Potentially inappropriate medication prescribed to elderly outpatients at a general medicine unit

ABSTRACT Objective: To establish the prevalence of potentially inappropriate medications prescribed for elderly patients, to identify the most commonly involved drugs, and to investigate whether age, sex and number of medications were related with the prescription of these drugs. Methods: Prescriptions for 1,800 elderly patients (≥ 60 years) were gathered from a database. These prescriptions were written by general physicians at a tertiary level university hospital in the city of Sao Paulo, Brazil, from February to May 2008. Only one prescription per patient was considered. The prescriptions were classified according to sex and age (60-69, 70-79 and ≥ 80). The Beers criteria (2003 version) were used to evaluate potentially inappropriate medications. Results: Most of the sample comprised women (66.6%) with a mean age of 71.3 years. The mean prevalence of potentially inappropriate medication prescriptions was 37.6%. The 60-69 age group presented the highest prevalence (49.9%). The most frequently prescribed potentially inappropriate medications to women were carisoprodol, amitriptyline, and fluoxetine; amitriptyline, carisoprodol, fluoxetine and clonidine were prescribed more often to men. The female sex (p<0.001; OR=2.0) and number of medications prescribed (p<0.001) were associated with prescription of potentially inappropriate medications. The chance of having a prescription of these drugs was lower among patients aged over 80 years (OR=0.7). The mean number of prescribed medications for both sexes and all age groups was 7.1. The mean number of medications per patient was higher among females (p<0.001); this result was not age-dependent (p=0.285). Conclusion: The prevalence of potentially inappropriate medications was similar to previously reported values in the literature and was correlated with the female sex. The chance of having a potentially inappropriate medication prescription was lower among patients aged over 80 years. The chance of having a potentially inappropriate medications prescription increased proportionally with the number of medications prescribed (≥ 5).

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Potentially inappropriate medications among elderly Brazilian outpatients

Sao Paulo Medical Journal ◽

10.1590/s1516-31802013000100004 ◽

2013 ◽

Vol 131 (1) ◽

pp. 19-26 ◽

Cited By ~ 14

Author(s):

Christine Grützmann Faustino ◽

Maria Cristina Guerra Passarelli ◽

Wilson Jacob-Filho

Keyword(s):

Sao Paulo ◽

University Hospital ◽

Potentially Inappropriate Medications ◽

Age Group ◽

São Paulo ◽

Female Sex ◽

Elderly Outpatients ◽

The Mean ◽

Inappropriate Medications ◽

De Medicina

CONTEXT AND OBJECTIVESIn Brazil, few studies have investigated the prevalence of potentially inappropriate medications (PIMs) among elderly outpatients. This study aimed to determine the prevalence of PIMs prescribed for elderly outpatients, identify the PIMs most commonly involved, and investigate whether age, sex and number of medications are related to prescription of such medications.DESIGN AND SETTINGObservational descriptive study developed in the Geriatrics Service of the Central Institute of Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.METHODSPrescriptions issued to 1,270 elderly patients (≥ 60 years) were gathered from a database. These prescriptions had been written by geriatricians at a tertiary-level university hospital in São Paulo, Brazil, between February and May 2008. The prescriptions were divided according to sex and age group (60-69, 70-79 and ≥ 80). The Beers criteria were used to evaluate PIMs.RESULTSMost of the sample comprised women (77%) and the mean age was 80.1 years. The mean prevalence of PIM prescriptions was 26.9%. Female sex and number of medications prescribed were associated with prescription of PIMs. The chance of having a PIM prescription was lower among patients ≥ 70 years.CONCLUSIONThe greater prevalence of PIMs was correlated with female sex. The chance of having a PIM prescription was lower among patients ≥ 70 years and became greater with increasing numbers of medications prescribed (≥ 7).

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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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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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Identifikasi Potentially Inappropriate Medications (PIMs) Berdasarkan Kriteria STOPP START pada Pasien Geriatri Rawat Inap di RS Advent Bandar Lampung

Jurnal Analis Kesehatan ◽

10.26630/jak.v7i1.912 ◽

2018 ◽

Vol 7 (1) ◽

pp. 657 ◽

Cited By ~ 1

Author(s):

Siti Juliha

Keyword(s):

