Associations Between Potentially Inappropriate Medications and Adverse Health Outcomes in the Elderly: A Systematic Review and Meta-analysis

Background: Adverse drug outcomes in the elderly have led to the development of lists of potentially inappropriate medications (PIMs), such as the Beers criteria, and these PIMs have been studied widely; however, it is still unclear whether PIM use is predictive of adverse outcomes in older people. Objective: To qualitatively examine the associations between exposure to PIMs from the general Beers criteria and the Screening Tool of Older Persons’ Prescriptions list and adverse outcomes, such as adverse drug reactions (ADRs)/adverse drug events (ADEs), hospitalization, and mortality. Methods: Specified databases were searched from inception to February 1, 2018. Two reviewers independently selected studies that met the inclusion criteria, assessed study quality, and extracted data. Data were pooled using Stata 12.0. The outcomes were ADRs/ADEs, hospitalization, and mortality. Results: A total of 33 studies met the inclusion criteria. The combined analysis revealed a statistically significant association between ADRs/hospitalizations and PIMs (odds ratio [OR] = 1.44, 95% CI = 1.33-1.56; OR = 1.27, 95% CI = 1.20-1.35), but no statistically significant association was found between mortality and PIMs (OR = 1.04; 95% CI = 0.75-1.45). It is interesting to note that the results changed when different continents/criteria were used for the analysis. Compared with the elderly individuals exposed to 1 PIM, the risk of adverse health outcomes was much higher for those who took ≥2 PIMs. Conclusion and Relevance: We recommend that clinicians avoid prescribing PIMs for older adults whenever feasible. In addition, the observed associations should be generalized to other countries with different PIM criteria with caution.

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Prevalence of polypharmacy and associated adverse health outcomes in adult patients with chronic kidney disease: protocol for a systematic review and meta-analysis

Systematic Reviews ◽

10.1186/s13643-021-01752-z ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Ikechi G. Okpechi ◽

Mohammed M. Tinwala ◽

Shezel Muneer ◽

Deenaz Zaidi ◽

Feng Ye ◽

...

Keyword(s):

Public Health ◽

Systematic Review ◽

Chronic Kidney Disease ◽

Health Outcomes ◽

Meta Analysis ◽

Adverse Outcomes ◽

Adult Patients ◽

Adverse Health ◽

Adverse Health Outcomes ◽

Inappropriate Medications

Abstract Background Polypharmacy, often defined as the concomitant use of ≥ 5 medications, has been identified as a significant global public health threat. Aging and multimorbidity are key drivers of polypharmacy and have been linked to a broad range of adverse health outcomes and mortality. Patients with chronic kidney disease (CKD) are particularly at high risk of polypharmacy and use of potentially inappropriate medications given the numerous risk factors and complications associated with CKD. The aim of this systematic review will be to assess the prevalence of polypharmacy among adult patients with CKD, and the potential association between polypharmacy and adverse health outcomes within this population. Methods/design We will search empirical databases such as MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, and PsycINFO and grey literature from inception onwards (with no language restrictions) for observational studies (e.g., cross-sectional or cohort studies) reporting the prevalence of polypharmacy in adult patients with CKD (all stages including dialysis). Two reviewers will independently screen all citations, full-text articles, and extract data. Potential conflicts will be resolved through discussion. The study methodological quality will be appraised using an appropriate tool. The primary outcome will be the prevalence of polypharmacy. Secondary outcomes will include any adverse health outcomes (e.g., worsening kidney function) in association with polypharmacy. If appropriate, we will conduct random effects meta-analysis of observational data to summarize the pooled prevalence of polypharmacy and the associations between polypharmacy and adverse outcomes. Statistical heterogeneity will be estimated using Cochran’s Q and I2 index. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., sex, kidney replacement therapy, multimorbidity). Discussion Given that polypharmacy is a major and a growing public health issue, our findings will highlight the prevalence of polypharmacy, hazards associated with it, and medication thresholds associated with adverse outcomes in patients with CKD. Our study will also draw attention to the prognostic importance of improving medication practices as a key priority area to help minimize the use of inappropriate medications in patients with CKD. Systematic review registration PROSPERO registration number: [CRD42020206514].

