Reply to Comment on Potentially Inappropriate Medication Prescriptions for Older Adults With Painful Conditions and Association With Return Emergency Department Visits

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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Trends in emergency department visits and hospitalizations for acute allergic reactions and anaphylaxis among US older adults: 2006-2014

The Journal of Allergy and Clinical Immunology In Practice ◽

10.1016/j.jaip.2021.03.032 ◽

2021 ◽

Author(s):

Anna Chen Arroyo ◽

Lacey B. Robinson ◽

Rebecca E. Cash ◽

Mohammad Kamal Faridi ◽

Kohei Hasegawa ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

Emergency Department Visits ◽

Allergic Reactions

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Potentially Inappropriate Medication Use in Older Adults with Alzheimer’s Disease and Related Dementias Living in the Community: A Cross-Sectional Analysis

Drugs - Real World Outcomes ◽

10.1007/s40801-021-00265-4 ◽

2021 ◽

Author(s):

Lauren E. Vickers ◽

Ashley I. Martinez ◽

Alexandra M. Wallem ◽

Clare Johnson ◽

Daniela C. Moga

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Inappropriate Medication ◽

Medication Use ◽

Potentially Inappropriate Medication ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Inappropriate Medication Use ◽

Sectional Analysis

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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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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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