Vascular Disease ◽

Inappropriate Medication ◽

Potentially Inappropriate Medication ◽

Potentially Inappropriate Medications ◽

Chi Square ◽

Cerebral Vascular Disease ◽

Inappropriate Medications ◽

Cerebral Vascular

Identifikasi peresepan obat pada populasi geriatri sangat penting untuk terus dilakukan karena peresepan yang membahayakan pada populasi ini akan berasosiasi dengan peningkatan morbiditas, terjadinya kejadian yang tidak diinginkan terkait obat, dan mortalitas. Tujuan penelitian ini adalah untuk mengidentifikasi PIM (Potentially Inappropriate Medication) pada pasien geriatri rawat inap di RS Advent Bandar Lampung pada tahun 2016 berdasarkan Kriteria STOPP START. Jenis penelitian ini adalah deskriptif. Populasi dalam penelitian ini adalah seluruh rekam medik pasien geriatric yang berobat rawat inap di RS Advent Bandar Lampung tahun 2016 dengan jumlah sampel sebanyak 72 rekam medik. Uji statistic yang digunakan adalah uji Chi square. Identifikasi penggunaan PIM disesuaikan dengan criteria STOPP START. Hasil analisis univariat menunjukkan tiga jenis PIM terbanyak pada pengobatan pasien geritari di RS Advent Bandar Lampung adalah tidak digunakannya statin pada pasien yang memiliki riwayat penyakit jantung koroner dan cerebral vascular disease (51,28%), adanya duplikasi kelas obat (17,95%), dan penggunaan benzodiazepine pada pasien yang berisiko jatuh (11,43%). Analisis bivariat menunjukkan tidak ada hubungan secara bermakna antara kejadian PIM dengan jenis kelamin, usia, jumlah obat yang diberikan, komorbid, dan lama rawat.

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Drug therapy, potential interactions and iatrogenesis as factors related to frailty in the elderly

Revista Brasileira de Geriatria e Gerontologia ◽

10.1590/1981-22562018021.180085 ◽

2018 ◽

Vol 21 (5) ◽

pp. 588-596 ◽

Cited By ~ 3

Author(s):

Andressa Rodrigues Pagno ◽

Carolina Baldissera Gross ◽

Daiana Meggiolaro Gewehr ◽

Christiane de Fátima Colet ◽

Evelise Moraes Berlezi

Keyword(s):

Drug Therapy ◽

Drug Interactions ◽

Inappropriate Medication ◽

The Elderly ◽

Potentially Inappropriate Medication ◽

Potentially Inappropriate Medications ◽

Elderly Persons ◽

Potential Drug ◽

Increased Risk ◽

Inappropriate Medications

Abstract Objective: to investigate the use of drugs, potential drug interactions and iatrogenesis, as factors associated with frailty. Method: an observational, cross-sectional, population-based study of elderly persons registered with the Family Health Strategies of the urban area of a municipal region in the south of Brazil was carried out. The sample was probabilistic and involved 554 elderly persons; and the proportional stratified sampling technique by FHS and gender was used. Data collection was performed in the home, with the gathering of information regarding sociodemographic characteristics and pharmacotherapeutic profile and the evaluation of frailty based on Fried et al. (2001). Results: medications were taken by 86.3% of the elderly and there was a prevalence of frailty of 63.0%. A total of 39.4% of the elderly were exposed to polypharmacy, 49.1% used potentially inappropriate medications and 52.2% were exposed to potential drug interactions, the most frequent being enalapril and metformin. An association between increased risk of frailty and the variables: polypharmacy; use of potentially inappropriate medications; potential drug interactions; more than two potential drug interactions with the presence or absence of potentially inappropriate medication was identified. Conclusion: an association was found between frailty and polypharmacy, the use of potentially inappropriate medication and the presence of drug interactions. The findings underscore the importance of the monitoring of drug therapy in this population group with a view to the early detection, prevention and resolution of iatrogenesis arising from the use of medicines.

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Comparison of Beers criteria and EU(7) potentially inappropriate medications list for the potentially inappropriate medications in Indian elderly inpatients

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20191609 ◽

2019 ◽

Vol 8 (5) ◽

pp. 1106

Author(s):

Manoj H. Thummar ◽

Tejas K. Patel ◽

Varsha Y. Godbole ◽

Manoj Kumar Saurabh

Keyword(s):

Internal Medicine ◽

Elderly Patients ◽

Inappropriate Medication ◽

Cross Sectional Study ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Cross Sectional ◽