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Application of STOPP Criteria and Beers Criteria in an inpatient psychiatric facility and impact on utilization of potentially inappropriate medications and adverse outcomes

Mental Health Clinician ◽

10.9740/mhc.n204529 ◽

2014 ◽

Vol 4 (4) ◽

pp. 201-206 ◽

Cited By ~ 1

Author(s):

Morgan C. Snyder ◽

Lisa M. Mican ◽

Tawny Smith ◽

Jamie Barner

Keyword(s):

Geriatric Patients ◽

Adverse Drug Events ◽

Adverse Outcomes ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Psychiatric Facility ◽

Stopp Criteria ◽

Secondary Outcomes ◽

Inappropriate Medications ◽

Inpatient Psychiatric Facility

Background: The Beers Criteria and STOPP Criteria were developed to identify potentially inappropriate medications (PIMs) in the geriatric population. Utilization of STOPP Criteria PIMs have shown a significant association with presence of avoidable adverse drug events (ADEs) as compared to utilization of Beers Criteria PIMs. Objectives: The purpose of this study was to utilize STOPP and Beers Criteria to identify PIMs in geriatric patients at an inpatient psychiatric facility, with the goal of implementing a formal process for assessing medication regimens. This process would be expected to decrease adverse outcomes. Methods: Both criteria were used by the pharmacist to identify PIMs and recommendations were made to address the PIMs. A retrospective chart review evaluated whether utilization of the two criteria led to a significant change in number of PIMs and associated adverse outcomes. The primary outcome was the change in number of PIMs for the Beers Criteria versus the STOPP Criteria. Secondary outcomes included the change in number of PIMs, falls, required referrals/transfers, and medication-specific ADEs for each set of criteria assessed separately. Results: Twenty-nine patients met inclusion criteria, and 76 treatment recommendations were made. More PIMs per patient were identified at baseline utilizing STOPP (mean±SD,3.9±2.3) versus Beers Criteria (mean±SD, 2.2±1.3) (p<0.001). The number of PIMs decreased using STOPP (from 112 to 66; mean decrease per patient −1.6±1.5, p<0.0001) and Beers Criteria (from 63 to 23; mean decrease per patient −1.4±1.1, p<0.0001), although the change was not significant for STOPP vs. Beers (p=0.375). All secondary outcomes decreased using both criteria. Conclusions: Utilization of each set of criteria by the pharmacist led to a significant decrease in PIMs and adverse outcomes decreased at follow-up using both criteria. Implementation of a process for assessing medication regimens of geriatric patients utilizing the Beers and/or STOPP Criteria would likely be beneficial to this institution.

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Adherence to Beers Criteria in Geriatrics: A Retrospective Study in a Saudi Teaching Hospital

Geriatrics ◽

10.3390/geriatrics5040097 ◽

2020 ◽

Vol 5 (4) ◽

pp. 97

Author(s):

Samah Alshehri ◽

Mohannad Alshibani ◽

Ghaydaa Magboul ◽

Albandari Albandar ◽

Roaa Nasser ◽

...

Keyword(s):

Retrospective Study ◽

Older Patients ◽

Adverse Drug Events ◽

Healthcare Providers ◽

Tertiary Hospital ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Inflammatory Drugs ◽

The Mean ◽

Inappropriate Medications

Background: The aging process makes geriatric populations more prone to various chronic diseases. Such diseases require older patients to be on more medications than any other age group and make them more susceptible to adverse drug events related to potentially inappropriate medications (PIMs). Aim: To identify the prevalence of potentially inappropriate medications among older people and explore the most commonly prescribed PIMs in hospitalized patients. Design and Setting: A retrospective study conducted in a large tertiary hospital among patients hospitalized in a 4 year period from January 2015 to December 2018. Methods: The 2019 Beers Criteria were used to assess PIMs in all inpatient prescribed medications focusing on the first class (i.e., drug/drug class to be avoided in older adults). Results: The mean age was 75.17 ± 7.66 years. A total of 684 (80.6%) patients were prescribed at least one medication listed in the first-class category of the 2019 Beers Criteria. Top five drugs were proton pump inhibitors (40.3%), nonsteroidal anti-inflammatory drugs (10.2%), metoclopramide (9.3%), benzodiazepines (8.4%), and insulin (5.4%). Conclusions: The prevalence of PIMs is high among older patients admitted to the hospital. More efforts are needed to investigate the potential reasons and develop action plans to improve concordance to Beers Criteria among healthcare providers.

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Adverse Staff Health Outcomes Associated with Endoscope Reprocessing

Biomedical Instrumentation & Technology ◽

10.2345/0899-8205-47.2.172 ◽

2013 ◽

Vol 47 (2) ◽

pp. 172-179 ◽

Cited By ~ 2

Author(s):

Elane Gutterman ◽

Lindsay Jorgensen ◽

Amber Mitchell ◽

Sherry Fua

Keyword(s):

United States ◽

Health Outcomes ◽

Health Workers ◽

The United States ◽

Adverse Outcomes ◽

Healthcare Personnel ◽

Health Administration ◽

Adverse Health ◽

Adverse Health Outcomes ◽

Pubmed Database

Abstract There are occupational challenges associated with cleaning, disinfecting, storing, and transporting flexible endoscopes. Although the Occupational Safety and Health Administration (OSHA) has set standards to protect the safety of health workers in the United States, the standards are not specific to endoscope reprocessing, and the general standards that are in place are not fully implemented. Furthermore, adverse staff outcomes may not be fully preventable. To assess the evidence for adverse outcomes in staff associated with endoscope reprocessing, a literature review was performed in the PubMed database for articles on this topic published between Jan. 1, 2007 and March 7, 2012. Eight studies were identified, mainly European, which reported numerous adverse outcomes to healthcare personnel associated with endoscope reprocessing including respiratory ailments and physical discomfort. More scientifically rigorous studies are required to comprehensively describe adverse health outcomes in personnel engaged in reprocessing, particularly in the United States, and examine whether increased automation of the reprocessing process leads to decreased adverse health outcomes for staff.

