Sex Differences in Potentially Inappropriate Prescribing Among Older Adults With Multimorbidity

Abstract Sex differences in prescribing potentially inappropriate medications (PIMs) for various multimorbidity patterns are not well understood. This study sought to identify sex specific risk of PIMs in older adults with cardiovascular-metabolic patterns. Secondary analysis of the Health and Retirement Study interview data (2004-2014; n=6,341, ≥65 y/o) linked to Medicare claims data was conducted. Four multimorbidity patterns were identified based on the list of 20 chronic conditions and included: ‘cardiovascular-metabolic only’, ‘cardiovascular-metabolic plus other physical conditions’, ‘cardiovascular-metabolic plus mental conditions’, and ‘no cardiovascular-metabolic disease’ patterns. Presence of PIM prescribing was identified using the 2015 American Geriatrics Society Beers Criteria, limited to the list of medications to avoid in older adults. Chi-square tests and logistic regressions were used to identify sex differences in prescribing PIMs across multimorbidity patterns: (1) for PIMs overall and (2) for each PIM drug class. Results indicate that on average women were prescribed PIMs more often than men (39.4% and 32.8%, respectively). Women with cardiovascular-metabolic plus other physical patterns (Adj.OR=1.25, 95% CI: 1.07-1.45) and cardiovascular-metabolic plus mental patterns (Adj.OR=1.25, 95% CI: 1.06-1.48) had higher odds of PIM compared to men, however, there were no sex differences in PIM prescribing in the cardiovascular-metabolic only patterns (Adj.OR=1.13, 95% CI: 0.79-1.62). There was variation by sex across different PIM drug classes. Our study emphasizes the need to further reduce PIM prescribing among older adults, and identifies target populations for potential interventions to improve medication prescribing practices.

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Potentially inappropriate medications in older adults: A review of the 2012 Beers Criteria and the implications in persons with dementia

Mental Health Clinician ◽

10.9740/mhc.n204331 ◽

2014 ◽

Vol 4 (4) ◽

pp. 166-169 ◽

Cited By ~ 1

Author(s):

Nicole J. Brandt ◽

Traci Turner

Keyword(s):

Older Adults ◽

Adverse Drug Events ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Clinical Tool ◽

Drug Classes ◽

Information Set ◽

Sliding Scale ◽

Institutionalized Patients ◽

Inappropriate Medications

In 2012, the American Geriatrics Society (AGS), along with a panel of 11 experts, updated the Beers Criteria which has evolved significantly since its inception in 1991. The Beers Criteria, in general, classifies medications/medication classes as: (1) potentially inappropriate for use in all older adults, (2) potentially inappropriate for older adults with certain diseases or symptoms and (3) requiring extra caution when used in older adults. Although each patient must be evaluated individually, the Beers Criteria is a useful clinical tool that can be used when initiating pharmacologic agents in both ambulatory and institutionalized patients. The concept behind use of the Beers Criteria is that it allows prescribers to readily identify, and avoid, medications associated with negative outcomes in older adults therefore decreasing the risk of adverse drug events (ADEs). Within this review article, there will be a highlight of potentially inappropriate medications (PIMs) commonly seen in clinical practice settings such as antipsychotics, benzodiazepines, non-benzodiazepine sedative-hypnotics, anticholinergics and sliding scale insulin. The focus will be to outline the risk-benefits of these drug classes within the context of persons with dementia. Furthermore, the use of PIMs has both clinical and financial implications in Medicare Star ratings and Healthcare Effectiveness Data and Information Set (HEDIS) measures.

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Investigation of a possible association of potentially inappropriate medication for older adults and frailty in a prospective cohort study from Germany

Age and Ageing ◽

10.1093/ageing/afz127 ◽

2019 ◽

Vol 49 (1) ◽

pp. 20-25 ◽

Cited By ~ 4

Author(s):

Dana Clarissa Muhlack ◽

Liesa Katharina Hoppe ◽

Kai-Uwe Saum ◽

Walter E Haefeli ◽

Hermann Brenner ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Cox Regression ◽

Inappropriate Medication ◽

Population Based ◽

Community Dwelling ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Drug Classes ◽

