Correlation Between the Number of Drugs Prescribed and Potentially Inappropriate Medication (PIMS) Based on Beers Criteria in Geriatric Hypertension Outpatients at Dr. Soedomo Hospital in Trenggalek

Background: Geriatric patients are elderly people who have various diseases and or problems as a result of diminished organ, psychological, social, economic, and environmental functioning and who require integrated health treatments from a multidisciplinary team. Uncontrolled hypertension can lead to complications such as stroke, CHD, and kidney failure. The more incidence of complications, causing the geriatrics to get more drugs (polypharmacy). Polypharmacy is one of the risk factors for the occurrence of Potentially Inappropriate Medication (PIMs) that often occurs in geriatric patients. The 2019 Beers Criteria is one of the clear criteria that can be used to determine the prevalence of PIMs in geriatric individuals. Objectives: The objective of this study was to see if there was a correlation between the number of drugs administered to hypertensive geriatric outpatients at Dr. Soedomo General Hospital in Trenggalek and the incidence of PIMs. This study employed an observational study with an analytical approach and retrospective. This study included a sample of 85 prescriptions for outpatient geriatric hypertension outpatient at Dr. Soedomo General Hospital in the period October - December 2020 taken using the purposive sampling technique. Data were analyzed using the C contingency coefficient correlation test. Results: 67,1% of prescriptions contained ≥ 5 kinds of drugs and 32,9% of prescriptions contained < 5 kinds of drugs. Based on the incidence of PIMs, there were 97.6% of prescriptions for PIMs and 2.4% of prescriptions without PIMs. The C contingency coefficient correlation test shows the correlation coefficient (r) of 0.216 with a positive direction and p-value = 0.041. Conclusions: The number of drugs has a significant correlation and can cause the incidence of PIMs in geriatric patients with weak correlation strength. Collaboration between pharmacists and doctors is needed to provide the best therapy to patients, to maximize the role of pharmacists in monitoring drug use in geriatric patients at Dr. Soedomo Hospital in Trenggalek.

Analysis of anticholinergic adverse effects using two large databases: The US Food and Drug Administration Adverse Event Reporting System database and the Japanese Adverse Drug Event Report database

Introduction Anticholinergic adverse effects (AEs) are a problem for elderly people. This study aimed to answer the following questions. First, is an analysis of anticholinergic AEs using spontaneous adverse drug event databases possible? Second, what is the main drug suspected of inducing anticholinergic AEs in the databases? Third, do database differences yield different results? Methods We used two databases: the US Food and Drug Administration Adverse Event Reporting System database (FAERS) and the Japanese Adverse Drug Event Report database (JADER) recorded from 2004 to 2020. We defined three types of anticholinergic AEs: central nervous system (CNS) AEs, peripheral nervous system (PNS) AEs, and a combination of these AEs. We counted the number of cases and evaluated the ratio of drug–anticholinergic AE pairs between FAERS and JADER. We computed reporting odds ratios (RORs) and assessed the drugs using Beers Criteria®. Results Constipation was the most reported AE in FAERS. The ratio of drug–anticholinergic AE pairs was statistically significantly larger in FAERS than JADER. Overactive bladder agents were suspected drugs common to both databases. Other drugs differed between the two databases. CNS AEs were associated with antidementia drugs in FAERS and opioids in JADER. In the assessment using Beers Criteria®, signals were detected for almost all drugs. Between the two databases, a significantly higher positive correlation was observed for PNS AEs (correlation coefficient 0.85, P = 0.0001). The ROR was significantly greater in JADER. Conclusions There are many methods to investigate AEs. This study shows that the analysis of anticholinergic AEs using spontaneous adverse drug event databases is possible. From this analysis, various suspected drugs were detected. In particular, FAERS had many cases. The differences in the results between the two databases may reflect differences in the reporting countries. Further study of the relationship between drugs and CNS AEs should be conducted.

Education of Caregivers and Veterans to Improve the Care of the Geriatric Psychiatric Patient

The geriatric psychiatry outpatient clinic provides assessment of the elderly Veteran with mental illness and behavioral and psychological symptoms of dementia. I will describe strategies developed and implemented in this setting to provide education to the caregiver (family) to improve early identification of delirium, depression and cognitive impairment. This education proved to reduce the number of pharmacological treatment and increase the use of nonpharmacological interventions based on "what matters to the patient" and following the BEERS criteria guidelines. One of the most important outcomes of the education and evaluation in the geriatric psychiatric clinic was a decrease in number of emergency room visits of elderly, specifically those with dementia.

