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Rodríguez-Ramallo H, Báez-Gutiérrez N, Villalba-Moreno Á, Jaramillo Ruiz D, Santos-Ramos B, Prado-Mel E, Sanchez-Fidalgo S. Reducing the drug burden of sedative and anticholinergic medications in older adults: a scoping review of explicit decision criteria. Arch Gerontol Geriatr 2024; 121:105365. [PMID: 38364710 DOI: 10.1016/j.archger.2024.105365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/27/2024] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To describe the extent, characteristics, and knowledge gaps regarding explicit decision criteria for deprescribing drugs with anticholinergic or sedative properties (Ach/Sed) in older adults. DESIGN Scoping review. SETTING AND PARTICIPANTS Original studies, clinical trial protocols, grey literature, and Summaries of Product Characteristics. METHODS Searches targeting explicit decision criteria for deprescribing Ach/Sed were performed across MEDLINE, EMBASE, CINAHL, and Web of Science, including trial registries (clinicaltrials.gov, ICTRP, EU-CTR, ANZCTR) for pertinent articles, study protocols. Additionally, to encompass non-traditional or 'grey literature' sources, Google searches and relevant agency websites were explored, alongside the summary of product characteristics for Ach/Sed. RESULTS The initial literature search identified 8,192 unique data sources. After review, 188 original articles or books, 79 internet sources, and 127 SmPCs were included. Examining these sources for explicit criteria for 154 Ach/Sed, overall, 1,271 explicit criteria guidance for identifying clinical scenarios warranting deprescription of Ach/Sed across 145/154 Ach/Sed were identified. These criteria were identified mainly from qualitative research and Summaries of Product Characteristics. Additionally, 455 criteria-based recommendations suggesting approaches for tapering implementation across 76/154 Ach/Sed were identified, mostly from sources classified as expert opinions. Significant heterogeneity was found across the approaches for tapering Ach/Sed. CONCLUSIONS This scoping review provides a comprehensive overview of the literature providing guidance for clinical scenarios where Ach/Sed should be deprescribed and highlights the existing knowledge gaps regarding comprehensive guidance on tapering these drugs which warranties future research and development.
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Affiliation(s)
- Hector Rodríguez-Ramallo
- Pharmacy Department, Virgen del Rocío University Hospital, Seville, Spain; Clinical Unit of Pneumology and Thoracic Surgery, Institute of Biomedicine of Seville, Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Seville, Spain
| | | | | | - Didiana Jaramillo Ruiz
- Pharmacy Department, Virgen del Rocío University Hospital, Seville, Spain; Andalusian Public Foundation for Health Research Management of Seville, Seville, Spain
| | | | - Elena Prado-Mel
- Pharmacy Department, Virgen del Rocío University Hospital, Seville, Spain
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Prabahar K, Alhawiti MS, Yosef AM, Alqarni RS, Sayd FY, Alsharif MO, Subramani V, Alshareef H, Hamdan AME, Alqifari S, Alqarni GS, Yousuf SM. Potentially Inappropriate Medications in Hospitalized Older Patients in Tabuk, Saudi Arabia Using 2023 Beers Criteria: A Retrospective Multi-Centric Study. J Multidiscip Healthc 2024; 17:1971-1979. [PMID: 38706504 PMCID: PMC11070160 DOI: 10.2147/jmdh.s461180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose Older persons are frequently prescribed several medications; therefore, inappropriate medication prescriptions are common. Prescribing potentially inappropriate medications (PIMs) poses a serious risk and hence, we aimed to assess the PIMs in older patients in Tabuk, using the 2023 Beers criteria. Patients and Methods A retrospective cross-sectional study was carried out, including older persons ≥65 years of age admitted in two government hospitals from June 2022 to May 2023, and prescribed with five or more medications. PIMs were assessed using the 2023 Beers criteria. Descriptive analysis was performed for the categorical and continuous variables. Logistic regression was used to assess the influence of age, gender, number of medications and comorbidities on PIMs using SPSS version 27. Results The study included 420 patients. The mean age of the participants was 75.52 ± 8.70 years (range, 65-105 years). There was a slightly higher proportion of females (52%). The prevalence of PIMs was 81.43%, where 35.41% were prescribed one PIM, 26.48% were prescribed two PIMs, and 17.32% were prescribed three PIMs. The proportion of medications considered potentially inappropriate among older patients was 70.11%, and proton pump inhibitors were the most commonly prescribed medication (52.99%). The proportion of medications to be used with caution was 19.55%, with diuretics being the most frequently administered medication (91.43%). Gender and comorbidity did not influence PIMs, but age and number of medications significantly influenced the likelihood of PIMs. Conclusion PIMs are prevalent among older people and are significantly associated with age and multiple medications. Caution should be exercised while prescribing medications to older persons. Frequent audits should be performed to assess PIMs, and clinicians should be informed of the same to avoid serious outcomes associated with PIMs. Interventions designed to reduce PIM need to be initiated.
