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

2011 ◽  
Vol 45 (11) ◽  
pp. 1363-1370 ◽  
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.

scholarly journals Development of a Risk Assessment Tool for Falls Prevention in Hospital Inpatients Based on the Medication Appropriateness Index (MAI) and Modified Beer's Criteria

2012 ◽  
Vol 3 (1) ◽  
Author(s):  
Martha M. Rumore ◽  
Georgeta Vaidean
Keyword(s):  
Medication Review ◽  
Assessment Tool ◽  
Inappropriate Prescribing ◽  
Falls Prevention ◽  
Beers Criteria ◽  
Medication Appropriateness Index ◽  
Assessment Index ◽  
Advantages And Disadvantages ◽  
Hospital Inpatients ◽  
Elderly Hospitalized Patients

Medication review is an essential component of comprehensive falls assessment. A medication review by pharmacists can assist to identify and notify prescribers of medications that require adjustment or discontinuation. Beers Criteria and the Medication Assessment Index (MAI) are explicit and implicit inappropriate prescribing (IP) tools, respectively. While the Beers Criteria has been applied to falls prevention, the MAI has not. Developing alternative falls prevention tools has been spurned by both the desire to overcome limitations of the Beers Criteria, coupled with the need for implicit criteria which includes consideration for patient äóñspecific clinical judgement. A literature search and review of the Beers Criteria and MAI tools revealed advantages and disadvantages of each. Using combined explicit/implicit falls assessment criteria using both the Beers Criteria and MAI as a framework, a falls specific inappropriate prescribing (FASPIP) tool for use in elderly hospitalized patients was developed. Validation of the FASPIP in the clinical setting is needed.   Type: Review

scholarly journals Focus and features of prescribing indications spanning multiple chronic conditions in older adults: A narrative review

2021 ◽  
Vol 11 ◽  
pp. 263355652110128
Author(s):  
Carole E Aubert ◽  
Eve A Kerr ◽  
Mandi L Klamerus ◽  
Timothy P Hofer ◽  
Melissa Y Wei
Keyword(s):  
Older Adults ◽  
Adverse Drug Event ◽  
Chronic Conditions ◽  
Patient Perspective ◽  
Inappropriate Prescribing ◽  
Adverse Outcomes ◽  
Drug Event ◽  
Multiple Chronic Conditions ◽  
Level Of Evidence ◽  
Prescribing Quality

Background: Inappropriate prescribing is frequent in older adults and associated with adverse outcomes. Prescribing indications aim to optimize prescribing, but little is known about the focus and features of prescribing indications for the most common chronic conditions in older adults. Understanding the conditions, medications, and issues addressed (e.g., patient perspective, drug-disease interaction, adverse drug event) in current prescribing indications may help to identify missing indications and develop standardized measures to improve prescribing quality. Methods: We searched Ovid/MEDLINE and EMBASE for articles published between 2015 and 2020 reporting prescribing indications for older adults. Prescribing indication included 1) prescribing “criteria,” or statements that guide prescribing action, and 2) prescribing “measures,” or prescribing actions observed in a population. We categorized their focus by conditions, medications and issues addressed, as well as level of evidence provided. Results: Among 16 sets of prescribing indications, we identified 748 criteria and 47 measures. The most common addressed medications were antihypertensives, analgesics/antirheumatics, and antiplatelets/anticoagulants. The most frequently addressed issues were drug-disease interaction, adverse drug event, administration, better therapeutic alternative, and (co-)prescription omission (20.8–36.1%). Age/functioning, drug-drug interaction, monitoring, and efficacy/safety ratio were found in only 9.9–16.5% of indications. Indications rarely focused on the patient perspective or issues with multiple providers. Conclusion: Most prescribing indications for chronic conditions in older patients are criteria rather than measures. Indications accounting for patient perspective and multiple providers are limited. The gaps identified in this review may help improve the development of prescribing measures for older adults and ultimately improve quality of care.