Before And After

Abstract Objective potentially inappropriate medications (PIMs) are commonly defined as drugs that should be avoided in older adults because they are considered to have a negative risk-benefit ratio. PIMs are suspected to increase the risk for frailty, but this has yet to be examined. Design prospective population-based cohort study. Setting and participants a German cohort of community-dwelling older adults (≥60 years) was followed from October 2008 to September 2016. Methods in propensity score-adjusted logistic and Cox regression models, associations between baseline PIM use and prevalent/incident frailty were investigated. Frailty was assessed using the definition by Fried and co-workers, PIM were defined with the 2015 BEERS criteria, the BEERS criteria to avoid in cognitively impaired patients (BEERS dementia PIM), the EU(7)-PIM and the PRISCUS list. Results of 2,865 participants, 261 were frail at baseline and 423 became frail during follow-up. Only BEERS dementia PIM use was statistically significantly associated with prevalent frailty (odds ratio (95% confidence interval), 1.51 (1.04–2.17)). The strength of the association was comparable for all frailty components. Similarly, in longitudinal analyses, only BEERS dementia PIM use was associated with incident frailty albeit not statistically significant (hazard ratio, 1.19 (0.84–1.68)). Conclusions the association of PIM use and frailty seems to be restricted to drug classes, which can induce frailty symptoms (anticholinergics, benzodiazepines, z-substances and antipsychotics). Physicians are advised to perform frailty assessments before and after prescribing these drug classes to older patients and to reconsider treatment decisions in case of negative performance changes.

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Continue Or Not To Continue? Attitudes Towards Deprescribing Among Community- Dwelling Older Adults In China

10.21203/rs.3.rs-1111462/v1 ◽

2021 ◽

Author(s):

Jie Tan ◽

MinHong Wang ◽

XiaoRui Pei ◽

Quan Sun ◽

ChongJun Lu ◽

...

Keyword(s):

Older Adults ◽

Chronic Disease ◽

Inappropriate Prescribing ◽

Prescription Medication ◽

Adverse Outcomes ◽

Community Dwelling ◽

Potentially Inappropriate Medications ◽

Cross Sectional ◽

Wide Range ◽

Community Dwelling Older Adults

Abstract Background: Inappropriate prescribing of medications and polypharmacy among older adults are associated with a wide range of adverse outcomes. It is critical to understand the attitudes towards deprescribing—reducing the use of potentially inappropriate medications (PIMs)—among this vulnerable group. Such information is particularly lacking in low - and middle-income countries.Methods: The present study examined attitudes towards deprescribing and individual-based characteristics that might be associated with these attitudes among community-dwelling older adults in China. We conducted a cross-sectional study through in-person interviews using the Patients' Attitudes Towards Deprescribing (PATD) and the revised PATD (rPATD) (version for older adults) questionnaires in two communities through the community-based physical examination platform in China. Participants were 65 years and older and had at least one chronic disease and one regular prescription medication.Results: Of the 1,897 participants in this study, average age was 73.8 years (SD=6.2 years) and 1,023 (53.9%) were women. The majority had one chronic disease (n=1,364 [71.9%]) and took 1-2 medications (n=1,483 [78.2%]). A total of 947 (50.0%) older adults reported being willing to stop taking one or more of their medicines if their physician said it was possible, and 1,204 (63.5%) older adults wanted to stop a medicine been taking for a long time. We did not find Individual-level factors to be associated with attitudes towards deprescribing. Conclusions: The proportions of participants’ willingness to deprescribing were much lower than what prior investigations among western populations reported. It is important to identify the reasons for the low wiliness to deprescribe and develop a patient-centered and practical deprescribing guideline that is suitable for Chinese older adults.

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SEQUENTIAL IMPLEMENTATION AS A LEARNING HEALTH ORGANIZATION: THE EQUIPPED GERIATRIC MEDICATION SAFETY MODEL

Innovation in Aging ◽

10.1093/geroni/igz038.3434 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S945-S945

Author(s):

Ann E Vandenberg ◽

Michelle Kegler ◽

Susan Hastings ◽

Ula Hwang ◽

Camille Vaughan

Keyword(s):