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Affiliation(s)
- Kousalya Prabahar
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | | | | | | | - Fai Yahya Sayd
- Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | | | - Vikashini Subramani
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Nilgiris, TN, India
| | - Hanan Alshareef
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Ahmed M E Hamdan
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Saleh Alqifari
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
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Alageel NA, Hughes CM, Alwhaibi M, Alkeridy W, Barry HE. Potentially inappropriate prescribing for people with dementia in ambulatory care: a cross-sectional observational study. BMC Geriatr 2024; 24:328. [PMID: 38600444 PMCID: PMC11008018 DOI: 10.1186/s12877-024-04949-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Studies have shown that potentially inappropriate prescribing (PIP) is highly prevalent among people with dementia (PwD) and linked to negative outcomes, such as hospitalisation and mortality. However, there are limited data on prescribing appropriateness for PwD in Saudi Arabia. Therefore, we aimed to estimate the prevalence of PIP and investigate associations between PIP and other patient characteristics among PwD in an ambulatory care setting. METHODS A cross-sectional, retrospective analysis was conducted at a tertiary hospital in Saudi Arabia. Patients who were ≥ 65 years old, had dementia, and visited ambulatory care clinics between 01/01/2019 and 31/12/2021 were included. Prescribing appropriateness was evaluated by applying the Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP) criteria. Descriptive analyses were used to describe the study population. Prevalence of PIP and the prevalence per each STOPP criterion were calculated as a percentage of all eligible patients. Logistic regression analysis was used to investigate associations between PIP, polypharmacy, age and sex; odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Analyses were conducted using SPSS v27. RESULTS A total of 287 PwD were identified; 56.0% (n = 161) were female. The mean number of medications prescribed was 9.0 [standard deviation (SD) ± 4.2]. The prevalence of PIP was 61.0% (n = 175). Common instances of PIP were drugs prescribed beyond the recommended duration (n = 90, 31.4%), drugs prescribed without an evidence-based clinical indication (n = 78, 27.2%), proton pump inhibitors (PPIs) for > 8 weeks (n = 75, 26.0%), and acetylcholinesterase inhibitors with concurrent drugs that reduce heart rate (n = 60, 21.0%). Polypharmacy was observed in 82.6% (n = 237) of patients and was strongly associated with PIP (adjusted OR 24.1, 95% CI 9.0-64.5). CONCLUSIONS Findings have revealed a high prevalence of PIP among PwD in Saudi Arabia that is strongly associated with polypharmacy. Future research should aim to explore key stakeholders' experiences and perspectives of medicines management to optimise medication use for this vulnerable patient population.
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Affiliation(s)
- Nahla A Alageel
- Primary Care Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, BT9 7BL, Belfast, UK
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Carmel M Hughes
- Primary Care Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, BT9 7BL, Belfast, UK
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Walid Alkeridy
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, Geriatric Division, University of British Columbia, Vancouver, Canada
- General Administration of Home Health Care, Therapeutic Affairs Deputyship, Riyadh, Saudi Arabia
| | - Heather E Barry
- Primary Care Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, BT9 7BL, Belfast, UK.
