scholarly journals Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department

2017 ◽  
Vol 13 (1) ◽  
pp. 197-202 ◽  
Author(s):  
Ajit Kumar Sah ◽  
Rajesh Kumar Jha ◽  
Phoolgen Sah ◽  
Sangharshila Basnet
Keyword(s):  
Inappropriate Medication ◽  
Inappropriate Prescribing ◽  
The Elderly ◽  
Tertiary Hospital ◽  
Medical Problem ◽  
Potentially Inappropriate Medications ◽  
Older Individuals ◽  
The Impact ◽  
Inappropriate Medications ◽  
Patient Department

Background & Objectives: Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The study was conducted with objectives to determine the prevalence of potentially inappropriate medicine (PIM) prescribing in older Nepalese patients in a medicine outpatient department.Materials & Methods: A prospective observational analysis of drugs prescribed in medicine out-patient department (OPD) of a tertiary hospital of central Nepal was conducted during November 2012 to October 2013 among 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM) in elderly patients was analysed using Beer’s Criteria updated to 2013. Results: In the 869 patients included, the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%), amlodipine (23.16%), paracetamol (17.6%), salbutamol (15.72%) and vitamin B complex (13.26%). The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Conclusion: Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with number of medications prescribed. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly.

scholarly journals Prevalence, Factors and Cost Comparison due to Potentially Inappropriate Medications (PIMs) of Elderly Outpatients in a State Hospital in Malaysia.

2021 ◽  
Vol 1 (1) ◽  
pp. 27-33
Author(s):  
Wei Chern Ang ◽  
Nur Syafiqah Zulkepli ◽  
Nur Safinaz Mukhtar ◽  
Nur Atikah Zulkefli
Keyword(s):  
The Elderly ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cost Comparison ◽  
Potentially Inappropriate Medications ◽  
Cross Sectional ◽  
Prescription Cost ◽  
Factors Associated ◽  
Elderly Outpatients ◽  
Inappropriate Medications

Introduction: Malaysia will be a full aging nation by 2030. The elderly (aged >65 years old) population often has multiple comorbidities, which increases the risk of polypharmacy and potentially inappropriate medications (PIMs). This study aims to investigate the prevalence, factors associated with PIMs among elderly outpatients, and its burden of direct pharmacotherapy cost to the Ministry of Health Malaysia. Materials and method:  A cross-sectional study involving clinic prescriptions among the elderly with more than one-month prescribing duration received from a tertiary hospital specialist clinic pharmacy from March to April 2017. Patient identifiers were screened using the Pharmacy Information System (PhIS) by including prescriptions from other clinics while excluding multiple visits and duplicate prescriptions. Patients were categorised as PIM group and non-PIM groups using Beers Criteria 2015. Logistic regression analysis was conducted to examine the factors associated with PIMs. The median monthly prescription cost was compared between PIM and non-PIM groups by Mann-Whitney test. Results: Among 472 patients, 39.4% of patients had at least one PIM while 60.6% of patients did not receive any PIM. The number of medications prescribed was an independent risk factor contributing to PIMs (OR:2.04; 95% CI:1.40, 2.97). The median monthly prescription cost for the PIM group was MYR 29.50 (?USD 7.53) which was not statistically significant (p=0.735) compared with the non-PIM group which was MYR 28.50 (USD 7.28).  Conclusion: PIM was frequently prescribed in our setting with the number of medications as the only factor. However, the prescribing of PIM did not add nor reduce the direct cost of pharmacotherapy.

scholarly journals Inappropriate prescribing in hospitalized elderly patients

2017 ◽  
Vol 6 (4) ◽  
pp. 701
Author(s):  
Lina K. Massoud ◽  
Hala Z. AlAgha ◽  
Mahmoud H. Taleb
Keyword(s):  
Elderly Patients ◽  
Elderly People ◽  
Inappropriate Prescribing ◽  
The Elderly ◽  
Potentially Inappropriate Medications ◽  
Hospitalized Elderly ◽  
Different Types ◽  
Elderly Inpatients ◽  
Hospitalized Elderly Patients ◽  
Inappropriate Medications