Older Adults ◽

Structural Characteristics ◽

Scale Up ◽

Lessons Learned ◽

Research Network ◽

Public Health Issue ◽

Potentially Inappropriate Medications ◽

Prescribing Practices ◽

Intervention Package ◽

Health Organization

Abstract A learning health organization (LHO) is one that systematically integrates internal data and experience with external evidence to improve internal healthcare practice. Yet collaborative research networks implementing evidence-based interventions across sites with the goal of widespread dissemination are also effectively LHOs. The EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) network formed to address an important public health issue: potentially inappropriate medications (PIMs) prescribed to older adults at discharge from hospital Emergency Departments (ED). EDs nationwide serve increasing numbers of older adults but lack clinical decision support to avoid prescribing PIMs associated with adverse events including hospitalization and death. The EQUIPPED geriatric safety program was adapted from the VA and implemented sequentially at three different academic institutions sharing the same electronic health record (Epic)(AHRQ R18HS24499). Implementation challenges, solutions, and innovations informed successive iterations. Using the Replicating Effective Programs framework, we conducted a process evaluation using data from implementation team focus groups (n=3), meeting minutes (n=98 hours), and organizational profiles (n =3) to understand how organizations working together within a research network build an intervention package for program scale-up. We present structural characteristics of the three organizations, implementation steps as they developed across three sites, and the resulting process protocol and a prototype toolkit. Lessons learned include having multiple internal champions at the intervention site, observing workflow pre-intervention, and streamlining data collection with a relational database and visualization software. Insights from the EQUIPPED experience can serve as a model for other systems and collaborative networks.

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Sex Differences in Characteristics Associated with Potentially Inappropriate Medication Use and Associations with Functional Capacity in Older Participants of the Berlin Aging Study II

Gerontology ◽

10.1159/000518411 ◽

2021 ◽

pp. 1-9

Author(s):

Sarah Toepfer ◽

Maximilian König ◽

Dominik Spira ◽

Johanna Drewelies ◽

Reinhold Kreutz ◽

...

Keyword(s):

Higher Education ◽

Older Adults ◽

Sex Differences ◽

Nutritional Status ◽

Functional Capacity ◽

Medication Use ◽

Potentially Inappropriate Medications ◽

Men And Women ◽

Lower Odds ◽

Aging Study

Introduction: Medication safety is a vital aim in older adults’ pharmacotherapy. Increased morbidity and vulnerability require particularly careful prescribing. Beneath avoiding unnecessary polypharmacy and prescribing omissions, physicians have to be aware of potentially inappropriate medications (PIMs) and related outcomes to optimize older adults’ drug therapy, and to reduce adverse drug events. Objective: The aim of this study was to identify participants characteristics associated with PIM use and associations of PIM use with functional capacity with a focus on sex differences. Methods: Multivariable logistic regression analyses of cross-sectional Berlin Aging Study II (BASE-II) data (N = 1,382, median age 69 years, interquartile range 67–71, 51.3% women) were performed with PIM classification according to the EU(7)-PIM list. Results: In the overall study population, higher education was associated with lower odds of PIM use (odds ratio [OR] 0.93, confidence interval [CI] 95% 0.87–0.99, p = 0.017). Falls (OR 1.53, CI 95% 1.08–2.17, p = 0.016), frailty/prefrailty (OR 1.68, 1.17–2.41, p = 0.005), and depression (OR 2.12, CI 95% 1.32–3.41, p = 0.002) were associated with increased odds of PIM use. A better nutritional status was associated with lower odds of PIM use (OR 0.88, CI 95% 0.81–0.97, p = 0.008). In the sex-stratified analysis, higher education was associated with lower odds of PIM use in men (OR 0.90, CI 95% 0.82–0.99, p = 0.032). Frailty/prefrailty was associated with increased odds of PIM use in men (OR 2.04, CI 95% 1.18–3.54, p = 0.011) and a better nutritional status was associated with lower odds of PIM use in men (OR 0.83, CI 95% 0.72–0.96, p = 0.011). Falls in the past 12 months were related to an increased prevalence of PIM use in women (OR 1.74, CI 95% 1.10–2.75, p = 0.019). Depression was associated with a higher prevalence of PIM use in both men (OR 2.74, CI 95% 1.20–6.24, p = 0.016) and women (OR 2.06, CI 95% 1.14–3.71, p = 0.017). We did not detect sex differences regarding the overall use of drugs with anticholinergic effects, but more men than women used PIMs referring to the cardiovascular system (p = 0.036), while more women than men used PIMs referring to the genitourinary system and sex hormones (p < 0.001). Conclusion: We found similarities, but also differences between men and women as to the associations between PIM use and participants’ characteristics and functional capacity assessments. The association of lower education with PIM use may suggest that physicians’ prescribing behavior is modified by patient education, a relationship that could evolve from more critical attitudes of educated patients towards medication use. We conclude that sex differences in associations of PIM use with functional capacities might be partly attributable to sex differences in drug classes used, but not with regard to anticholinergics, as these are used to a similar extent in men and women in the cohort studied here.

