Potentially inappropriate medications in older adults: A review of the 2012 Beers Criteria and the implications in persons with dementia

2014 ◽  
Vol 4 (4) ◽  
pp. 166-169 ◽  
Author(s):  
Nicole J. Brandt ◽  
Traci Turner
Keyword(s):  
Older Adults ◽  
Adverse Drug Events ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Clinical Tool ◽  
Drug Classes ◽  
Information Set ◽  
Sliding Scale ◽  
Institutionalized Patients ◽  
Inappropriate Medications

In 2012, the American Geriatrics Society (AGS), along with a panel of 11 experts, updated the Beers Criteria which has evolved significantly since its inception in 1991. The Beers Criteria, in general, classifies medications/medication classes as: (1) potentially inappropriate for use in all older adults, (2) potentially inappropriate for older adults with certain diseases or symptoms and (3) requiring extra caution when used in older adults. Although each patient must be evaluated individually, the Beers Criteria is a useful clinical tool that can be used when initiating pharmacologic agents in both ambulatory and institutionalized patients. The concept behind use of the Beers Criteria is that it allows prescribers to readily identify, and avoid, medications associated with negative outcomes in older adults therefore decreasing the risk of adverse drug events (ADEs). Within this review article, there will be a highlight of potentially inappropriate medications (PIMs) commonly seen in clinical practice settings such as antipsychotics, benzodiazepines, non-benzodiazepine sedative-hypnotics, anticholinergics and sliding scale insulin. The focus will be to outline the risk-benefits of these drug classes within the context of persons with dementia. Furthermore, the use of PIMs has both clinical and financial implications in Medicare Star ratings and Healthcare Effectiveness Data and Information Set (HEDIS) measures.

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

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Burcin M. Atak ◽  
Gulali Aktas ◽  
Tuba T. Duman ◽  
Ozge Kurtkulagi ◽  
Satilmis Bilgin ◽  
...  
Keyword(s):  
Older Adults ◽  
Inappropriate Medication ◽  
Bleeding Risk ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Tertiary Referral Hospital ◽  
Inappropriate Use ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Inappropriate Medications

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.

scholarly journals Adherence to Beers Criteria in Geriatrics: A Retrospective Study in a Saudi Teaching Hospital

Geriatrics ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 97
Author(s):  
Samah Alshehri ◽  
Mohannad Alshibani ◽  
Ghaydaa Magboul ◽  
Albandari Albandar ◽  
Roaa Nasser ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Older Patients ◽  
Adverse Drug Events ◽  
Healthcare Providers ◽  
Tertiary Hospital ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Inflammatory Drugs ◽  
The Mean ◽  
Inappropriate Medications

Background: The aging process makes geriatric populations more prone to various chronic diseases. Such diseases require older patients to be on more medications than any other age group and make them more susceptible to adverse drug events related to potentially inappropriate medications (PIMs). Aim: To identify the prevalence of potentially inappropriate medications among older people and explore the most commonly prescribed PIMs in hospitalized patients. Design and Setting: A retrospective study conducted in a large tertiary hospital among patients hospitalized in a 4 year period from January 2015 to December 2018. Methods: The 2019 Beers Criteria were used to assess PIMs in all inpatient prescribed medications focusing on the first class (i.e., drug/drug class to be avoided in older adults). Results: The mean age was 75.17 ± 7.66 years. A total of 684 (80.6%) patients were prescribed at least one medication listed in the first-class category of the 2019 Beers Criteria. Top five drugs were proton pump inhibitors (40.3%), nonsteroidal anti-inflammatory drugs (10.2%), metoclopramide (9.3%), benzodiazepines (8.4%), and insulin (5.4%). Conclusions: The prevalence of PIMs is high among older patients admitted to the hospital. More efforts are needed to investigate the potential reasons and develop action plans to improve concordance to Beers Criteria among healthcare providers.

scholarly journals Potentially Inappropriate Medications Use among Older Adults with Comorbid Diabetes and Hypertension