Inappropriate prescribing (IP) is a major healthcare problem in elderly patients. The risk of this problem increases during hospitalization. This is due to increase morbidity and thus increases the use of medications by the inpatients. This study will clarify the problem of IP for elderly people during hospitalization and will identify the different types of it. It also will highlight some tools that are used to assess the different types of IP and the prevalence of it in elderly patients during hospitalization. Finally, the study will address the consequences of IP in the elderly inpatients and the risks associated with the use of some potentially inappropriate medications (PIMs) in the elderly. 

scholarly journals Inappropriate Medication Use in Hospitalized Patients Diagnosed with Parkinson’s Disease

Pharmacy ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 100 ◽  
Author(s):  
Nicholas Cox ◽  
Jessica Louie ◽  
Benson Sederholm
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Inappropriate Medication ◽  
Academic Medical Center ◽  
Inappropriate Prescribing ◽  
Admission Diagnosis ◽  
P Value ◽  
Potentially Inappropriate Medications ◽  
Duration Of Stay ◽  
Inappropriate Medications

The purpose of this study was to evaluate the rate at which potentially inappropriate medications were administered for patients diagnosed with Parkinson’s disease (PD). This is a single-center, retrospective, case cohort study with data collected at an academic medical center between January 2010 and December 2013. Participants included all adult patients with admission diagnosis codes for PD. Included patients were screened for administrations of 27 potentially inappropriate medications and two potentially appropriate medications to be used for comparison. There were 1736 patients who met inclusion criteria with 175 documented administrations of potentially inappropriate medications to 77 patients. Patients who received potentially inappropriate medications had a longer mean duration of stay than the baseline population of PD patients (3.3 days vs. 1.9 days, p-value < 0.001). Despite recommendations to avoid certain medications in PD patients, a substantial number of administrations still occurred. The use of these medications can have clinical implications and our findings demonstrate increases in duration of stay. The findings from this study can assist in developing technological alerts to reduce inappropriate prescribing to PD patients. Larger prospective studies are warranted to further investigate the administration of inappropriate medications to patients diagnosed with PD.

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

2018 ◽  
Vol 21 (5) ◽  
pp. 588-596 ◽  
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.

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 Potentially Inappropriate Medication Use in the Elderly

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.

scholarly journals De-presciption: what, when and how?

2020 ◽  
Vol 38 (4) ◽  
pp. 185-190
Author(s):  
HAM Nazmul Ahasan ◽  
Homayra Tahseen Hossain ◽  
Chandra Shekhar Bala ◽  
Ishrat Binte Reza
Keyword(s):  
Adverse Reactions ◽  
Clinical Medicine ◽  
Inappropriate Medication ◽  
The Elderly ◽  
Drug Discontinuation ◽  
Potentially Inappropriate Medications ◽  
Care Facilities ◽  
Cns Drugs ◽  
Developed Nations ◽  
Inappropriate Medications

De-prescription or de-prescribing is a new idea in clinical medicine. This is the structured way of withdrawing of inappropriate medication supervised by a health care professional with the goal of managing polypharmacy and improving outcomes. It is estimated that half of older adult patients are treated with polypharmacy (five or more drugs). The prevalence of Polypharmacy in the elderly is higher, ranging from 30% to 70%, even reaching 90% in residents of some residential geriatric care facilities in developed nations. Polypharmacy in the elderly increases the risk of adverse reactions, inappropriate prescriptions, drug interactions, number of hospitalizations, costs, and even death. Polypharmacy and CNS drugs increase fall risk by about 50%. Withdrawal of psychotropic drugs reduced falls by 66%. There are different deprescribing models. These are focused especially on elderly patients as well as on specific specialties such as psychiatry. It includes meticulous evaluation of the patient, identifying potentially inappropriate medications, prioritizing drug discontinuation, performing the deprescription and monitoring the result bearing in mind the risks of deprescribing. J Bangladesh Coll Phys Surg 2020; 38(4): 185-190

scholarly journals Quality Improvement Project to Reduce Drug-Related Problems (DRPs) and Potentially Inappropriate Medications (PIMs) in Geriatrics Cardiac Clinic in Saudi Arabia

