Inappropriate Prescribing for the Elderly: Beers Criteria-Based Review

OBJECTIVE: To review currently available literature applying the Beers criteria for inappropriate medication use in the elderly to prescribing practices in various settings. DATA SOURCE: Key words including inappropriate, Beers, medication, prescribing, elderly, geriatric, and criteria were used to search MEDLINE records from January 1992 to June 1999. DATA EXTRACTION: Eight relevant studies were found that applied the Beers criteria in various healthcare settings. DATA SYNTHESIS: Each study was examined for methodologic issues, criteria used, prevalence, nature and extent of inappropriate medication use, and factors associated with their use. Despite the methodologic differences, the review revealed some consistent patterns across healthcare settings. This review has shown that: (1) most of the researchers modified the Beers criteria to examine inappropriate medication use in the elderly; (2) studies using patient-based prevalence showed that between nearly one in four (23.5%) and one in seven (14.0%) elderly patients received an inappropriate medication as defined by either the Beers list of 20 inappropriate medications or the Modified Beers list; (3) the majority of these patients received one inappropriate agent; and (4) long-acting benzodiazepines, dipyridamole, propoxyphene, and amitriptyline were among the most frequently prescribed inappropriate medications. Univariate analyses indicated that women, patients >80 years old, and Medicaid patients appeared to receive more inappropriate medications than others; however, multivariate analyses found that only a higher number of medications was consistently associated with inappropriate medication use. CONCLUSIONS: Inappropriate prescribing or use trends are noteworthy because they were observed despite methodologic differences. The findings can be instrumental in developing targeted interventions to influence future prescribing practices. More research is needed to address the national trends and healthcare impact of inappropriate drug use in the elderly.

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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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Potentially Inappropriate Medication Use in the Elderly

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.1017/s0714980821000234 ◽

2021 ◽

pp. 1-8

Author(s):

Lesley Charles ◽

Elena Kumar ◽

Eimad Elghol ◽

Bonnie Dobbs ◽

Peter George Jaminal Tian ◽

...

Keyword(s):

Older Patients ◽

Community Hospital ◽

Inappropriate Medication ◽

Medication Use ◽

The Elderly ◽

Potentially Inappropriate Medications ◽

Rehabilitation Hospital ◽

Oral Medications ◽

Inappropriate Medication Use ◽

Inappropriate Medications

Abstract It is estimated that approximately half of adults, older than 65 years of age, have been prescribed potentially inappropriate medications (PIMs). This study’s objective was to determine the prevalence of PIM use among older patients. Two retrospective chart reviews were performed on 200 and 164 older patients who underwent comprehensive geriatric assessments (CGAs) at outpatient geriatrics clinics at the Glenrose Rehabilitation Hospital (Glenrose) in 2012–13 and at the Misericordia Community Hospital (Misericordia) in 2016–17, respectively. Outcome measures included demographics; prevalence of PIM use; common PIMs used; whether PIM use was addressed, and if so, how; and total number of oral medications. At the Glenrose, the prevalence of PIM use was 45 per cent (90/200). Of the 90 patients who had used PIMs, 46.7 per cent (42/90) had at least one of their medications stopped or modified. At the Misericordia, the prevalence of PIM use was 57.3 per cent (94/164). Of the 94 patients who used PIMs, 47.9 per cent (45/94) had at least one of their medications stopped or modified. These results suggest that an increased awareness of PIM among physicians is needed to further decrease PIM use.

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Patterns of Potentially Inappropriate Medication Use Across Three Cohorts of Older Medicaid Recipients

Annals of Pharmacotherapy ◽

10.1345/aph.1e581 ◽

2005 ◽

Vol 39 (7-8) ◽

pp. 1175-1181 ◽

Cited By ~ 21

Author(s):

Sally K Rigler ◽

Carolyn M Jachna ◽

Subashan Perera ◽

Theresa I Shireman ◽

Marty L Eng

Keyword(s):

Muscle Relaxant ◽

Inappropriate Medication ◽

Inappropriate Prescribing ◽

Medication Use ◽

Potentially Inappropriate Medication ◽

Inappropriate Drug ◽

Short Term ◽

Community Based ◽

Inappropriate Medication Use ◽

Disease Associations

BACKGROUND Potentially inappropriate medication use is a serious quality concern, especially when it occurs in more vulnerable older adults or for extended durations. OBJECTIVE To characterize patterns of inappropriate medication use and duration among 3 cohorts with differing health status. METHODS We identified unconditionally inappropriate drug use, using Beers 1997 criteria, among 3185 older Kansas Medicaid beneficiaries. Claims from May 2000 to April 2001 provided data for 3 cohorts: nursing facility (NF) residents, recipients of home- and community-based services through the Frail Elderly (FE) program, and persons with neither NF/FE care (Ambulatory). Duration, categorized as short-term (≤1 month's supply), extended (>1–9 mo), or chronic (>9–12 mo), was determined for each drug and cohort. Drug–disease associations were explored. RESULTS Any inappropriate medication use occurred in 21%, 48%, and 38% of Ambulatory, FE, and NF cohorts, respectively. Inappropriate analgesics, antihistamines, antidepressants, muscle relaxants, and oxybutynin were most common, but prevalence and duration varied by cohort. Short-term analgesic and antihistamine use was common. FE cohort members had the highest use rates for all drugs. The NF cohort had less antidepressant and muscle relaxant use. Drug–disease associations were noted for amitriptyline use in diabetes mellitus, propoxyphene use in musculoskeletal and upper gastrointestinal conditions, and muscle relaxant use in musculoskeletal conditions. CONCLUSIONS Cross-sectional, one-year prevalence figures are comprised of both short- and long-term use that varies by drug and cohort. NF residence is associated with reduced use of drugs scrutinized during mandated medication review. Relevant diseases are associated with specific inappropriate prescribing. Future efforts should target extended and chronic duration of use and persons at highest risk for adverse effects, including recipients of home- and community-based care.

