Polypharmacy and Potentially Inappropriate Medications in Patients With Dementia

Abstract INTRODUCTION: The use of polypharmacy and potentially inappropriate medication (PIM) is a critical issue in geriatrics. Furthermore, the number of patients with dementia is dramatically increasing worldwide. In this study, we investigated: (1) if the states of polypharmacy and PIM differed in patients with and without dementia; (2) the types of medicine that were commonly prescribed; (3) the types of dementia that resulted in the prescription of multiple medicines; (4) if there was a correlation between the number of medicines and the number of medical institutions (hospitals and clinics) that the patients attended. METHODS: In total, 216 patients who were 65 years of age and older were analyzed. The number of medicines prescribed and the medical institutions they attended were counted through the electronic medical charts of Tohoku Medical and Pharmaceutical University Hospital. We employed the Beers 2019 criteria for the definition of PIM. RESULTS: (1) The number of prescribed medicines was not significantly different between patients with dementia and those without dementia. (2) Anti-hypertensives and gastro-intestinal medicines were the most commonly prescribed medicines in patients with and without dementia. (3) Patients with “dementia with Lewy bodies” and “mixed dementia” were prescribed the highest number of medicines. (4) The number of medicines and PIM use were significantly and positively correlated with the number of medical institutions. CONCLUSIONS: The number of medical institutions strongly affected the number of medicines prescribed and PIM use. Efforts should be made to organize and reduce the number of medical institutions that a patient attends.

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Potentially inappropriate medication prescribed to elderly outpatients at a general medicine unit

Einstein (São Paulo) ◽

10.1590/s1679-45082011ao1844 ◽

2011 ◽

Vol 9 (1) ◽

pp. 18-23 ◽

Cited By ~ 4

Author(s):

Christine Grützmann Faustino ◽

Milton de Arruda Martins ◽

Wilson Jacob Filho

Keyword(s):

Elderly Patients ◽

Inappropriate Medication ◽

Age Groups ◽

General Medicine ◽

University Hospital ◽

Potentially Inappropriate Medication ◽

Potentially Inappropriate Medications ◽

Female Sex ◽

The Mean ◽

Inappropriate Medications

ABSTRACT Objective: To establish the prevalence of potentially inappropriate medications prescribed for elderly patients, to identify the most commonly involved drugs, and to investigate whether age, sex and number of medications were related with the prescription of these drugs. Methods: Prescriptions for 1,800 elderly patients (≥ 60 years) were gathered from a database. These prescriptions were written by general physicians at a tertiary level university hospital in the city of Sao Paulo, Brazil, from February to May 2008. Only one prescription per patient was considered. The prescriptions were classified according to sex and age (60-69, 70-79 and ≥ 80). The Beers criteria (2003 version) were used to evaluate potentially inappropriate medications. Results: Most of the sample comprised women (66.6%) with a mean age of 71.3 years. The mean prevalence of potentially inappropriate medication prescriptions was 37.6%. The 60-69 age group presented the highest prevalence (49.9%). The most frequently prescribed potentially inappropriate medications to women were carisoprodol, amitriptyline, and fluoxetine; amitriptyline, carisoprodol, fluoxetine and clonidine were prescribed more often to men. The female sex (p<0.001; OR=2.0) and number of medications prescribed (p<0.001) were associated with prescription of potentially inappropriate medications. The chance of having a prescription of these drugs was lower among patients aged over 80 years (OR=0.7). The mean number of prescribed medications for both sexes and all age groups was 7.1. The mean number of medications per patient was higher among females (p<0.001); this result was not age-dependent (p=0.285). Conclusion: The prevalence of potentially inappropriate medications was similar to previously reported values in the literature and was correlated with the female sex. The chance of having a potentially inappropriate medication prescription was lower among patients aged over 80 years. The chance of having a potentially inappropriate medications prescription increased proportionally with the number of medications prescribed (≥ 5).