2020 ◽  
Author(s):  
Monira Alwhaibi
Keyword(s):  
Older Adults ◽  
Secondary Outcome ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Ambulatory Care Setting ◽  
Large Hospital ◽  
Cross Sectional ◽  
Retrospective Study Design ◽  
Inappropriate Medications ◽  
American Geriatric Society

Abstract Background Potentially inappropriate medications (PIMs) are medications that should be avoided among older adults due to their risk which offsets their benefit. The objective of this study is to estimate the prevalence of PIMs use and to evaluate its associated factors among older adults with comorbid diabetes and hypertension using the 2019 Beers criteria.Methods A cross-sectional retrospective study design was used. This study included 1,853 older adults (age ≥ 65 years) with comorbid diabetes and hypertension visited an ambulatory care setting in a large hospital in the central region of Saudi Arabia. The primary outcome was the prevalence of PIMs use based on the updated 2019 American Geriatric Society (AGS) Beers Criteria. The secondary outcome was the factors associated with the presence of PIMs use (use of one or more PIMs) by referencing the Beers Criteria list.Results Almost one out of two individuals had PIMs use with the average number of medication taken was seven; where 40.3% of the older adults taken one PIMs, and about 16% were using two or more PIMs. The most commonly prescribed PIMs were the use of gastrointestinal and endocrine medications. High risk of PIMs use was among those with ischemic heart disease and anxiety comorbidities and those using multiple medications (i.e., polypharmacy).Conclusions Given higher PIMs use among older adults with diabetes and hypertension comorbidities, tailored strategies and interventions to minimize the PIMs use in this population are warranted. There is a need for greater vigilance when managing patients with comorbid conditions to avoid the use of inappropriate medications.

scholarly journals Chloroquine and hydroxychloroquine: potentially inappropriate medications for older adults?

2020 ◽  
Vol 14 (4) ◽  
pp. 298-302
Author(s):  
Milton Gorzoni
Keyword(s):  
Older Adults ◽  
Adverse Effects ◽  
Older People ◽  
Drug Analysis ◽  
American Geriatrics Society ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Definition Of ◽  
Inappropriate Medications

Introduction: Potentially inappropriate medications (PIMs) for older adults cause more adverse effects than benefits. The 2019 American Geriatrics Society Beers Criteria (2019BC) considered five clinical situations as PIM use in older adults. Can drug analysis, according to these situations, assist in the act of making prescriptions for older people? Seeking a practical example for this question, we assessed drugs currently questioned as to their safe use among older people. Objective: To check if chloroquine and hydroxychloroquine fit the PIM criteria for older adults and whether this analysis is clinically applicable. Method: We systematized the objective based on the five clinical situations defined as PIM use in older adults by the 2019BC. Results: Chloroquine and hydroxychloroquine fulfill, respectively, four and five of these clinical situations. This evaluation allowed the likely definition of these drugs as PIMs for older adults in a simple way, based on a brief analysis of the available literature. Conclusion: Chloroquine and hydroxychloroquine may be considered PIMs for older adults. We expect that this analysis can be replicated with other drugs and reduce iatrogenesis in older people.

scholarly journals Potentially inappropriate medications use and its associated factors among geriatric patients: a cross-sectional study based on 2019 Beers Criteria

Pharmacia ◽  
2021 ◽  
Vol 68 (4) ◽  
pp. 789-795
Author(s):  
Heba Khader ◽  
Luai Z. Hasoun ◽  
Ahmad Alsayed ◽  
Mahmoud Abu-Samak
Keyword(s):  
Geriatric Patients ◽  
Adverse Drug Events ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Sample Population ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Sectional Study ◽  
Cross Sectional ◽  
Inappropriate Medications

The aims of this study were to estimate the prevalence of potentially inappropriate medications (PIMs) in a community-dwelling Jordanian population of geriatrics according to the 2019 American Geriatrics Society Beers Criteria, to identify the most used PIMs and factors independently associated with PIMs use. This was an observational, descriptive, cross-sectional study. The sample population included 386 participants. Data were collected by face-to-face interviews. A total of 2894 medications were evaluated. The prevalence of patients using at least one PIM was 49.2%. The most used PIMs were proton pump inhibitors (24.6%) and long-acting sulfonylurea (20.5%). Participants who had diabetes mellitus, peptic ulcer, or irritable bowel syndrome had significantly higher numbers of PIMs. The use of PIMs was high in Jordanian geriatric patients. The results of this study might help healthcare providers to detect high-risk patients and reconsider the necessity of using PIMs to decrease the risk of adverse drug events.