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Rodrigues DA, Herdeiro MT, Mateos-Campos R, Figueiras A, Roque F. Comparing AGS Beers 2019, STOPP version 2, and EU(7)-PIM list in Portuguese older adults in primary health care. Eur J Clin Pharmacol 2024; 80:603-612. [PMID: 38319349 PMCID: PMC10937751 DOI: 10.1007/s00228-024-03633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE This study aims to identify PIM prevalence in older adults according to the 2019 Beers criteria, Screening Tool of Older Person's Prescriptions version 2 (STOPP v2) criteria, and the Portuguese EU(7)-PIM list and also to analyze the concordance between these criteria. METHODS A retrospective study was conducted among 1200 Portuguese older adults (≥ 65 years old), users of primary health care. Demographic, clinical, and pharmacological data were collected concerning the period between April 2021 and August 2022. A comparative analysis was performed between the three PIM identification criteria, and the concordance was determined according to the Lin concordance correlation coefficient. RESULTS The mean age was 76.3 (SD 7.7) years old and 57.6% of the older adults were females. Our findings indicate varying prevalence rates among these criteria with 63.8% (95% CI 61.0-66.6%), 66.8% (95% CI 64.1-69.5%), and 50.1% (95% CI 47.2-53.0%) of the older adults take at least one PIM according to the EU(7)-PIM list, Beers 2019, and STOPP v2 criteria, respectively. The highest prevalence observed was for proton pump inhibitors according to EU(7)-PIM list (30.1%, 95% CI 27.6-32.9) and Beers criteria (30.1%, 95% CI 27.6-32.9) and alprazolam according to STOPP v2 criteria (10.1%, 95% CI 8.4-11.9%). A poor concordance between criteria was observed (< 0.834). The highest concordance coefficient was found between the EU(7)-PIM list and the Beers criteria (0.833), and the lowest between the EU(7)-PIM list and STOPP criteria (0.735). CONCLUSION This study reveals varying prevalence rates of PIM in older adults, as assessed by different criteria, and highlights the need for targeted interventions and improved prescribing practices. In the future, studies should focus on the occurrence of negative outcomes in older adults associated with PIM consumption.
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Affiliation(s)
- Daniela A Rodrigues
- Research Laboratory on Epidemiology and Population Health, Polytechnic of Guarda (IPG), 6300-559, Guarda, Portugal
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506, Covilhã, Portugal
- PhD Student, University of Salamanca, 37007, Salamanca, Spain
| | - Maria Teresa Herdeiro
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193, Aveiro, Portugal
| | - Ramona Mateos-Campos
- Area of Preventive Medicine and Public Health, Department of Biomedical and Diagnostic Sciences, University of Salamanca, 37007, Salamanca, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15702, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), 15706, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health-CIBERESP), 28001, Madrid, Spain
| | - Fátima Roque
- Research Laboratory on Epidemiology and Population Health, Polytechnic of Guarda (IPG), 6300-559, Guarda, Portugal.
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506, Covilhã, Portugal.
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Alanazi SA, Al Amri A, Almuqbil M, Alroumi A, Gamal Mohamed Alahmadi M, Obaid Ayesh Alotaibi J, Mohammed Sulaiman Alenazi M, Hassan Mossad Alahmadi W, Hassan Saleh Al Bannay A, Khaled Ahmad Marai S, AlKhatham SM, Al-kanhal S, Asdaq SMB. Use of potentially inappropriate medication for elderly patients in tertiary care hospital of Riyadh, Saudi Arabia. Saudi Pharm J 2024; 32:102015. [PMID: 38497086 PMCID: PMC10940805 DOI: 10.1016/j.jsps.2024.102015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/24/2024] [Indexed: 03/19/2024] Open
Abstract
Background and objectives The elderly population is affected by chronic diseases and lifelong medication. The American Geriatrics Society (AGS) Beers Criteria is a comprehensive approach to medication usage in the older population to reduce potentially inappropriate medication (PIM) use. The purpose of this study was to assess the usage of PIMs in elderly patients upon discharge from tertiary care hospital settings in Riyadh, Saudi Arabia, using the AGS Beers Criteria 2019. Methods The data was obtained from the medical records of 1237 patients (>65 years) who were discharged from medical or surgical wards at two hospitals affiliated with King Abdulaziz Medical City. The data was analyzed to determine the prevalence of PIM prescription, and the proportional odds of the independent factors influencing outcomes were estimated using ordinal regression analysis for criteria 1 and 2, while Binary regression analysis was conducted for criterion 3. Results There were approximately equal numbers of male and female participants in our study (male: 50.8 % vs. female: 49.2 %). One-third of the patients were above the age of 80 years, with 41 % being between the ages of 70 and 80 years. Moreover, almost 70 % of the samples had chronic illnesses. The overall prevalence of PIMs was 29.2 %, with 11 % of PIMs to be avoided in elderly patients and 17 % to be used with caution in the elderly, while disease-specific PIMs were identified in 1.2 % of the patients. The most common PIM class was proton pump inhibitors (44.41 %), and patients discharged from the surgical unit were more likely to be prescribed PIMs. Proton pump inhibitors (44.41 %) were the most inappropriately prescribed drug class, and patients discharged from the surgical unit were more likely to be prescribed PIMs. Conclusion The study noticed that male gender, the presence of multiple diseases, and obesity are associated with more than one PIM prescription. There is a need to streamline the surgical department's prescription procedure to eliminate prescription disparities. Prescription monitoring is recommended to avoid medication errors, particularly in patients who are taking multiple medications.