scholarly journals 111 Tripper: Trying to Reduce Inappropriate Prescribing in Patients Who are Elderly and At Risk of Falls

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
A O'Kane ◽  
N McGarry ◽  
J Baillie ◽  
R Plumb
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
At Risk ◽  
Inappropriate Medication ◽  
Inappropriate Prescribing ◽  
Beers Criteria ◽  
Risk Area ◽  
Discharge Letter ◽  
Risk Of Falls ◽  
History Of

Abstract Background Falls in older adults are common, and a major cause of mortality and morbidity. Polypharmacy is associated with a greater number of falls and is prevalent but preventable. The American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults are used worldwide. This project focused on Table 3 of the 2019 Beers Criteria which recommends an explicit list of PIMs to be avoided in older adults with a history of falls. Aims To increase documented discussion about PIMs on discharge letters for elderly patients at risk of falls over a 6-week period. Method A retrospective review was undertaken to define baseline data on falls, PIMs and documented discussion of PIMs on discharge letters. Stickers for Kardexes were introduced to highlight PIMs for review. A table documenting discussion of PIMs was incorporated to discharge letter templates. Data was then collected on falls, PIMs and documented discussion of PIMs on discharge letters over a 6-week period. Results: Of patients discharged over 10 weeks, 44% had a history of falls. Of patients with a history of falls, 73% were taking at least one PIM pre-admission. Following intervention, the median percentage of discharge letters with documented discussion of PIMs increased from 4% to 30%. Following intervention, there was a greater average reduction in prescribed PIMs on discharge in patients with a history of falls. Discussion We confirmed a significant burden of falls and PIMs in our patient population. QIP intervention increased documentation of PIM discussion and reduced the volume of PIMs prescribed on discharge. Communicating PIM discussion on discharge letters encourages deprescribing; informs primary care and future admissions; and promotes patient centred decision-making in this important risk area. Further work includes collecting feedback from primary care and introducing a PIMs review table to discharge letter templates throughout the hospital.

Inappropriate Prescribing for the Elderly: Beers Criteria-Based Review

2000 ◽  
Vol 34 (3) ◽  
pp. 338-346 ◽  
Author(s):  
Rajender R Aparasu ◽  
Jane R Mort
Keyword(s):  
Inappropriate Medication ◽  
Inappropriate Prescribing ◽  
Medication Use ◽  
The Elderly ◽  
Inappropriate Drug ◽  
Beers Criteria ◽  
Prescribing Practices ◽  
Healthcare Settings ◽  
Inappropriate Medication Use ◽  
Inappropriate Medications

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.

scholarly journals Sex Differences in Potentially Inappropriate Prescribing Among Older Adults With Multimorbidity

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 335-336
Author(s):  
Maria Ukhanova ◽  
Sheila Markwardt ◽  
Jon Furuno ◽  
Laura Davis ◽  
Brie Noble ◽  
...  
Keyword(s):  
Older Adults ◽  
Sex Differences ◽  
Inappropriate Prescribing ◽  
Secondary Analysis ◽  
Potentially Inappropriate Medications ◽  
Prescribing Practices ◽  
Chi Square ◽  
Physical Conditions ◽  
Disease Patterns ◽  
Drug Classes

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.

scholarly journals Antipsychotic Prescribing Practices in Those with Parkinsonism: Adherence to Guidelines

2017 ◽  
Vol 44 (5) ◽  
pp. 603-606 ◽  
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.

