Prevalence and follow-up of potentially inappropriate medication and potentially omitted medication in older patients with cancer – The PIM POM study

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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Prevalence and determinants of potentially inappropriate medication use in Hong Kong older patients: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2021-051527 ◽

2021 ◽

Vol 11 (7) ◽

pp. e051527

Author(s):

Huanyu Zhang ◽

Eliza LY Wong ◽

Samuel YS Wong ◽

Patsy YK Chau ◽

Benjamin HK Yip ◽

...

Keyword(s):

Older Adults ◽

Regression Analysis ◽

Hong Kong ◽

Older Patients ◽

Inappropriate Medication ◽

Cross Sectional Study ◽

Potentially Inappropriate Medication ◽

Multivariable Logistic Regression Analysis ◽

Sectional Study ◽

Cross Sectional

ObjectivesTo assess the prevalence of potentially inappropriate medication (PIM) use in Hong Kong older patients visiting general outpatient clinics (GOPCs) between 2006 and 2014 and to identify factors associated with PIM use among older adults visiting GOPCs in 2014.DesignCross-sectional study.SettingGOPC.ParticipantsTwo study samples were constructed including a total of 844 910 patients aged 65 and above from 2006 to 2014 and a cohort of 489 301 older patients in 2014.MeasurementsTwo subsets of the 2015 American Geriatrics Society Beers criteria—PIMs independent of diagnosis and PIMs due to drug–disease interactions—were used to estimate the prevalence of PIM use over 12 months. PIMs that were not included in the Hospital Authority drug formulary or with any specific restriction or exception in terms of indication, dose or therapy duration were excluded. Characteristics of PIM users and non-PIM users visiting GOPCs in 2014 were compared. Independent associations between patient variables and PIM use were assessed by stepwise multivariable logistic regression analysis.ResultsThe 12-month period prevalence of PIM use decreased from 55.56% (95% CI 55.39% to 55.72%) in 2006 to 47.51% (95% CI 47.37% to 47.65%) in 2014. In the multivariable regression analysis, the strongest factor associated with PIM use was the number of different drugs prescribed (adjusted OR, AOR 23.01, 95% CI 22.36 to 23.67). Being female (AOR 0.89, 95% CI 0.85 to 0.87 for males vs females) and having a greater number of GOPC visits (AOR 1.83, 95% CI 1.78 to 1.88) as well as more than six diagnoses (AOR 1.43, 95% CI 1.36 to 1.52) were associated with PIM use.ConclusionsThe overall prevalence of PIM use in older adults visiting GOPCs decreased from 2006 to 2014 in Hong Kong although the prevalence of PIM use was still high in 2014. Patients with female gender, a larger number of medications prescribed, more frequent visits to GOPCs, and more than six diagnoses were at higher risk for PIM use.

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Overall survival in older patients with cancer

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-001516 ◽

2018 ◽

Vol 10 (1) ◽

pp. 25-35 ◽

Cited By ~ 7

Author(s):

Beatrice J Edwards ◽

Xiaotao Zhang ◽

Ming Sun ◽

Juhee Song ◽

Peter Khalil ◽

...

Keyword(s):

