Visual Comparison of Guidelines: Method and Application to Potentially Inappropriate Medication Lists

Visual Method ◽

Visual Comparison ◽

Therapeutic Guidelines ◽

Therapeutic guidelines developed by experts are essential tools for improving therapy and drug prescription. Several guidelines often exist that target the same patient, from different organizations and countries. The case of lists for the detection of potentially inappropriate medications (PIMs) is an example which illustrates how these guidelines can be varied and multiple. In order to have an overview to the divergences and similarities between different lists of PIMs, we propose a visual method to compare PIMs lists, based on set visualization, and we apply it to 5 guidelines.

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 ◽

Medication Use ◽

Adverse Outcomes ◽

Inappropriate Medication Use ◽

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.

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 ◽

Medication Use ◽

Community Dwelling ◽

Inappropriate Drug ◽

African American Adults ◽

Inappropriate Medication Use ◽

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.

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 ◽

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.

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 ◽

The Elderly ◽

Elderly Persons ◽

Potential Drug ◽

Increased Risk ◽

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.

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

Einstein (São Paulo) ◽

10.1590/s1679-45082011ao1844 ◽

2011 ◽

Vol 9 (1) ◽

pp. 18-23 ◽

Cited By ~ 4

Author(s):

Christine Grützmann Faustino ◽

Milton de Arruda Martins ◽

Wilson Jacob Filho

Keyword(s):

Elderly Patients ◽

Age Groups ◽

General Medicine ◽

University Hospital ◽

Female Sex ◽

The Mean ◽

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).

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 Drug ◽

National Committee ◽

Beers Criteria ◽

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.

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 ◽

Medication Use ◽

Inappropriate Use ◽

Inappropriate Medication Use ◽

Multiple Drugs ◽

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.

Inappropriate medications and physical function: a systematic review

Therapeutic Advances in Drug Safety ◽

10.1177/20420986211030371 ◽

2021 ◽

Vol 12 ◽

pp. 204209862110303

Author(s):

Elizabeth Manias ◽

Md Zunayed Kabir ◽

Andrea B. Maier

Keyword(s):

Older Adults ◽

Physical Function ◽

Physical Performance ◽

Functional Independence ◽

Timed Up And Go ◽

Risk Of Falls ◽

Prescribing Omissions ◽

Background and aims: Inappropriate medication prescription is highly prevalent in older adults and is associated with adverse health outcomes. The aim of this study was to examine the associations between potentially inappropriate medications (PIMS) and potential prescribing omissions with physical function in older adults situated in diverse environments. Methods: A systematic search was completed using the following databases: MEDLINE, CINAHL, PsycINFO, EMBASE and COCHRANE. Results were extracted from the included studies. Results: In total, 55 studies reported on 2,767,594 participants with a mean age of 77.1 years (63.5% women). Study designs comprised 26 retrospective cohort studies, 21 prospective cohort studies and 8 cross-sectional studies. Inappropriate medications in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), impaired activities of daily living (ADL; 8 out of 10 studies) and impaired instrumental ADL (IADL) score (4 out of 6 studies). Five out of seven studies also showed that PIMs were associated with poorer physical performance comprising the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many medication classes were implicated as PIMs in falls, fractures and impairment in physical performance including antipsychotic, sedative, anti-anxiety, anticholinergic, antidiabetic, opioid and antihypertensive medications. For patients not receiving musculoskeletal medications, such as calcium, vitamin D and bisphosphonates, older adults were found to be at risk of a hospital admission for a fall or fracture. Conclusion: Inappropriate medication prescriptions are associated with impaired physical function across longitudinal and cross-sectional studies in older adults situated in diverse settings. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions. Plain language summary Inappropriate medications and physical function Background and aims: The use of inappropriate medications is very common in older adults and is associated with harmful health problems. The aim was to examine associations between potentially inappropriate medications and potential prescribing omissions with physical function in older adults situated in diverse environments. Methods: Library databases were examined for possible studies to include and a systematic search was completed. Relevant information was obtained from the included studies. Results: In total, 55 studies reported on 2,767,594 participants who were an average age of 77.1 years and about 6 out of 10 were women. A variety of different study designs were used. Inappropriate medication prescriptions in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), problems with activities of daily living (ADL), such as eating, bathing, dressing, grooming, walking and toileting (8 out of 10 studies) and problems with instrumental ADL such as managing medications, house cleaning and shopping (4 out of 6 studies). Five out of seven studies also showed that inappropriate medications were associated with poorer physical performance involving the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many types of medication classes were shown to be associated with a risk of falls, fractures and problems with physical performance. Omitted medications were also associated with falls and fractures. Conclusion: Inappropriate medication prescriptions are associated with problems relating to physical function. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions.