Refining Evidence-Based Treatments for Late-Life Depression

GeroPsych ◽  
2015 ◽  
Vol 28 (2) ◽  
pp. 67-76
Author(s):  
Grace C. Niu ◽  
Patricia A. Arean
Keyword(s):  
Older Adults ◽  
Mental Illness ◽  
Brain Plasticity ◽  
Late Life ◽  
Aging Population ◽  
The United States ◽  
Future Research ◽  
Evidence Based ◽  
Late Life Depression ◽  
Evidence Based Treatments

The recent increase in the aging population, specifically in the United States, has raised concerns regarding treatment for mental illness among older adults. Late-life depression (LLD) is a complex condition that has become widespread among the aging population. Despite the availability of behavioral interventions and psychotherapies, few depressed older adults actually receive treatment. In this paper we review the research on refining treatments for LLD. We first identify evidence-based treatments (EBTs) for LLD and the problems associated with efficacy and dissemination, then review approaches to conceptualizing mental illness, specifically concepts related to brain plasticity and the Research Domain Criteria (RDoc). Finally, we introduce ENGAGE as a streamlined treatment for LLD and discuss implications for future research.

scholarly journals Social Engagement and Episodic Memory in Non-Hispanic Black and White Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 343-343
Author(s):  
Abbey Hamlin ◽  
A Zarina Kraal ◽  
Laura Zahodne
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Episodic Memory ◽  
Cognitive Aging ◽  
Social Engagement ◽  
Future Research ◽  
Social Activities ◽  
Linear Regression Models ◽  
Significant Positive Association ◽  
Cross Sectional

Abstract Social engagement may confer cognitive benefits in older adulthood, but studies have typically been restricted to largely non-Hispanic White (NHW) samples. Levels of social engagement vary across race such that NHW report larger social networks, more frequent participation in social activities, and greater social support than non-Hispanic Blacks (NHB). Associations between social engagement and cognition may also vary by race, but research is sparse. The current cross-sectional study examined associations between different aspects of social engagement and episodic memory performance, as well as interactions between social engagement and race among NHB and NHW participants in the Michigan Cognitive Aging Project (N = 247; 48.4% NHB; age = 64.19 ± 2.92). Social engagement (network size, activities, support) was self-reported. Episodic memory was a z-score composite of immediate, delayed, and recognition trials of a list-learning task. Separate hierarchical linear regression models quantified interactions between race and each of the three social engagement variables on episodic memory, controlling for sociodemographics, depressive symptoms, and health conditions. Results showed a main effect of more frequent social activity on better episodic memory, as well as an interaction between race and social support indicating a significant positive association in NHB but not NHW. These preliminary findings suggest that participating in social activities may be equally beneficial for episodic memory across NHB and NHW older adults and that social support may be particularly beneficial for NHB. Future research is needed to determine the potential applications of these results in reducing cognitive inequalities through the development of culturally-relevant interventions.

scholarly journals Spontaneous Eye Blinks Predict Executive Functioning in Seniors

2021 ◽  
Author(s):  
Jessika I. V. Buitenweg ◽  
Jaap M. J. Murre ◽  
K. Richard Ridderinkhof
Keyword(s):  
Older Adults ◽  
Working Memory ◽  
Executive Functioning ◽  
Cognitive Training ◽  
Functional Decline ◽  
Future Research ◽  
Blink Rate ◽  
Memory Updating ◽  
Age Related ◽  
Working Memory Updating

AbstractAs the world’s population is aging rapidly, cognitive training is an extensively used approach to attempt improvement of age-related cognitive functioning. With increasing numbers of older adults required to remain in the workforce, it is important to be able to reliably predict future functional decline, as well as the individual advantages of cognitive training. Given the correlation between age-related decline and striatal dopaminergic function, we investigated whether eye blink rate (EBR), a non-invasive, indirect indicator of dopaminergic activity, could predict executive functioning (response inhibition, switching and working memory updating) as well as trainability of executive functioning in older adults. EBR was collected before and after a cognitive flexibility training, cognitive training without flexibility, or a mock training. EBR predicted working memory updating performance on two measures of updating, as well as trainability of working memory updating, whereas performance and trainability in inhibition and switching tasks could not be predicted by EBR. Our findings tentatively indicate that EBR permits prediction of working memory performance in older adults. To fully interpret the relationship with executive functioning, we suggest future research should assess both EBR and dopamine receptor availability among seniors.

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