Elderly Inpatients ◽

Internal Medicine Wards ◽

Inappropriate Medications

Background: Use of inappropriate medication is an important problem in present geriatric clinical practice. No specific potentially inappropriate medications (PIM) tools are available considering the availability of drugs in India. Aim and objective were to assess prevalence and pattern of potentially inappropriate medication (PIM) use in elderly inpatients by updated Beers criteria 2015 and EU(7) PIM list 2015.Methods: This cross-sectional study was carried out on medical records of elderly patients (≥65 yrs) admitted in the internal medicine wards and intensive care units (ICU) over a period of 6 weeks. The medications were evaluated for the PIM use as per Beers criteria and EU(7) PIM list.Results: A total of 225 patients (mean age- 71.48 yrs) were admitted in internal medicine wards and ICU during study period. Total 184 PIM belonged to 33 different medications were used during study period. The prevalence of PIM in internal medicine wards and ICUs were 51.96% and 57.14%, respectively. The prevalence of PIM was significantly higher with the EU(7) PIM list than Beers criteria (49.77% vs. 21.77%) [p<0.0001]. The commonly prescribed PIM were dextromethorphan (13.33%), ranitidine (11.11%) and glipizide (10.22%).Conclusions: Elderly patients frequently receive PIM. EU(7) PIM list identifies more PIM among elderly inpatients than Beers criteria.

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The Effect of Beers Criteria-Based Training in General Practitioners on Prescribing Potentially Inappropriate Medications in Elderly Patients

Journal of Pharmaceutical Care ◽

10.18502/jpc.v8i2.3829 ◽

2020 ◽

Author(s):

Hananeh Baradaran ◽

Mohammad Nasirpur ◽

Hadi Hamishehkar

Keyword(s):

Elderly Patients ◽

General Practitioners ◽

Geriatric Patients ◽

Drug Prescription ◽

Inappropriate Medication ◽

Inappropriate Drug ◽

National Committee ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Inappropriate Medications

Background: Pharmacotherapy in elderly patients has become a major concern due to their physiological changes, pharmacokinetic and pharmacodynamics variations and poly-pharmacy. In considering the global trend in population aging, we aim to evaluate the effect of “Beers Criteria” education on prescribing medications for elderly patients by General Practitioners (GPs). Methods: Thirty GPs with the highest number of prescriptions were included in this pilot study. All prescriptions written over a three-month period were considered, then prescriptions for geriatric patients were selected and evaluated. The GPs were trained using pamphlets and booklets which were prepared based on Beers 2015 explicit criteria. In order to evaluate the effect of education, appropriateness of prescriptions was analyzed before and 1 month following training. Results: Of 15,447 prescriptions selected during the first step, 1,281 prescriptions were related to geriatric patients in which the prevalence of inappropriate drug prescriptions was 37.3%. The most inappropriate medications identified were Bisacodyl, Alprazolam, and Hyoscyamine. While in the second step 1,055 of 15,154 prescriptions concerned the elderly and inappropriate drug prescription rate was noted as 23.6%. The most common inappropriate medications included Alprazolam, Amitriptyline, and Hyoscyamine. Based on our results, the prevalence of prescribing potentially inappropriate medications (PIMs) for elderly patients is high among GPs and educational interventions that raise awareness about “Beers Criteria” significantly reduce the prescribing PIMs. Conclusion: Given the importance of GP training programs in reducing inappropriate prescription rates among geriatric patients, it will be necessary for the National Committee of Rational Use of Drugs (NCRUD) to consider undertaking comprehensive educational strategies for reducing the prevalence of inappropriate medication use in elderly people.

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Potentially Inappropriate Medication Use in Community Residential Care Facilities

Annals of Pharmacotherapy ◽

10.1345/aph.1c365 ◽

2003 ◽

Vol 37 (7-8) ◽

pp. 988-993 ◽

Cited By ~ 31

Author(s):

Shelly L Gray ◽

Susan C Hedrick ◽

Ellen E Rhinard ◽

Anne E Sales ◽

Jean H Sullivan ◽

...

Keyword(s):