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Inappropriate medications and physical function: a systematic review

Therapeutic Advances in Drug Safety ◽

10.1177/20420986211030371 ◽

2021 ◽

Vol 12 ◽

pp. 204209862110303

Author(s):

Elizabeth Manias ◽

Md Zunayed Kabir ◽

Andrea B. Maier

Keyword(s):

Older Adults ◽

Physical Function ◽

Physical Performance ◽

Inappropriate Medication ◽

Functional Independence ◽

Potentially Inappropriate Medications ◽

Timed Up And Go ◽

Risk Of Falls ◽

Prescribing Omissions ◽

Inappropriate Medications

Background and aims: Inappropriate medication prescription is highly prevalent in older adults and is associated with adverse health outcomes. The aim of this study was to examine the associations between potentially inappropriate medications (PIMS) and potential prescribing omissions with physical function in older adults situated in diverse environments. Methods: A systematic search was completed using the following databases: MEDLINE, CINAHL, PsycINFO, EMBASE and COCHRANE. Results were extracted from the included studies. Results: In total, 55 studies reported on 2,767,594 participants with a mean age of 77.1 years (63.5% women). Study designs comprised 26 retrospective cohort studies, 21 prospective cohort studies and 8 cross-sectional studies. Inappropriate medications in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), impaired activities of daily living (ADL; 8 out of 10 studies) and impaired instrumental ADL (IADL) score (4 out of 6 studies). Five out of seven studies also showed that PIMs were associated with poorer physical performance comprising the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many medication classes were implicated as PIMs in falls, fractures and impairment in physical performance including antipsychotic, sedative, anti-anxiety, anticholinergic, antidiabetic, opioid and antihypertensive medications. For patients not receiving musculoskeletal medications, such as calcium, vitamin D and bisphosphonates, older adults were found to be at risk of a hospital admission for a fall or fracture. Conclusion: Inappropriate medication prescriptions are associated with impaired physical function across longitudinal and cross-sectional studies in older adults situated in diverse settings. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions. Plain language summary Inappropriate medications and physical function Background and aims: The use of inappropriate medications is very common in older adults and is associated with harmful health problems. The aim was to examine associations between potentially inappropriate medications and potential prescribing omissions with physical function in older adults situated in diverse environments. Methods: Library databases were examined for possible studies to include and a systematic search was completed. Relevant information was obtained from the included studies. Results: In total, 55 studies reported on 2,767,594 participants who were an average age of 77.1 years and about 6 out of 10 were women. A variety of different study designs were used. Inappropriate medication prescriptions in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), problems with activities of daily living (ADL), such as eating, bathing, dressing, grooming, walking and toileting (8 out of 10 studies) and problems with instrumental ADL such as managing medications, house cleaning and shopping (4 out of 6 studies). Five out of seven studies also showed that inappropriate medications were associated with poorer physical performance involving the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many types of medication classes were shown to be associated with a risk of falls, fractures and problems with physical performance. Omitted medications were also associated with falls and fractures. Conclusion: Inappropriate medication prescriptions are associated with problems relating to physical function. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions.

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Use of potentially inappropriate medications among ambulatory home-dwelling elderly patients with dementia: A review of the literature

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada ◽

10.1177/1715163517701770 ◽

2017 ◽

Vol 150 (3) ◽

pp. 169-183 ◽

Cited By ~ 12

Author(s):

Tejal Patel ◽

Karen Slonim ◽

Linda Lee

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Adverse Events ◽

Inappropriate Medication ◽

Medication Use ◽

Adverse Outcomes ◽

Potentially Inappropriate Medication ◽

Potentially Inappropriate Medications ◽

Inappropriate Medication Use ◽

Inappropriate Medications

Background: Older adults with dementia are at high risk for drug-related adverse outcomes. While much is known about potentially inappropriate medication use in older adults, its prevalence and characteristics among those with dementia are not as well elucidated. We conducted a literature review to examine the prevalence of potentially inappropriate medication use among home-dwelling older adults with dementia. Our secondary aim was to determine the most frequently implicated medications and factors associated with potentially inappropriate medication use. Methods: MEDLINE, EMBASE, CINAHL, and International Pharmaceutical Abstracts were searched between 1946 and 2014 for articles that referenced potentially inappropriate medication use and types of dementia. One reviewer screened all titles and abstracts from the initial search and full-text articles after the initial screen for eligibility, then 2 reviewers independently abstracted data from included studies. Results: Searches yielded 81 articles, of which 7 met inclusion criteria. Prevalence of potentially inappropriate medication use varied from 15% to 46.8%. No single drug or drug class was reported consistently across all studies as the most frequent potentially inappropriate medication, but anticholinergics and benzodiazepines, drugs that affect cognition, were among the most common medications or pharmacological classes listed. Discussion: Older adults with dementia may be particularly vulnerable to potentially inappropriate medications because of cognitive impairment from their condition and the greater likelihood of experiencing adverse events from medications. Given this population’s greater susceptibility to adverse events, more intense medication and patient monitoring may be warranted, especially among those taking anticholinergics and benzodiazepines, as these drugs can contribute to cognitive impairment.

