Assessment of Inappropriate Prescribing to Elderly Patients in an Internal Medicine Ward According to the 2019 Beers Criteria

Introduction: Polypharmacy is often observed in elderly patients and is associated with an increased risk of adverse drug reactions, side effects and interactions. Clinicians should be alert to inappropriate drug prescribing and reduce polypharmacy. Material and Methods: Observational, longitudinal, retrospective and descriptive study in an internal medicine ward in a Portuguese hospital. Polypharmacy was defined as the use of five or more different medicines. The purpose of this study was to describe the prevalence of polypharmacy and inappropriate prescribing at admission and discharge in an internal medicine ward, according to deprescribing.org guidelines/algorithms. A total of 838 consecutive patients were admitted between January and July 2017. All patients were aged under 65 years old, and those who died before discharge were excluded. Patients’ medications were reviewed from a medical database at hospital admission and discharge. We examined whether patients were taking anticoagulants, proton pump inhibitors, benzodiazepines, antipsychotics and/or antihyperglycemic medication.Results: A total of 483 patients were included, mean age was 79.2 ± 8.0 years, and 42% of patients were male. Median number of medications at admission and discharge was six. Polypharmacy was present in more than 70% of admitted patients. Proton pump inhibitors were the most common inappropriate prescription at discharge (17.2%). Discussion: This study demonstrated a low use of inappropriate medicine (11.2% - 17.2%) in older people discharged from hospital, when compared to other studies. Conclusion: Our study shows that polypharmacy is present in more than 70% of elderly admitted patients. Nevertheless, the drug inappropriateness rate was not significantly affected by polypharmacy at both admission and discharge, being overall lower than published data.

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Reply to the Letter to the Editor Regarding the Article: “Inappropriate Prescribing to Elderly Patients in an Internal Medicine Ward” Mariana Alves, Marco Ribeiro Narciso, Teresa Fonseca, João Gorjão Clara” [Acta Med Port.2019;32:249-249].

Acta Médica Portuguesa ◽

10.20344/amp.12203 ◽

2019 ◽

Vol 32 (5) ◽

pp. 408

Author(s):

Joana Isabel Pires Urzal

Keyword(s):

Internal Medicine ◽

Elderly Patients ◽

Inappropriate Prescribing ◽

Internal Medicine Ward ◽

Letter To The Editor

N/a.

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Prognostic significance of a prolonged international normalized ratio in elderly patients in an internal medicine ward

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2017.10.021 ◽

2018 ◽

Vol 74 ◽

pp. 141-144

Author(s):

Galina Plotnikov ◽

Lior Bracha ◽

Shimon Izhakian ◽

Moshe Tishler ◽

Oleg Gorelik

Keyword(s):

Internal Medicine ◽

Elderly Patients ◽

Prognostic Significance ◽

International Normalized Ratio ◽

Internal Medicine Ward

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Prescription of Potentially Inappropriate Medication in Older Inpatients of an Internal Medicine Ward: Concordance and Overlap Among the EU(7)-PIM List and Beers and STOPP Criteria

Frontiers in Pharmacology ◽

10.3389/fphar.2021.676020 ◽

2021 ◽

Vol 12 ◽

Author(s):

Carla Perpétuo ◽

Ana I. Plácido ◽

Daniela Rodrigues ◽

Jorge Aperta ◽

Maria Piñeiro-Lamas ◽

...

Keyword(s):