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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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A Closer Look at the 2015 Beers Criteria

Journal of Pharmacy Practice ◽

10.1177/0897190016663072 ◽

2016 ◽

Vol 30 (4) ◽

pp. 419-424 ◽

Cited By ~ 10

Author(s):

Rebecca L. Salbu ◽

Judith Feuer

Keyword(s):

Elderly Patients ◽

Health Care Providers ◽

Clinical Judgment ◽

The Elderly ◽

Specific Information ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Care Providers ◽

Inappropriate Medications ◽

Made In

The Beers Criteria identifies potentially inappropriate medications for patients who are 65 years of age and older. Initially published in 1991, the criteria have been updated multiple times, most recently in 2015. The Beers Criteria is a tool designed to alert health-care providers to the potential harms of specific medications so they may better tailor therapeutic regimens for their elderly patients. The expert panel of the 2015 update made changes to a number of previous recommendations and provided 2 new tables on select drug interactions and select medications requiring renal dose adjustments. The purpose of this review is to provide additional details and rationale behind selected noteworthy changes within the 2015 criteria. Specific information is provided on the changes in recommendations for the use of nitrofurantoin, antiarrhythmics, nonbenzodiazepine receptor agonist hypnotics, antipsychotics, and proton pump inhibitors in the elderly. Additional comparisons are made between the 2012 recommendations and newer recommendations made in the 2015 update, along with rationale for the change. This review will allow practitioners to apply the 2015 Beers Criteria and integrate their clinical judgment when evaluating and selecting drug therapy for elderly patients.

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Potentially inappropriate medications use and its associated factors among geriatric patients: a cross-sectional study based on 2019 Beers Criteria

Pharmacia ◽

10.3897/pharmacia.68.e73597 ◽

2021 ◽

Vol 68 (4) ◽

pp. 789-795

Author(s):

Heba Khader ◽

Luai Z. Hasoun ◽

Ahmad Alsayed ◽

Mahmoud Abu-Samak

Keyword(s):

Geriatric Patients ◽

Adverse Drug Events ◽

Cross Sectional Study ◽

Community Dwelling ◽

Sample Population ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Sectional Study ◽

Cross Sectional ◽

Inappropriate Medications

The aims of this study were to estimate the prevalence of potentially inappropriate medications (PIMs) in a community-dwelling Jordanian population of geriatrics according to the 2019 American Geriatrics Society Beers Criteria, to identify the most used PIMs and factors independently associated with PIMs use. This was an observational, descriptive, cross-sectional study. The sample population included 386 participants. Data were collected by face-to-face interviews. A total of 2894 medications were evaluated. The prevalence of patients using at least one PIM was 49.2%. The most used PIMs were proton pump inhibitors (24.6%) and long-acting sulfonylurea (20.5%). Participants who had diabetes mellitus, peptic ulcer, or irritable bowel syndrome had significantly higher numbers of PIMs. The use of PIMs was high in Jordanian geriatric patients. The results of this study might help healthcare providers to detect high-risk patients and reconsider the necessity of using PIMs to decrease the risk of adverse drug events.

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Factors associated with potentially inappropriate medications use by the elderly according to Beers criteria 2003 and 2012

International Journal of Clinical Pharmacy ◽

10.1007/s11096-013-9880-y ◽

2013 ◽

Vol 36 (2) ◽

pp. 316-324 ◽

Cited By ~ 27

Author(s):

André de Oliveira Baldoni ◽

Lorena Rocha Ayres ◽

Edson Zangiacomi Martinez ◽

Nathalie de Lourdes Souza Dewulf ◽

Vânia dos Santos ◽

...

Keyword(s):

The Elderly ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Factors Associated ◽

Inappropriate Medications

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Prevalence of cognitive impairment in Chinese older inpatients and its relationship with 1-year adverse health outcomes: a multi-center cohort study

BMC Geriatrics ◽

10.1186/s12877-021-02556-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Li Yuan ◽

Xiaoming Zhang ◽

Na Guo ◽

Zhen Li ◽

Dongmei Lv ◽

...