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Inappropriate Medication Use In Older Adults According To Beers Criteria In A Tertiary Referral Hospital, In Bolu, Turkey

Russian Open Medical Journal ◽

10.15275/rusomj.2021.0211 ◽

2021 ◽

Vol 10 (2) ◽

Author(s):

Burcin M. Atak ◽

Gulali Aktas ◽

Tuba T. Duman ◽

Ozge Kurtkulagi ◽

Satilmis Bilgin ◽

...

Keyword(s):

Older Adults ◽

Inappropriate Medication ◽

Bleeding Risk ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Tertiary Referral Hospital ◽

Inappropriate Use ◽

Increased Risk ◽

Risk Of Falls ◽

Inappropriate Medications

Aims — We aimed to study the medications used by older adults for any potentially inappropriate medications. Material and Methods — A hundred and four consecutive subjects over 65 years of age who visited our clinic were enrolled in the study. Possible inappropriate medications were defined according to Beers Criteria. Results — A total of 57 women and 49 men were enrolled in the study. Mean ages of the women and men were 78.6±6.1 years and 77.4±5.4 years, respectively (p=0.30). While 18 subjects (17%) had no increased risk due to inappropriate use of medications, 30 were on inappropriate medications that increased renal failure risk, 5 were on inappropriate medication that amplified neurological side effects, 12 were on inappropriate medications that augmented bleeding risk, 20 were on inappropriate medication that lack safety and efficacy data, and 30 were on inappropriate medication that amplified the risk of falls. The number of increased risks according to Beers Criteria was significantly and positively correlated with number of medications used (r=0.366, p<0.001) and the number of comorbidities (r=0.312, p=0.001). Conclusion — The number of increased risks due to inappropriate use of medicines in older adults is positively correlated with the number of medicines used and the number of accompanied diseases. Therefore we suggest that the medicines used by older people should be reviewed in all settings, and unnecessary drugs should be avoided to be prescribed.

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Drug safety profiles in geriatric patients with Parkinson’s disease using the FORTA (Fit fOR The Aged) classification: results from a mono-centric retrospective analysis

Journal of Neural Transmission ◽

10.1007/s00702-020-02276-x ◽

2020 ◽

Author(s):

S. Greten ◽

J. I. Müller-Funogea ◽

F. Wegner ◽

G. U. Höglinger ◽

N. Simon ◽

...

Keyword(s):

Drug Safety ◽

Geriatric Patients ◽

Demographic Data ◽

University Hospital ◽

Potentially Inappropriate Medications ◽

Hannover Medical School ◽

The Common ◽

The University ◽

Geriatric Inpatients ◽

Inappropriate Medications

AbstractTo reduce potentially inappropriate medications, the FORTA (Fit fOR The Aged) concept classifies drugs in terms of their suitability for geriatric patients with different labels, namely A (indispensable), B (beneficial), C (questionable), and D (avoid). The aims of our study were to assess the medication appropriateness in PD inpatients applying the FORTA list and drug-drug interaction software, further to assess the adequacy of FORTA list for patients with PD. We retrospectively collected demographic data, comorbidities, laboratory values, and the medication from the discharge letters of 123 geriatric inpatients with PD at the university hospital of Hannover Medical School. Patients suffered on average from 8.2 comorbidities. The majority of the medication was labeled A (60.6% of PD-specific and 40.9% of other medication) or B (22.3% of PD-specific and 26.9% of other medication). Administered drugs labeled with D were amantadine, clozapine, oxazepam, lorazepam, amitriptyline, and clonidine. Overall, 545 interactions were identified, thereof 11.9% severe interactions, and 1.7% contraindicated combinations. 81.3% of patients had at least one moderate or severe interaction. The FORTA list gives rational recommendations for PD-specific and other medication, especially for general practitioners. Considering the demographic characteristics and the common multimorbidity of geriatric PD patients, this study underlines the importance of awareness, education, and preventive interventions to increase drug safety.

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Polypharmacy among Underserved Older African American Adults

Journal of Aging Research ◽

10.1155/2017/6026358 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 15

Author(s):

Mohsen Bazargan ◽

James Smith ◽

Masoud Movassaghi ◽

David Martins ◽

Hamed Yazdanshenas ◽

...