Older Adults ◽

Overall Survival ◽

Older Patients ◽

Eastern Cooperative Oncology Group ◽

Karnofsky Performance Scale ◽

Haematological Malignancies ◽

Patients With Cancer ◽

Number Of Patients ◽

Traditional Performance

ObjectivesA growing number of patients with cancer are older adults. We sought to identify the predictors for overall survival (OS) in older adults with solid tumour and haematological malignancies between January 2013 and December 2016.MethodsRetrospective cohort study. A comprehensive geriatric assessment was performed, with a median follow-up of 12.8 months. Analysis: univariate and multivariate Cox proportional hazards regression analysis.ResultsIn this study, among the 455 patients with last follow-up date or date of death, 152 (33.4%) died during the follow-up. The median follow-up is 12.8 months (range 0.2–51.1 months) and the median OS is 20.5 months (range 0.3–44.5 months). Among all older patients with cancer, predictors of OS included male gender, cancer stage, malnutrition, history of smoking, heavy alcohol use, frailty, weight loss, major depression, low body weight and nursing home residence. Traditional performance scores (Eastern Cooperative Oncology Group (ECOG) and Karnofsky Performance Scale (KPS)) were predictors of OS. Independent predictors included age >85 years and haematological malignancies. Among solid tumours (n=311) in addition to the above predictors, comorbidity, gait speed and vitamin D deficiency were associated with OS.ConclusionsWe identified specific geriatric factors associated with OS in older patients with cancer, and comparable in predictive ability to traditional performance scores such as KPS and ECOG. Prospective studies will be necessary to confirm our findings.

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The impact of a tailored follow-up intervention on comprehensive geriatric assessment in older patients with cancer - a randomised controlled trial

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2020.07.011 ◽

2021 ◽

Vol 12 (1) ◽

pp. 41-48

Author(s):

Marianne Ørum ◽

Stine Vestergaard Eriksen ◽

Merete Gregersen ◽

Anni Ravnsbæk Jensen ◽

Kenneth Jensen ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Older Patients ◽

Controlled Trial ◽

Patients With Cancer ◽

Randomised Controlled ◽

The Impact

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Association between education level and potentially inappropriate medication among older patients

Aging Clinical and Experimental Research ◽

10.1007/s40520-017-0743-6 ◽

2017 ◽

Vol 30 (1) ◽

pp. 101-103

Author(s):

Chia-Ter Chao ◽

◽

Hung-Bin Tsai ◽

Chih-Kang Chiang ◽

Jenq-Wen Huang ◽

...

Keyword(s):

Older Patients ◽

Inappropriate Medication ◽

Education Level ◽

Potentially Inappropriate Medication

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Use of potentially inappropriate medication in older patients with lung cancer at the end of life

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2021.07.009 ◽

2021 ◽

Author(s):

Laurien Ham ◽

Eric C.T. Geijteman ◽

Mieke J. Aarts ◽

Josephina G. Kuiper ◽

Peter W.A. Kunst ◽

...

Keyword(s):

Lung Cancer ◽

End Of Life ◽

Older Patients ◽

Inappropriate Medication ◽

Potentially Inappropriate Medication

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Considerations and Controversies in the Management of Older Patients with Advanced Cancer

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2012.32.168 ◽

2012 ◽

pp. 321-328 ◽

Cited By ~ 1

Author(s):

Supriya Gupta Mohile ◽

Heidi D. Klepin ◽

Arati V. Rao

Keyword(s):

Advanced Cancer ◽

Older Patients ◽

Clinical Care ◽

Treatment Options ◽

Screening Tools ◽

Patients With Cancer ◽

Functional Consequences ◽

Oncology Practice ◽

Combined Data

Overview: The incidence of cancer increases with age. Oncologists need to be adept at assessing physiologic and functional capacity in older patients in order to provide safe and efficacious cancer treatment. Assessment of underlying health status is especially important for older patients with advanced cancer, for whom the benefits of treatment may be low and the toxicity of treatment high. The comprehensive geriatric assessment (CGA) is the criterion standard for evaluation of the older patient. The combined data from the CGA can be used to stratify patients into categories to better predict risk for chemotherapy toxicity as well as overall outcomes. The CGA can also be used to identify and follow-up on possible functional consequences from treatment. A variety of screening tools might be useful in the oncology practice setting to identify patients who may benefit from further testing and intervention. In this chapter, we discuss how the principles of geriatrics can help improve the clinical care of older adults with advanced cancer. Specifically, we discuss assessing tolerance for treatment, options for chemotherapy scheduling and dosing for older patients with advanced cancer, and management of under-recognized symptoms in older patients with cancer.

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