Keyword(s):

Cohort Study ◽

Cognitive Impairment ◽

Cognitive Function ◽

Health Outcomes ◽

Adverse Outcomes ◽

Adverse Health ◽

Adverse Health Outcomes ◽

Normal Cognitive Function ◽

Older Inpatients ◽

The Relationship

Abstract Background Previous studies on the relationship between cognitive impairment and adverse outcomes among geriatric inpatients are not representative of older inpatients in China because of insufficient sample sizes or single-center study designs. The purpose of our study was to examine the prevalence of cognitive impairment and the relationship between cognitive impairment and 1-year adverse health outcomes in older inpatients. Methods This study was a large-scale multi-center cohort study conducted from October 2018 to February 2020. Six tertiary hospitals across China were selected using a two-stage cluster sampling method, and eligible older inpatients were selected for the baseline survey and follow-up. The Mini Cognitive Scale and the FRAIL scale were used to screen for cognitive impairment and frailty, respectively. The EuroQol-5 Dimension-5 Level questionnaire was used to assess health-related quality of life (HRQoL). We used a generalized estimating model to evaluate the relationship between cognitive impairment and adverse outcomes. Results The study included 5008 men (58.02%) and 3623 women (41.98%), and 70.64% were aged 65–75 years, and 26.27% were aged 75–85 years. Cognitive impairment was observed in 1756 patients (20.35%). There were significant differences between participants with cognitive impairment and those with normal cognitive function for age, gender, surgery status, frailty, depression, handgrip strength and so on. After adjusting for multiple covariates, compared with patients with normal cognitive function, the odds ratio for 1-year mortality was 1.216 (95% confidence interval [CI]: 1.076–1.375) and for 1-year incidence of frailty was 1.195 (95% CI: 1.037–1.376) in patients with cognitive impairment. Similarly, the regression coefficient of 1-year HRQoL was − 0.013 (95% CI: − 0.024−− 0.002). In the stratified analysis, risk of adverse outcome within 1 year was higher in older patients with cognitive impairment aged over 75 years than those aged 65–74 years. Conclusions We revealed that cognitive impairment was highly correlated with occurrence of 1-year adverse health outcomes (death, frailty, and decreased HRQoL) in older inpatients, which provides a basis for formulating effective intervention measures. Trial registration Chinese Clinical Trial Registry, ChiCTR1800017682, registered 09 August 2018.

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Physiological Dysregulation, Frailty, and Impacts on Adverse Health and Functional Outcomes

Frontiers in Medicine ◽

10.3389/fmed.2021.751022 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yanxia Lu ◽

Xinyi Gwee ◽

Denise Q. L. Chua ◽

Crystal T. Y. Tan ◽

Keng Bee Yap ◽

...

Keyword(s):

Health Outcomes ◽

Functional Outcomes ◽

Predictive Accuracy ◽

Adverse Outcomes ◽

Physical Frailty ◽

Adverse Health ◽

Adverse Health Outcomes ◽

Physiological Dysregulation ◽

Aging Studies ◽

Secondary Analyses

Background: Multi-system physiological dysregulation (PD) may represent a biological endo-phenotype of clinical frailty. We investigated the co-occurrence of PD with physical frailty and its contributions to the known impact of frailty on adverse health outcomes.Methods: Data of 2,725 participants from the Singapore Longitudinal Aging Studies (SLAS-2), included baseline measures of physical frailty and PD derived from Mahalanobis distance (Dm) value of 23 blood biomarkers. We analyzed their concurrent association and their impacts on 9-year mortality, MMSE cognition, GDS depression, number of medications, disability, and hospitalization at baseline and follow up (mean 4.5 years).Results: Global PD (Log10Dm, mean = 1.24, SD = 0.24) was significantly but weakly associated with pre-frailty-and-frailty. Controlling for age, sex and education, pre-frailty-and-frailty (HR = 2.12, 95% CI = 1.51–3.00) and PD (HR = 3.88, 95% CI = 2.15–6.98) predicted mortality. Together in the same model, mortality HR associated with pre-frailty-and-frailty (HR = 1.83, 95% CI = 1.22–2.73) and PD (HR = 3.06, 95% CI = 1.60–5.85) were reduced after additionally adding global PD to the prediction model. The predictive accuracy for mortality were both approximately the same (PD: AUC = 0.62, frailty: AUC = 0.64), but AUC was significantly increased to 0.68 when combined (p < 0.001). Taken into account in the same model, frailty remained significantly associated with all health and functional outcomes, and PD was significantly associated with only MMSE, disability and medications used. In secondary analyses, there were mixed associations of system-specific PDs with frailty and different adverse outcomes.Conclusions: Co-existing PD and physical frailty independently predict mortality and functional and health outcomes, with increased predictive accuracy when combined. PD appears to be a valid representation of a biological endo-phenotype of frailty, and the potential utility of such subclinical measures of frailty could be further studied.

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