Cognitive Behavioral Therapy for Insomnia in Geriatric Primary Care

Insomnia is common in older adults and may have adverse cognitive, emotional, and physical consequences. Some older people are prescribed sleep medications for insomnia despite longstanding concerns about their use with older people (i.e., BEERS criteria). Cognitive Behavioral Therapy for Insomnia (CBT-I) is highly effective in the treatment for insomnia in adults and older adults. However, most studies of CBT-I in late life have been conducted with individuals younger than 70. This paper discusses four years of experience of providing CBT-I to older people in geriatric primary care, two-thirds of whom were older than 75 years of age. Among the subgroup of 29 individuals who completed a full course of CBT-I, almost all of those who had been on sleep medications discontinued them. Treatment outcomes were large and clinically meaningful. This paper will also describe our experience in providing CBT-I via telehealth because of the COVID pandemic.

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

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.

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

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.

Based on the Beers Criteria 2019 Edition Over-the-Counter Drugs Risk Confirmation of Elderly Chinese

Objective. To explore OTC (over-the-counter drugs) in Chinese community pharmacies often causes ADE (adverse drug event) in elderly patients. Methods. Use the drugs in the Beers Criteria 2019 potentially inappropriate medication use (PIM) list as search terms. Search for drugs registered on the National Medical Products Administration of China website before December 2019 to determine the drugs containing PIM active ingredients and, then, search the Chinese OTC selection and conversion catalog database to determine it as OTC. Two databases are considered to be the same drug if they have the same drug composition. Results. The incidence of PIM in elderly patients in our community is relatively high, and the management of OTC may be related to risk factors. Statistics found that 71 OTC contained the Beers Criteria ingredients, including 65 chemicals and six Chinese patent medicines. Varieties of compound preparations accounted for 78.9% and cold medicines accounted for 47.9%. Conclusions. The high detection rate of the Beers Criteria in Chinese OTC suggests that medical practitioners in China, especially community pharmacists, should pay attention to the rational use of OTC in the elderly.

Pharmacoepidemiological Safety of Drugs Used in Geriatrics: A Systematic Review in Madanapalle and Punganur Region of Andhra Pradesh

In this study, we were provided universal considerations for the setting up and carry out of pharmacoepidemiological studies of drug use for disorders like Osteoarthritis, Hypertension, Hyperlipidemia, Hypothyroidism, Depression, and Osteoporosis in geriatric patient. The study method was focused on monitored and categorized the prescriptions of geriatrics from 650 patient in Madapalle and Puganur region of Andhra Pradesh, Identified and prepare the list of drugs, which were inappropriately prescribed and used in geriatrics by using Revised Beers criteria and also assess the Activities of Daily Living (ADL) by using Modified Barthel Index (MBI). Identify any drug-drug interactions among the drugs used in geriatrics. We were reported the adverse drug reactions appeared in geriatrics and the various treatments that the patients are received with different co-morbidity disease with the assessment of drug exposure, and ascertainment of PIM, PPO STOPP, START criteria and MBI outcomes. Characteristic of statistics sources include evaluation of complete history of drug use in elderly patient with co-morbidity condition, allowing approximate of collective exposure. Result data from beers criteria with PIM, modified barthel index are preferable, but elderly patient treatment data from reliable sources, for example, patient or pathology registries, and medical records are also considered. We present report to showed poly-pharmacy effects of drug use on elderly patient improvement and converse the need for employing STOPP and START criteria of PIM and PPO to avoid undesirable drug reaction causation. We emphasize that a study design of beers criteria always be considered and result of Modified barthel index shows the dependency rate in elderly patient. We also underline the need for Comorbidity analyses in geriatric patient and drug usage, as drug utilization in geriatric are prone to dose and number of drugs in treatment dependent. In the main, studies of Prescription analyses like polypharmacy, PIM, PPO in prescription should explore risk Geriatric patient, the present study reveal the PIM and PPO of in prescription from six hundred and fifty geriatric patient. We conclude the pharmacoepidemiological studies of elderly patient are likely to develop significantly in the coming years, due to the rising mortality of long-term drug exposures and less awareness of poly-pharmacy result, the increasing perform of multinational studies, permiting studies of rare and common disease in elderly people, types of medication and procedural development specifically addressing geriatric treatment and long-term outcomes.