Residential Care ◽

Inappropriate Medication ◽

Medication Use ◽

Potentially Inappropriate Medication ◽

Potentially Inappropriate Medications ◽

Inappropriate Use ◽

Inappropriate Medication Use ◽

Multiple Drugs ◽

Inappropriate Medications

OBJECTIVE: To describe the prevalence of potentially inappropriate medication use in community residential care (CRC) facilities at baseline, describe exposure to potentially inappropriate drugs during the 1-year follow-up, and examine characteristics associated with potentially inappropriate use. DESIGN: A cohort study was conducted using 282 individuals aged ≥65 years entering a CRC facility in a 3-county area in the Puget Sound region of Washington State between April 1998 and December 1998 on Medicaid funding. MAIN OUTCOME MEASURE: Use of potentially inappropriate medications as defined by explicit criteria (e.g., drugs that should generally be avoided in the elderly because potential risks outweigh any potential benefits). RESULTS: Sixty-two (22%) residents took a total of 75 potentially inappropriate medications at baseline. The most common agents used at baseline were oxybutynin (3.5%) and amitriptyline (3.5%). The incidence of new use of potentially inappropriate medications was 0.1/100 person-days during the follow-up period. Potentially inappropriate use was related to self-reported fair or poor health (adjusted OR 1.42; 95% CI 1.05 to 1.92) and number of prescription drugs (adjusted OR 1.12; 95% CI 1.05 to 1.19). In the Cox proportional hazard model, no characteristics predicted new potentially inappropriate medication use during the follow-up. CONCLUSIONS: Potentially inappropriate medication use is common among residents in CRC facilities. A comprehensive periodic review may be beneficial for reducing potentially inappropriate use, especially for patients taking multiple drugs.

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Polypharmacy and Potentially Inappropriate Medications in Patients With Dementia

Innovation in Aging ◽

10.1093/geroni/igaa057.673 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 208-208

Author(s):

Ryo Nonaka ◽

Atsuhiro Kanno ◽

Takahiro Ohara ◽

Kazuhiro Sumitomo ◽

Shigeru Sato ◽

...

Keyword(s):

Inappropriate Medication ◽

Lewy Bodies ◽

Critical Issue ◽

University Hospital ◽

Potentially Inappropriate Medications ◽

Medical Institutions ◽

Number Of Patients ◽

Prescribed Medicines ◽

Definition Of ◽

Inappropriate Medications

Abstract INTRODUCTION: The use of polypharmacy and potentially inappropriate medication (PIM) is a critical issue in geriatrics. Furthermore, the number of patients with dementia is dramatically increasing worldwide. In this study, we investigated: (1) if the states of polypharmacy and PIM differed in patients with and without dementia; (2) the types of medicine that were commonly prescribed; (3) the types of dementia that resulted in the prescription of multiple medicines; (4) if there was a correlation between the number of medicines and the number of medical institutions (hospitals and clinics) that the patients attended. METHODS: In total, 216 patients who were 65 years of age and older were analyzed. The number of medicines prescribed and the medical institutions they attended were counted through the electronic medical charts of Tohoku Medical and Pharmaceutical University Hospital. We employed the Beers 2019 criteria for the definition of PIM. RESULTS: (1) The number of prescribed medicines was not significantly different between patients with dementia and those without dementia. (2) Anti-hypertensives and gastro-intestinal medicines were the most commonly prescribed medicines in patients with and without dementia. (3) Patients with “dementia with Lewy bodies” and “mixed dementia” were prescribed the highest number of medicines. (4) The number of medicines and PIM use were significantly and positively correlated with the number of medical institutions. CONCLUSIONS: The number of medical institutions strongly affected the number of medicines prescribed and PIM use. Efforts should be made to organize and reduce the number of medical institutions that a patient attends.

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The study on prevalence of polypharmacy in elderly patients presenting for first time to the geriatric clinic of a tertiary care hospital in Kerala

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v5i2.10 ◽

2018 ◽

Vol 5 (2) ◽

pp. 3542-3544 ◽

Cited By ~ 1

Author(s):

Dr Aswin Rajeev ◽

Dr George Paul ◽

Dr Sobha George ◽

Dr Priya Vijayakumar

Keyword(s):

Elderly Patients ◽

Tertiary Care Hospital ◽

Inappropriate Medication ◽

Tertiary Care ◽

Potentially Inappropriate Medications ◽

Care Hospital ◽

Inappropriate Drugs ◽

Geriatric Clinic ◽

First Time ◽

Inappropriate Medications

Introduction : Elderly patients are the most common group who use heath care facilities. This study assesses the prevalence of polypharmacy and use of potentially inappropriate medications in elderly patients presenting to the geriatric clinic of a tertiary care hospital in Kerala for first time. Materials and methods : The study was a hospital based retrospective study. The data from patients presenting to Geriatrics clinic from period of 1 st January 2016 to 31 st December 2016 were retrieved from the medical records and assessed for polypharmacy (taking >5 medications at a time) and potentially inappropriate drugs in accord with modified 2012 Beer’s criteria. Results : A total of 275 patients were included in the study of which 110 (40%) were males and 165 (60%) were females. The prevalence of polypharmacy found to be 22.9%. 63 out of total 275 patients took more than 5 medications at a time. 81 (29.5%) out of 275 patients had at least one potentially inappropriate medication. Conclusion : The prescription of potentially inappropriate medications is a serious problem which can affect overall quality of health care. Hence regular medication review and reconciliation practices should be implemented to prevent this to an extent.

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