scholarly journals Investigation of a possible association of potentially inappropriate medication for older adults and frailty in a prospective cohort study from Germany

2019 ◽  
Vol 49 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Dana Clarissa Muhlack ◽  
Liesa Katharina Hoppe ◽  
Kai-Uwe Saum ◽  
Walter E Haefeli ◽  
Hermann Brenner ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Cox Regression ◽  
Inappropriate Medication ◽  
Population Based ◽  
Community Dwelling ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Drug Classes ◽  
Before And After

Abstract Objective potentially inappropriate medications (PIMs) are commonly defined as drugs that should be avoided in older adults because they are considered to have a negative risk-benefit ratio. PIMs are suspected to increase the risk for frailty, but this has yet to be examined. Design prospective population-based cohort study. Setting and participants a German cohort of community-dwelling older adults (≥60 years) was followed from October 2008 to September 2016. Methods in propensity score-adjusted logistic and Cox regression models, associations between baseline PIM use and prevalent/incident frailty were investigated. Frailty was assessed using the definition by Fried and co-workers, PIM were defined with the 2015 BEERS criteria, the BEERS criteria to avoid in cognitively impaired patients (BEERS dementia PIM), the EU(7)-PIM and the PRISCUS list. Results of 2,865 participants, 261 were frail at baseline and 423 became frail during follow-up. Only BEERS dementia PIM use was statistically significantly associated with prevalent frailty (odds ratio (95% confidence interval), 1.51 (1.04–2.17)). The strength of the association was comparable for all frailty components. Similarly, in longitudinal analyses, only BEERS dementia PIM use was associated with incident frailty albeit not statistically significant (hazard ratio, 1.19 (0.84–1.68)). Conclusions the association of PIM use and frailty seems to be restricted to drug classes, which can induce frailty symptoms (anticholinergics, benzodiazepines, z-substances and antipsychotics). Physicians are advised to perform frailty assessments before and after prescribing these drug classes to older patients and to reconsider treatment decisions in case of negative performance changes.

scholarly journals Potentially inappropriate medications in nursing homes of iraqi elders: Pharmacists’ assessment and intervention based on 2019 beers criteria

2021 ◽  
Vol 9 (2) ◽  
pp. 95-102
Author(s):  
Hussein Naqash
Keyword(s):  
Older Adults ◽  
Elderly People ◽  
Human Population ◽  
Acceptance Rate ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Drug Reactions ◽  
Interventional Study ◽  
Increased Risk ◽  
Inappropriate Medications

The number of elderly people worldwide is growing with the increasing life expectancy of the human population; in Iraq, the number of elderly people aged ≥65 years was estimated to be 1.34 million in 2019. The use of potentially inappropriate medications (PIMs) is high among older adults, which is associated with an increased risk of adverse drug reactions. This study investigated the use of PIMs among elderly nursing home (NH) residents in Iraq based on 2019 Beers criteria and the application of the criteria and intervention by pharmacists. An interventional study was conducted from January 2019 to April 2019 at 2 NHs in Baghdad, Iraq. A total of 109 NH residents aged ≥65 years that were using ≥1 daily medicine were included. Patients discharged before completion of the assessment were excluded. Patients with PIMs were using significantly more medications (5.7±3.2) than those without PIMs (2.0 ±1.46) (p&#60;0.0001). The total number of PIMs identified according to the 2019 Beers criteria was 163; for 140 of these (85.9%), pharmacists recommended changing the prescription, with 112 (68.7%) discontinued/changed as a result for an acceptance rate of 80% by physicians. Our results indicate that the use of PIMs for the treatment of Iraqi NH residents is associated with polypharmacy. Thus, prescriptions for elderly people in Iraq with polypharmacy or multiple concurrent diagnoses should be reviewed for PIMs by pharmacists to reduce the risk of adverse events.

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