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Antipsychotic Prescribing Practices in Those with Parkinsonism: Adherence to Guidelines

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.36 ◽

2017 ◽

Vol 44 (5) ◽

pp. 603-606 ◽

Cited By ~ 1

Author(s):

Heather B. Rigby ◽

Sara Rehan ◽

Barbara Hill-Taylor ◽

Kara Matheson ◽

Ingrid Sketris

Keyword(s):

Older Adults ◽

Atypical Antipsychotics ◽

Treatment Guidelines ◽

Inappropriate Prescribing ◽

Typical Antipsychotic ◽

Potentially Inappropriate Prescribing ◽

Prescribing Practices ◽

Adherence To Guidelines ◽

Informed Treatment ◽

Typical Antipsychotics

ABSTRACTSeveral evidence-informed treatment guidelines recommend against the use of typical antipsychotics in patients with Parkinson’s disease; of the atypical antipsychotics, clozapine and quetiapine are preferred. The purpose of this study is to determine the frequency with which potentially inappropriate antipsychotics are dispensed to older adults in Nova Scotia who are on levodopa-containing medications. In this cohort, 59.9% were dispensed a preferred atypical antipsychotic and 12.6% a potentially harmful typical antipsychotic. Our results suggest that potentially inappropriate prescribing practices are common in the neuropsychiatric management of patients with parkinsonism and that there is an opportunity for education and improvement in prescribing practices.

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The effect of pharmacist-led interventions in optimising prescribing in older adults in primary care: A systematic review

SAGE Open Medicine ◽

10.1177/2050312116652568 ◽

2016 ◽

Vol 4 ◽

pp. 205031211665256 ◽

Cited By ~ 34

Author(s):

David O Riordan ◽

Kieran A Walsh ◽

Rose Galvin ◽

Carol Sinnott ◽

Patricia M Kearney ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Inappropriate Prescribing ◽

Community Dwelling ◽

Controlled Trials ◽

Potentially Inappropriate Medications ◽

Potentially Inappropriate Prescribing ◽

Randomised Controlled ◽

Community Dwelling Older Adults

Objective: To evaluate studies of pharmacist-led interventions on potentially inappropriate prescribing among community-dwelling older adults receiving primary care to identify the components of a successful intervention. Data sources: An electronic search of the literature was conducted using the following databases from inception to December 2015: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, MEDLINE (through Ovid), Trip, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, ISI Web of Science, ScienceDirect, ClinicalTrials.gov , metaRegister of Controlled Trials, ProQuest Dissertations & Theses Database (Theses in Great Britain, Ireland and North America). Review methods: Studies were included if they were randomised controlled trials or quasi-randomised studies involving a pharmacist-led intervention compared to usual/routine care which aimed to reduce potentially inappropriate prescribing in older adults in primary care. Methodological quality of the included studies was independently assessed. Results: A comprehensive literature search was conducted which identified 2193 studies following removal of duplicates. Five studies met the inclusion criteria. Four studies involved a pharmacist conducting a medication review and providing feedback to patients or their family physician. One randomised controlled trial evaluated the effect of a computerised tool that alerted pharmacists when elderly patients were newly prescribed potentially inappropriate medications. Four studies were associated with an improvement in prescribing appropriateness. Conclusion: Overall, this review demonstrates that pharmacist-led interventions may improve prescribing appropriateness in community-dwelling older adults. However, the quality of evidence is low. The role of a pharmacist working as part of a multidisciplinary primary care team requires further investigation to optimise prescribing in this group of patients.

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Drug-drug interactions and adverse drug reactions in polypharmacy among older adults: an integrative review

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.1316.2800 ◽

2016 ◽

Vol 24 (0) ◽

Cited By ~ 19

Author(s):

Maria Cristina Soares Rodrigues ◽

Cesar de Oliveira

Keyword(s):

Older Adults ◽

Drug Interactions ◽

Adverse Drug Reactions ◽

Inappropriate Prescribing ◽

Integrative Review ◽

Geriatric Nursing ◽

Drug Reactions ◽

Exclusion Criteria ◽

Drug Classes ◽

Negative Health Outcomes

ABSTRACT Objective: to identify and summarize studies examining both drug-drug interactions (DDI) and adverse drug reactions (ADR) in older adults polymedicated. Methods: an integrative review of studies published from January 2008 to December 2013, according to inclusion and exclusion criteria, in MEDLINE and EMBASE electronic databases were performed. Results: forty-seven full-text studies including 14,624,492 older adults (≥ 60 years) were analyzed: 24 (51.1%) concerning ADR, 14 (29.8%) DDI, and 9 studies (19.1%) investigating both DDI and ADR. We found a variety of methodological designs. The reviewed studies reinforced that polypharmacy is a multifactorial process, and predictors and inappropriate prescribing are associated with negative health outcomes, as increasing the frequency and types of ADRs and DDIs involving different drug classes, moreover, some studies show the most successful interventions to optimize prescribing. Conclusions: DDI and ADR among older adults continue to be a significant issue in the worldwide. The findings from the studies included in this integrative review, added to the previous reviews, can contribute to the improvement of advanced practices in geriatric nursing, to promote the safety of older patients in polypharmacy. However, more research is needed to elucidate gaps.