Keyword(s):

African American ◽

Inappropriate Medication ◽

Medication Use ◽

Community Dwelling ◽

Potentially Inappropriate Medication ◽

Inappropriate Drug ◽

Potentially Inappropriate Medications ◽

African American Adults ◽

Inappropriate Medication Use ◽

Inappropriate Medications

The purpose of the present study was to examine correlates of polypharmacy among underserved community-dwelling older African American adults. Methods. This study recruited 400 underserved older African Americans adults living in South Los Angeles. The structured face-to-face interviews collected data on participants’ characteristics and elicited data pertaining to the type, frequency, dosage, and indications of all medications used by participants. Results. Seventy-five and thirty percent of participants take at least five and ten medications per day, respectively. Thirty-eight percent of participants received prescription medications from at least three providers. Inappropriate drug use occurred among seventy percent of the participants. Multivariate analysis showed that number of providers was the strongest correlate of polypharmacy. Moreover, data show that gender, comorbidity, and potentially inappropriate medication use are other major correlates of polypharmacy. Conclusions. This study shows a high rate of polypharmacy and potentially inappropriate medication use among underserved older African American adults. We documented strong associations between polypharmacy and use of potentially inappropriate medications, comorbidities, and having multiple providers. Polypharmacy and potentially inappropriate medications may be attributed to poor coordination and management of medications among providers and pharmacists. There is an urgent need to develop innovative and effective strategies to reduce inappropriate polypharmacy and potentially inappropriate medication in underserved elderly minority populations.

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Identifikasi Potentially Inappropriate Medications (PIMs) Berdasarkan Kriteria STOPP START pada Pasien Geriatri Rawat Inap di RS Advent Bandar Lampung

Jurnal Analis Kesehatan ◽

10.26630/jak.v7i1.912 ◽

2018 ◽

Vol 7 (1) ◽

pp. 657 ◽

Cited By ~ 1

Author(s):

Siti Juliha

Keyword(s):

Vascular Disease ◽

Inappropriate Medication ◽

Potentially Inappropriate Medication ◽

Potentially Inappropriate Medications ◽

Chi Square ◽

Cerebral Vascular Disease ◽

Inappropriate Medications ◽

Cerebral Vascular

Identifikasi peresepan obat pada populasi geriatri sangat penting untuk terus dilakukan karena peresepan yang membahayakan pada populasi ini akan berasosiasi dengan peningkatan morbiditas, terjadinya kejadian yang tidak diinginkan terkait obat, dan mortalitas. Tujuan penelitian ini adalah untuk mengidentifikasi PIM (Potentially Inappropriate Medication) pada pasien geriatri rawat inap di RS Advent Bandar Lampung pada tahun 2016 berdasarkan Kriteria STOPP START. Jenis penelitian ini adalah deskriptif. Populasi dalam penelitian ini adalah seluruh rekam medik pasien geriatric yang berobat rawat inap di RS Advent Bandar Lampung tahun 2016 dengan jumlah sampel sebanyak 72 rekam medik. Uji statistic yang digunakan adalah uji Chi square. Identifikasi penggunaan PIM disesuaikan dengan criteria STOPP START. Hasil analisis univariat menunjukkan tiga jenis PIM terbanyak pada pengobatan pasien geritari di RS Advent Bandar Lampung adalah tidak digunakannya statin pada pasien yang memiliki riwayat penyakit jantung koroner dan cerebral vascular disease (51,28%), adanya duplikasi kelas obat (17,95%), dan penggunaan benzodiazepine pada pasien yang berisiko jatuh (11,43%). Analisis bivariat menunjukkan tidak ada hubungan secara bermakna antara kejadian PIM dengan jenis kelamin, usia, jumlah obat yang diberikan, komorbid, dan lama rawat.

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Prevalence of Polypharmacy and Inappropriate Medication in Adults With Intellectual Disabilities in a Hospital Setting in Switzerland

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.614825 ◽

2021 ◽

Vol 12 ◽

Author(s):

Sophie Lonchampt ◽

Fabienne Gerber ◽

Jean-Michel Aubry ◽

Jules Desmeules ◽

Markus Kosel ◽

...