Inappropriate Medication Use In Older Adults According To Beers Criteria In A Tertiary Referral Hospital, In Bolu, Turkey

Russian Open Medical Journal ◽

10.15275/rusomj.2021.0211 ◽

2021 ◽

Vol 10 (2) ◽

Author(s):

Burcin M. Atak ◽

Gulali Aktas ◽

Tuba T. Duman ◽

Ozge Kurtkulagi ◽

Satilmis Bilgin ◽

...

Keyword(s):

Older Adults ◽

Bleeding Risk ◽

Beers Criteria ◽

Tertiary Referral Hospital ◽

Inappropriate Use ◽

Increased Risk ◽

Risk Of Falls ◽

Aims — We aimed to study the medications used by older adults for any potentially inappropriate medications. Material and Methods — A hundred and four consecutive subjects over 65 years of age who visited our clinic were enrolled in the study. Possible inappropriate medications were defined according to Beers Criteria. Results — A total of 57 women and 49 men were enrolled in the study. Mean ages of the women and men were 78.6±6.1 years and 77.4±5.4 years, respectively (p=0.30). While 18 subjects (17%) had no increased risk due to inappropriate use of medications, 30 were on inappropriate medications that increased renal failure risk, 5 were on inappropriate medication that amplified neurological side effects, 12 were on inappropriate medications that augmented bleeding risk, 20 were on inappropriate medication that lack safety and efficacy data, and 30 were on inappropriate medication that amplified the risk of falls. The number of increased risks according to Beers Criteria was significantly and positively correlated with number of medications used (r=0.366, p<0.001) and the number of comorbidities (r=0.312, p=0.001). Conclusion — The number of increased risks due to inappropriate use of medicines in older adults is positively correlated with the number of medicines used and the number of accompanied diseases. Therefore we suggest that the medicines used by older people should be reviewed in all settings, and unnecessary drugs should be avoided to be prescribed.

Cross sectional study on the prevalence of polypharmacy and potentially inappropriate medications among elderly patients in a tertiary care centre in central Kerala

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20210836 ◽

2021 ◽

Vol 8 (3) ◽

pp. 1415

Author(s):

Jubina Bency Anthoorathodi ◽

Aqueen Joju ◽

Ann Mereena Reji ◽

Anupama Pallivalappil Asokan ◽

Anzeem Naseem ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Clinical Care ◽

Cross Sectional Study ◽

Health Concern ◽

Sectional Study ◽

Cross Sectional

Background: Polypharmacy or the concurrent use of multiple medications, is on the rise, especially in the elderly population as they suffer from multiple co-morbidities. Polypharmacy has been reported to increase the risks for inappropriate medication intake. Objectives: The aim was to investigate the prevalence of polypharmacy and usage of potentially inappropriate medication using Beer’s criteria and to find out the various risk factors of polypharmacy in hospitalised elderly.Methods: A cross sectional study was done in patients aged 60 years and above using a pre designed semi structured questionnaire and from their case records to assess the pattern of polypharmacy by different socio-demographic characteristics and also to found out the risk factors of polypharmacy.Results: 50 patients aged 60 and above were involved in our study out of which, 46% were females and 54% were males. Mean age of our study population was 71.5±8.3. Among them, 30 were hypertensive, 27 were diabetic, 9 of them had dyslipidaemia and 8 of them had coronary artery disease Mean number of medication use was 5.1±4.1. Polypharmacy was observed in 42% of the patients. 20% patients received potentially inappropriate drugs from Beer’s list. We also found significant association of polypharmacy with diabetes mellitus and hypertension.Conclusions: The present study has shown polypharmacy and usage of potentially inappropriate medication as an emerging public health concern. Diabetes mellitus and hypertension were found to be risk factors of polypharmacy. Deprescription should be integrated into clinical care and prescribers need to be educated about Beers criteria and encouraged for rational prescription.