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Continue or not to continue? Attitudes towards deprescription among community-dwelling older adults in China

Innovation in Aging ◽

10.1093/geroni/igab046.3038 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 836-837

Author(s):

Jie Tan ◽

Chenkai Wu ◽

Li Zhang ◽

Ying Wang ◽

Lihui Chen

Keyword(s):

Older Adults ◽

Chronic Disease ◽

Inappropriate Prescribing ◽

Prescription Medication ◽

Cross Sectional Study ◽

Community Dwelling ◽

Potentially Inappropriate Medications ◽

Cross Sectional ◽

Individual Level ◽

Community Dwelling Older Adults

Abstract Inappropriate prescribing of medications and polypharmacy among older adults could lead to avoidable harms. It is hence vital to stop potentially inappropriate medications in this vulnerable group. An approach coined ‘deprescribing’ has been used to describe a patient-centerd process of optimizing medication regimens. But patient resistance to discontinuing medication use is a significant barrier to deprescribing. The present study aims to describe attitudes towards deprescribing and to examine individual-based characteristics that might be associated with these attitudes among community-dwelling older adults in China. We conducted a cross-sectional study through in-person interviews using the validated Patients’ Attitudes Towards Deprescribing questionnaire in two communities through the community-based physical examination platform. Participants were 65 years and older and had at least one chronic disease and one regular prescription medication. Of the 1,897 participants in the study, the average age was 74 years and 1,023 (53.9%) were women. The majority had one chronic disease (n=1,364 [71.9%]) and took 1-2 medications (n=1,483 [78.2%]). A total of 947 (50.0%) older adults reported being willing to stop taking one or more of their medicines if their physician said it was possible, and 1204 (63.5%) older adults wanted to stop a medicine been taking for a long time. Chronological age, marital status, number of chronic diseases, and self-rated health status were associated with the attitudes towards deprescribing. This study showed that half of the participants were willing to cease a medication that their physician though was no longer required. Individual-level factors were associated with attitudes towards deprescribing.

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Beers Criteria as a Proxy for Inappropriate Prescribing of Other Medications Among Older Adults

Annals of Pharmacotherapy ◽

10.1345/aph.1q361 ◽

2011 ◽

Vol 45 (11) ◽

pp. 1363-1370 ◽

Cited By ~ 29

Author(s):

Brian C Lund ◽

Michael A Steinman ◽

Elizabeth A Chrischilles ◽

Peter J Kaboli

Keyword(s):

Older Adults ◽

Inappropriate Prescribing ◽

Quality Measurement ◽

Future Research ◽

Beers Criteria ◽

Prescribing Practices ◽

Medication Appropriateness Index ◽

Prescribing Quality ◽

Proxy Measure ◽

Expert Clinician

Background:: The Beers criteria are a compilation of medications deemed potentially inappropriate for older adults, widely used as a prescribing quality indicator. Objective: To determine whether Beers criteria serve as a proxy measure for other forms of inappropriate prescribing, as measured by comprehensive implicit review. Methods: Data for patients 65 years and older were obtained from the Veterans Affairs Enhanced Pharmacy Outpatient Clinic (EPOC) and the Iowa Medicaid Pharmaceutical Case Management (PCM) studies. Comprehensive measurement of prescribing quality was conducted using expert clinician review of medical records according to the Medication Appropriateness Index (MAI). MAI scores attributable to non-Beers medications were contrasted between patients who did and did not receive a Beers criteria medication. Results: Beers criteria medications accounted for 12.9% (EPOC) and 14.0% (PCM) of total MAI scores. Importantly, non-Beers MAI scores were significantly higher in patients receiving a Beers criteria medication in both studies (EPOC: 15.1 vs 12.4, p = 0.02; PCM: 11.1 vs 8.7, p = 0.04), after adjusting for important confounding factors. Conclusions: Beers criteria utility extended beyond direct measurement of a limited set of inappropriate prescribing practices by serving as a clinically meaningful proxy for other inappropriate practices. Using prescribing quality indicators to guide interventions should thus identify patients for comprehensive medication review, rather than identifying specific medication targets for discontinuation. Future research should explore both the quality measurement and the intervention targeting applications of the Beers criteria, particularly when integrated with other indicators.

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