Internal Medicine ◽

Older Patients ◽

Inappropriate Medication ◽

Circulatory System ◽

Beers Criteria ◽

Internal Medicine Ward ◽

The Poor ◽

Stopp Criteria ◽

Older Inpatients ◽

The Eu

Background: Age-related comorbidities prone older adults to polypharmacy and to an increased risk of potentially inappropriate medication (PIM) use. This work aims to analyze the concordance and overlap among the EU(7)-PIM list, 2019 Beers criteria, and Screening Tool of Older Person’s Prescriptions (STOPP) version 2 criteria and also to analyze the prevalence of PIM.Methods: A retrospective cohort study was conducted on older inpatients of an internal medicine ward. Demographic, clinical, and pharmacological data were collected, during March 2020. After PIM identification by the EU(7)-PIM list, Beers criteria, and STOPP v2 criteria, the concordance and overlap between criteria were analyzed. A descriptive analysis was performed, and all the results with a p-value lower than 0.05 were considered statistically significant.Results: A total of 616 older patients were included in the study whose median age was 85 (Q1–Q3) (78–89) years. Most of the older patients were male (51.6%), and the median (Q1–Q3) number of days of hospitalization was 17 (13–22) days. According to the EU(7)-PIM list, Beers criteria, and STOPP criteria, 79.7, 92.0, and 76.5% of older adults, respectively, used at least one PIM. A poor concordance (<63.4%) among criteria was observed. An association between PIM and the number of prescribed medicines was found in all applied criteria. Moreover, an association between the number of PIMs and diagnoses of endocrine, nutritional, and metabolic diseases, mental, behavioral, and neurodevelopmental disorders, and circulatory system diseases and days of hospitalization was observed according to Beers criteria, and that with diseases of the circulatory system and musculoskeletal system and connective tissue was observed according to STOPP criteria.Conclusion: Despite the poor concordance between the EU(7)-PIM list, 2019 Beers, and STOPP v2 criteria, this work highlights the need for more studies in inpatients to develop strategies to facilitate the identification of PIM to decrease the high prevalence of PIM in hospitalized patients. The poor concordance among criteria also highlights the need to develop new tools adapting the existing criteria to medical ward inpatients.

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Clinical outcomes of elderly patients with bloodstream infections due to extended-spectrum β-lactamase–producing Enterobacteriaceae in an Italian Internal Medicine ward

European Journal of Internal Medicine ◽

10.1016/j.ejim.2017.10.014 ◽

2018 ◽

Vol 48 ◽

pp. 50-56 ◽

Cited By ~ 2

Author(s):

Simone Meini ◽

Raffaele Laureano ◽

Carlo Tascini ◽

Fabio Arena ◽

Lucia Fani ◽

...

Keyword(s):

Internal Medicine ◽

Elderly Patients ◽

Clinical Outcomes ◽

Bloodstream Infections ◽

Internal Medicine Ward ◽

Extended Spectrum

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Life worth living: cross-sectional study on the prevalence and determinants of the wish to die in elderly patients hospitalized in an internal medicine ward

BMC Geriatrics ◽

10.1186/s12877-020-01762-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Marc-Antoine Bornet ◽

Eve Rubli Truchard ◽

Gérard Waeber ◽

Peter Vollenweider ◽

Mathieu Bernard ◽

...

Keyword(s):

Internal Medicine ◽

Quality Of Life ◽

Elderly Patients ◽

Cross Sectional Study ◽

Worth Living ◽

Sectional Study ◽

Internal Medicine Ward ◽

Cross Sectional ◽

Wish To Die

Abstract Background Elderly people frequently express the wish to die: this ranges from a simple wish for a natural death to a more explicit request for death. The frequency of the wish to die and its associated factors have not been assessed in acute hospitalization settings. This study aimed to investigate the prevalence and determinants of the wish to die in elderly (≥65 years) patients hospitalized in an internal medicine ward. Methods This cross-sectional study was conducted between 1 May, 2018, and 30 April, 2019, in an acute care internal medicine ward in a Swiss university hospital. Participants were a consecutive sample of 232 patients (44.8% women, 79.3 ± 8.1 years) with no cognitive impairment. Wish to die was assessed using the Schedule of Attitudes toward Hastened Death-senior and the Categories of Attitudes toward Death Occurrence scales. Results Prevalence of the wish to die was 8.6% (95% confidence interval [CI]: 5.3–13.0). Bivariate analysis showed that patients expressing the wish to die were older (P = .014), had a lower quality of life (P < .001), and showed more depressive symptoms (P = .044). Multivariable analysis showed that increased age was positively (odds ratio [OR] for a 5-year increase: 1.43, 95% CI 0.99–2.04, P = .048) and quality of life negatively (OR: 0.54, 95% CI 0.39–0.75, P < 0.001) associated with the likelihood of wishing to die. Participants did not experience stress during the interview. Conclusions Prevalence of the wish to die among elderly patients admitted to an acute hospital setting is low, but highly relevant for clinical practice. Older age increases and better quality of life decreases the likelihood of wishing to die. Discussion of death appears to be well tolerated by patients.

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