GPs, medications and older people: A qualitative study of general practitioners' approaches to potentially inappropriate medications in older people

The prevalence of complex multimorbidity is increasing steadily in tandem with global population ageing. Complex multimorbidity is in turn intimately associated with polypharmacy, the relationship being one of cause-and-effect. Polypharmacy commonly leads to prescription of inappropriate drugs, resulting in a substantially higher risk of drug-related problems, principally adverse drug–drug and drug–disease interactions. These problems become manifest in the form of common geriatric symptoms such as falls, acute confusion, and incontinence and commonly result in increased healthcare utilization, including hospitalization, with obvious economic consequences. In addition, adverse drug reactions and adverse drug events lead to death in older people. The challenge of optimization of pharmacotherapy in older people with complex multimorbidity is a major one. There is increasing evidence that avoidance of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) using validated PIM and PPO criteria lists leads to better and safer pharmacotherapy in this high-risk population.

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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 ◽

10.3390/medicina54040057 ◽

2018 ◽

Vol 54 (4) ◽

pp. 57 ◽

Cited By ~ 5

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.

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The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries

European Journal of Clinical Pharmacology ◽

10.1007/s00228-015-1860-9 ◽

2015 ◽

Vol 71 (7) ◽

pp. 861-875 ◽

Cited By ~ 141

Author(s):

Anna Renom-Guiteras ◽

Gabriele Meyer ◽

Petra A. Thürmann

Keyword(s):

Older People ◽

European Countries ◽

Potentially Inappropriate Medications ◽

Inappropriate Medications ◽

The Eu

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Decreasing trends in potentially inappropriate medications in older people: a nationwide repeated cross-sectional study

BMC Geriatrics ◽

10.1186/s12877-021-02568-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Solène Drusch ◽

Thien Le Tri ◽

Joël Ankri ◽

Mahmoud Zureik ◽

Marie Herr

Keyword(s):

Older People ◽

Antihypertensive Drugs ◽

Cross Sectional Study ◽

Anticholinergic Drugs ◽

Potentially Inappropriate Medications ◽

Linear Regression Models ◽

Health Insurance Data ◽

Annual Percent Change ◽

Cross Sectional ◽

Inappropriate Medications

Abstract Background Potentially Inappropriate Medications (PIMs) and polypharmacy are widely used indicators of suboptimal prescribing for older people. The aim of this study was to describe the changes in the prevalence of PIMs and polypharmacy among people aged 75 years and over between 2011 and 2019 in France. Methods PIMs and polypharmacy were assessed among people aged 75 years and over every two years between 2011 and 2019 using the French health insurance data system. Sixteen PIM criteria from the 2015 Beers and STOPP lists were assessed. Polypharmacy (5 to 9 drugs) and hyper-polypharmacy (≥10 drugs) were defined based on the average number of drugs dispensed per quarter. The Annual Percent Change (APC) and 95%CI were assessed using linear regression models after standardization of the prevalence on age and sex. Results The study population included 5,777,645 individuals over 75 years old in 2011 and 6,328,155 in 2019. The prevalence of PIMs decreased from 49.6 to 39.6% over the study period (APC: − 1.19% [− 1.35;-1.04]). Of the sixteen indicators assessed, the prevalence of thirteen decreased between 2011 and 2019. Benzodiazepines were the most frequent PIMs (34.7% in 2011 to 26.9% in 2019), followed by anticholinergic drugs (12.1% in 2011 to 8.3% in 2019), oral non-steroidal anti-inflammatory drugs (11.4 to 7.8%), and PIMs related to antihypertensive drugs (7.4 to 6.0%). Overall, women and individuals aged 85 years and older were more likely to receive PIMs. The prevalence of hyper-polypharmacy decreased from 30.5 to 25.9% over the study period. Conclusion This study, which is the first to assess the change in prevalence of PIMs and polypharmacy over time from comprehensive health data in France, highlights that PIMs and hyper-polypharmacy declined between 2011 and 2019. However, PIMs remains frequent for older people and often involves benzodiazepines.

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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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P35 Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners

10.1136/spcare-2019-acpicongressabs.119 ◽

2019 ◽

Author(s):

J Glaudemans ◽

E Moll van Charante ◽

J Wind ◽

J Oosterink ◽

D Willems

Keyword(s):

Qualitative Study ◽

Older People ◽

General Practitioners ◽

Advance Care Planning ◽

Care Planning ◽

Advance Care

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Health promotion and older people: a qualitative study of general practitioners' views

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1997.tb126654.x ◽

1997 ◽

Vol 167 (8) ◽

pp. 423-427 ◽

Cited By ~ 6

Author(s):

Ngaire M Kerse ◽

Doris Young ◽

Michael J Murphy ◽

Leon Flicker

Keyword(s):

Health Promotion ◽

Qualitative Study ◽

Older People ◽

General Practitioners

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Medication-Related Problems in Older People with Multimorbidity in Catalonia: A Real-World Data Study with 5 Years’ Follow-Up

Journal of Clinical Medicine ◽

10.3390/jcm10040709 ◽

2021 ◽

Vol 10 (4) ◽

pp. 709

Author(s):

Amelia Troncoso-Mariño ◽

Albert Roso-Llorach ◽

Tomás López-Jiménez ◽

Noemí Villen ◽

Ester Amado-Guirado ◽

...

Keyword(s):

Liver Disease ◽

Older People ◽

Potentially Inappropriate Medications ◽

Real World Data ◽

Health Records ◽

Cox Models ◽

Explanatory Variables ◽

Hazard Ratios ◽

Inappropriate Medications

Aging, multimorbidity, and polypharmacy are associated with medication-related problems (MRPs). This study aimed to assess the association that multimorbidity and mortality have with MRPs in older people over time. We followed multimorbid, older (65–99 years) people in Catalonia from 2012 to 2016, using longitudinal data and Cox models to estimate adjusted hazard ratios (HR). We reviewed electronic health records to collect explanatory variables and MRPs (duplicate therapy, drug–drug interactions, potentially inappropriate medications (PIM), and contraindicated drugs in chronic kidney disease (CKD) or liver disease). There were 723,016 people (median age: 74 years; 58.9% women) who completed follow-up. We observed a significant (p < 0.001) increase in the proportion with at least one MRP (2012: 66.9% to 2016: 75.5%); contraindicated drugs in CKD (11.1 to 18.5%) and liver disease (3.9 to 5.3%); and PIMs (62.5 to 71.1%), especially drugs increasing fall risk (67.5%). People with ≥10 diseases had more MRPs (in 2016: PIMs, 89.6%; contraindicated drugs in CKD, 34.4%; and in liver disease, 9.3%). All MRPs were independently associated with mortality, from duplicate therapy (HR 1.06; 95% confidence interval (CI) 1.04–1.08) to interactions (HR 1.60; 95% CI 1.54–1.66). Ensuring safe pharmacological treatment in elderly, multimorbid patient remains a challenge for healthcare systems.

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