modo que puedan llevar a cabo acciones para mejorar la situación. Descriptores: violencia; epidemiología; salud pública; notificatión obligatoria. 

Assessment of antipsychotic prescribing in Belgian nursing homes

2011 ◽  
Vol 23 (8) ◽  
pp. 1240-1248 ◽  
Author(s):  
Majda Azermai ◽  
Monique Elseviers ◽  
Mirko Petrovic ◽  
Luc van Bortel ◽  
Robert Vander Stichele
Keyword(s):  
Nursing Homes ◽  
Inappropriate Prescribing ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Prescribing Indicators ◽  
Prescribing Quality ◽  
Homes For The Elderly ◽  
Combined Use ◽  
Antipsychotic Prescribing

ABSTRACTBackground: Given the potential adverse effects of antipsychotics, high use in nursing homes creates concern. Our study goal was to explore the use of antipsychotics in relation to resident characteristics, and to assess the appropriateness of antipsychotic prescribing in Belgian nursing homes.Methods: Data were used from a cross-sectional study (Prescribing in Homes for the Elderly; PHEBE) conducted in 76 nursing homes in Belgium. Antipsychotics were classified into typical and atypical, using the anatomical therapeutic and chemical classification. Ten inappropriate antipsychotic prescribing indicators were selected from the updated Beers criteria (2003), Bergen District Nursing Home Study (BEDNURS) indicators, and Screening Tool of Older People's Prescriptions criteria (STOPP).Results: The residents' mean age was 84.8 years, 78.1% of whom were female. The prevalence of antipsychotic utilization was 32.9%. Antipsychotics were mainly indicated for dementia-related agitation, and psychosis with/without dementia. Higher use of antipsychotics was found for dementia (OR: 3.27; 95% CI: 2.61–4.09), insomnia (OR: 1.38; 95% CI: 1.10–1.73), depression (OR: 1.30; 95% CI: 1.03–1.65), and age <80 years (OR: 1.79; 95% CI: 1.38–2.33). Inappropriate antipsychotic prescribing indicators scoring the highest among users were: long-term use (92.6%), use despite risk of falling (45.6%), combined use with other psychotropics (31.8%), and duplicate use (15.1%). Inappropriate prescribing was associated with depression (OR: 3.41) and insomnia (OR: 2.17).Conclusion: The indicator-driven analysis of antipsychotic prescribing quality revealed a need for improvement, with the main prescribing problems relating to duration and combination of therapies. Risks/benefits of off-label use need to be evaluated more consciously at the start of therapy, and at periodic re-evaluations.

Sign in / Sign up

Export Citation Format

Share Document