2019 ◽  
Vol 22 (2) ◽  
Author(s):  
Sanaa S. Mekdad ◽  
Alaa A. Alsayed
Keyword(s):  
Saudi Arabia ◽  
Medication Review ◽  
Inappropriate Medication ◽  
Potentially Inappropriate Medications ◽  
Drug Related Problems ◽  
Improvement Project ◽  
Start Criteria ◽  
Geriatric Cardiology ◽  
The Impact ◽  
Inappropriate Medications

BackgroundElderly people have a high risk of potentially inappropriate medications (PIMs) and drug-related problems (DRPs) due to polypharmacy, physical and mental limitations, pharma-cokinetic, and pharmacodynamics changes.PurposeTo determine the role of geriatric pharmacists in reducing drug- related problems and potentially inappropriate medication. MethodsThe observational study was conducted from October 2014 to October 2017 to show the prevalence of DRPs, and PIMs. A total of 375 geriatric cardiology patients (aged ≥ 65) were recruited from Geriatrics Cardiac Clinic in Saudi Arabia. AGS Beers Criteria 2012 and STOPP/START Criteria were used to view the impact of services directed by clinical pharmacists in decreasing DRPs and PIMs including medication review, intervention, and education to junior physicians during multi-disciplinary rounds (MDRs) and by sending e-mail alerts. ResultsDRPs were found in 29.6% of patients and PIMs were found in 19% of patients. After medication review, 25% required interventions and the majority (89%) of interventions were accepted by the managing team. DRPs were found in 14.9% of patients and PIMs were found in 9.6% of the patients. DRPs and PIMs were reduced almost by 50% by reviewing the files and educating the involved physicians.ConclusionThis prospective study confirms a high prevalence of DRPs and PIMs in Saudi elderly cardiac patients.

scholarly journals Polypharmacy and potentially inappropriate medications (PIMS) in older adults referred to a liaison psychiatry service

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S306-S307
Author(s):  
Anietie Akpan ◽  
Omolade Longe
Keyword(s):  
Cognitive Impairment ◽  
Older Adult ◽  
Adverse Drug Events ◽  
Adult Population ◽  
Inappropriate Medication ◽  
Inappropriate Prescribing ◽  
Potentially Inappropriate Medications ◽  
Liaison Psychiatry ◽  
Anticholinergic Burden ◽  
Inappropriate Medications

AimsThe older adult is more likely to be prescribed a lot of medications (polypharmacy) on account of multi-morbidity and being under the care of several specialists. Adverse drug events and reactions account for a significant number of acute hospital presentations in this population group with increased risks of delirium, lasting cognitive impairment, falls and death.Medications are not routinely reviewed or rationalised in the elderly, often contributing to preventable harm.We sought to estimate the prevalence of polypharmacy and potentially inappropriate medications, anticholinergics in particular, in patients (65 years and older) referred to the St Mary's Hospital Liaison Psychiatry Department over a 3-month period.MethodBetween 01/06/2019 and 31/08/2019 all referral forms (from in-patient wards and A&E) for patients aged 65+ years were screened for medications currently prescribed and administered. The medications were confirmed via the St. Mary's Hospital electronic records, pharmacists’ completed Medicines Reconciliation and GP Summary Care Records. Polypharmacy was defined as patients prescribed 5 or more medications. Drugs with anticholinergic properties were considered as an example of Potentially Inappropriate Medication (PIMs) using the Anticholinergic Burden Scale. 77 patients were referred in the time period. 9 were excluded due to incomplete/unreconciled medication information.Result77.94% (n = 53) were prescribed 5 or more medications.38.24% (n = 26) were prescribed over 10 medications.10.29% (n = 7) prescribed over 15 medications.69% of (n = 47) prescribed an anticholinergic.42.65% (n = 29) prescribed more than 1 anticholinergic.ConclusionPolypharmacy and potentially inappropriate prescribing remain widespread within the older adult population.Increased anticholinergic burden further compounds risks of cognitive impairment, delirium and death.Other categories of Potentially Inappropriate Medications, including those no longer needed, ought to be identified and reviewed. Over-the-counter medications also need to be screened for.Elimination or reduction of anticholinergic burden may improve quality of life for patients, as well as cost burden on services.Pharmacovigilance, collaborative working, regular and systematic medication reviews, and on-going training are needed across services providing care for the older adult.

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