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Beers' Criteria for Potentially Inappropriate Medication Use in the Elderly

Journal of Gerontological Nursing ◽

10.3928/0098-9134-20031101-04 ◽

2003 ◽

Vol 29 (11) ◽

pp. 6-6 ◽

Cited By ~ 2

Author(s):

Sheila L Molony

Keyword(s):

Inappropriate Medication ◽

Medication Use ◽

The Elderly ◽

Potentially Inappropriate Medication ◽

Beers Criteria ◽

Inappropriate Medication Use

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Prevalence And Predictors Of Potentially Inappropriate Medication Use Among Elderly Patients Using Updated Beers Criteria 2019: A Single Centered Retrospective Analysis

Current Drug Safety ◽

10.2174/1574886316666210423113916 ◽

2021 ◽

Vol 16 ◽

Author(s):

Sreedharan Nair ◽

Syam Sundar ◽

Srilakshmi Cheeti ◽

Aditi Bajpai ◽

S Deepika ◽

...

Keyword(s):

Elderly Patients ◽

Inappropriate Medication ◽

Medication Use ◽

Potentially Inappropriate Medication ◽

Inappropriate Drug ◽

Control Group ◽

Beers Criteria ◽

Care Hospital ◽

Medication History ◽

Inappropriate Medication Use

Background: Inappropriate medication use poses a sizable health safety hazard in the elderly owing to aging-associated physiological and anatomic changes. Inappropriate drug prescribing and polypharmacy in this population elevates the risk of adverse drug reactions (ADR). To assess the prevalence and predictors of Potentially Inappropriate Medication (PIM) use in elderly patients according to updated Beers Criteria 2019. Method: Medical Records of 402 patients aged ≥65 years admitted a tertiary care hospital from June 2018 to May 2019 were analyzed. The patients who experienced at least one PIM based on the 2019 Updated Beers Criteria were considered as cases and others as control. Data were presented as descriptive statistics and logistic regression was performed to assess the factors affecting the outcomes. Result: The mean age was found to be 73.7 ± 6.4 years in the test and 70.5± 5.5 years in the control group. The prevalence of PIMs to be used with caution was found to be 54%. Whereas the prevalence of PIMs to be avoided and to be used with reduced dose was found to be 45% and 1% respectively. The most prescribed PIMs were aspirin, diuretics, long-acting sulfonylureas, and proton pump inhibitors (PPIs). Increasing age, polypharmacy, and the number of drugs in medication history were significantly (P<0.05) correlated with a substantial risk of PIM use. The risk of developing serious and moderate drug-drug interactions (DDIs) was significantly high in the test group (P<0.05) when compared to the control group. Conclusion: A high prevalence of PIMs was observed in this study. Age, polypharmacy and ≥3 drugs in medication history were identified as risk factors for PIM use and were at a higher risk of developing DDIs. Continuous medication review by clinical pharmacists can aid in reducing the occurrence of PIMs amongst geriatrics.

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A systematic review of prescribing criteria to evaluate appropriateness of medications in frail older people

Reviews in Clinical Gerontology ◽

10.1017/s0959259814000161 ◽

2014 ◽

Vol 24 (4) ◽

pp. 304-318 ◽

Cited By ~ 4

Author(s):

A Poudel ◽

NM Peel ◽

C Mitchell ◽

LM Nissen ◽

RE Hubbard

Keyword(s):

Inappropriate Medication ◽

Inappropriate Prescribing ◽

Medication Use ◽

Older Individuals ◽

Related Factors ◽

Inappropriate Medication Use ◽

Standardized Measure ◽

Surrogate Measures ◽

The Relationship ◽

Inappropriate Medications

SummaryThis study systematically reviews the published literature regarding inappropriate prescribing in frail individuals aged at least 65 years. Twenty-five of 466 identified studies met the inclusion criteria. All papers measured some surrogate indicators of frailty, such as performance-based tests, cognitive function and functional dependency. Beers criteria were used in 20 studies (74%) to evaluate inappropriate medication use and 36% (9/25) studies used more than one criterion. The prevalence of inappropriate medications ranged widely from 11 to 92%. Only a few studies reported the relationship between potentially inappropriate medication use and surrogate measures of frailty. These diverse findings indicate the need for a standardized measure for assessing appropriateness of medication in frail older individuals. Prescribing tools should address both medication and patient-related factors such as life expectancy and functional status to minimize inappropriate prescribing in frail individuals.

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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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