Keyword(s):

Inappropriate Medication ◽

Challenging Behaviors ◽

Hospital Setting ◽

Prescription Data ◽

Potentially Inappropriate Medications ◽

Inappropriate Prescription ◽

Hospital Unit ◽

Adults With Intellectual Disabilities ◽

Degrees Of Severity ◽

Inappropriate Medications

Background: Polypharmacy and inappropriate prescription are frequent in vulnerable and multi-morbid populations. Adults with intellectual disability (ID) are at risk of being polymedicated because they often present with multiple comorbidities and challenging behaviors.Aim: The objective of this study was thus to evaluate the prevalence of potentially inappropriate medications (PIM) and polypharmacy in a hospital unit dedicated to adults with ID.Methods: A 10-month prospective observational study took place at a hospital unit specializing in the care of adults with ID in Geneva, Switzerland. Once a week, health and prescription data were collected and screened for PIM according to preset definitions.Results: Fourteen patients consented to participate, leading to 20 hospitalization events assessed during the study. Hospitalizations lasted 12.8 weeks on average. ID severities ranged from mild to profound, all degrees of severity being equally represented. One hundred percent of the patients were polymedicated (defined as five drugs or more prescribed simultaneously). A mean number of 9.4 drugs were prescribed per week, including 5.3 psychotropic drugs. The number of prescribed drugs remained stable throughout the hospitalizations. Antipsychotics were the most prescribed drug class (19% of all prescribed drugs), followed by benzodiazepines (13%) and laxatives (12%). A total of 114 PIM were recorded with an average of 5.7 PIM per hospitalization.Conclusions: This study showed that polypharmacy and inappropriate prescription are very common in adults with ID, even though the literature and expert positions advocate for deprescription in these patients. Specific prescribing and deprescribing guidelines are needed for that specific population.

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Inappropriate Medication Use in Hospitalized Patients Diagnosed with Parkinson’s Disease

Pharmacy ◽

10.3390/pharmacy6030100 ◽

2018 ◽

Vol 6 (3) ◽

pp. 100 ◽

Cited By ~ 1

Author(s):

Nicholas Cox ◽

Jessica Louie ◽

Benson Sederholm

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Inappropriate Medication ◽

Academic Medical Center ◽

Inappropriate Prescribing ◽

Admission Diagnosis ◽

P Value ◽

Potentially Inappropriate Medications ◽

Duration Of Stay ◽

Inappropriate Medications

The purpose of this study was to evaluate the rate at which potentially inappropriate medications were administered for patients diagnosed with Parkinson’s disease (PD). This is a single-center, retrospective, case cohort study with data collected at an academic medical center between January 2010 and December 2013. Participants included all adult patients with admission diagnosis codes for PD. Included patients were screened for administrations of 27 potentially inappropriate medications and two potentially appropriate medications to be used for comparison. There were 1736 patients who met inclusion criteria with 175 documented administrations of potentially inappropriate medications to 77 patients. Patients who received potentially inappropriate medications had a longer mean duration of stay than the baseline population of PD patients (3.3 days vs. 1.9 days, p-value < 0.001). Despite recommendations to avoid certain medications in PD patients, a substantial number of administrations still occurred. The use of these medications can have clinical implications and our findings demonstrate increases in duration of stay. The findings from this study can assist in developing technological alerts to reduce inappropriate prescribing to PD patients. Larger prospective studies are warranted to further investigate the administration of inappropriate medications to patients diagnosed with PD.

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Chloroquine and hydroxychloroquine: potentially inappropriate medications for older adults?

Geriatrics Gerontology and Aging ◽

10.5327/z2447-212320202000074 ◽

2020 ◽

Vol 14 (4) ◽

pp. 298-302

Author(s):

Milton Gorzoni

Keyword(s):

Older Adults ◽

Adverse Effects ◽

Older People ◽

Drug Analysis ◽

American Geriatrics Society ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Definition Of ◽

Inappropriate Medications

Introduction: Potentially inappropriate medications (PIMs) for older adults cause more adverse effects than benefits. The 2019 American Geriatrics Society Beers Criteria (2019BC) considered five clinical situations as PIM use in older adults. Can drug analysis, according to these situations, assist in the act of making prescriptions for older people? Seeking a practical example for this question, we assessed drugs currently questioned as to their safe use among older people. Objective: To check if chloroquine and hydroxychloroquine fit the PIM criteria for older adults and whether this analysis is clinically applicable. Method: We systematized the objective based on the five clinical situations defined as PIM use in older adults by the 2019BC. Results: Chloroquine and hydroxychloroquine fulfill, respectively, four and five of these clinical situations. This evaluation allowed the likely definition of these drugs as PIMs for older adults in a simple way, based on a brief analysis of the available literature. Conclusion: Chloroquine and hydroxychloroquine may be considered PIMs for older adults. We expect that this analysis can be replicated with other drugs and reduce iatrogenesis in older people.

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