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Affiliation(s)
- Saleh A. Alanazi
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulrahman Al Amri
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mansour Almuqbil
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Abdullah Alroumi
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Science College of Pharmacy, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Joud Obaid Ayesh Alotaibi
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | | | | | | | - Shorooq Khaled Ahmad Marai
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
| | | | - Sarah Al-kanhal
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Dariyah, 13713 Riyadh, Saudi Arabia
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Veronese N, Gallo U, Boccardi V, Demurtas J, Michielon A, Taci X, Zanchetta G, Campbell Davis SE, Chiumente M, Venturini F, Pilotto A. Efficacy of deprescribing on health outcomes: An umbrella review of systematic reviews with meta-analysis of randomized controlled trials. Ageing Res Rev 2024; 95:102237. [PMID: 38367812 DOI: 10.1016/j.arr.2024.102237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Deprescribing is an important intervention across different settings in medicine, but the literature supporting such a practice is still conflicting. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of deprescribing for health outcomes. METHODS Umbrella review of systematic reviews of the use of deprescribing searching in Medline, Scopus, and Web of Science until 01 November 2023. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. RESULTS Among 456 papers, 12 systematic reviews (six with meta-analysis) for a total of 231 RCTs and 44,193 patients were included. In any setting, deprescribing was able to significantly reduce the number of total and of potentially inappropriate medications (PIMs) in older patients (low certainty of evidence) and to reduce the proportion of participants potentially having several or PIMs (moderate certainty of evidence). In community, supported by a high certainty of evidence, deprescribing was not more effective than standard care in decreasing injurious falls, any falls or number of fallers. In nursing home, deprescribing was associated with a significantly lower PIMs than standard care (very low certainty of evidence). In end-of-life situations, deprescribing significantly reduced mortality rate of approximately 41% (high certainty of evidence). CONCLUSIONS Deprescribing is a promising intervention across different settings and situations, but a notable gap in the literature concerning its effects on substantial outcomes still exists.
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Affiliation(s)
- Nicola Veronese
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy.
| | - Umberto Gallo
- Pharmaceutical Department, Local Health Unit n. 6 Euganea, Padua, Italy
| | - Virginia Boccardi
- Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Jacopo Demurtas
- Family Medicine Department, USL Sud Est Toscana, Grosseto, Italy
| | - Alberto Michielon
- School of Specialization in Hospital Pharmacy, University of Siena, Siena, Italy
| | - Xhoajda Taci
- School of Specialization in Hospital Pharmacy, Università degli Studi di Padova, Padua, Italy
| | - Giulia Zanchetta
- School of Specialization in Hospital Pharmacy, Università degli Studi di Padova, Padua, Italy
| | | | - Marco Chiumente
- Scientific Direction, SIFaCT - Società Italiana di Farmacia Clinica e Terapia, Turin, Italy
| | | | - Alberto Pilotto
- Geriatrics Unit, Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy; Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
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Stauffer SJ, Pohlig RT, Horne JR, Sarlo FB, Sions JM. Potentially inappropriate medication use among older adults with lower-limb loss. Geriatr Nurs 2024; 56:218-224. [PMID: 38367544 DOI: 10.1016/j.gerinurse.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence of, and explore factors related to, prescription of potentially inappropriate medications (PIMs) among older adults with lower-limb loss (LLL). METHODS This was a secondary analysis of a cross-sectional dataset collected through an interdisciplinary limb loss clinic between September 2013 and November 2022. Self-report medication lists were reviewed during in-clinic face-to-face interviews and compared to the American Geriatrics Society Beers Criteria corresponding to the patient's evaluation year. RESULTS Of 82 participants (72.9 ± 6.6 years-old; 78.0 % male), n = 41 (50.0 %) reported using one or more PIM. PIM prescription was significantly associated with presence of phantom limb pain, history of upper gastrointestinal issues, and a greater number of medications. DISCUSSION Polypharmacy and PIM use are common among older adults with LLL. Greater attention should be paid to medications post-amputation, especially pain management medications, to minimize potential adverse side-effects.
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Affiliation(s)
- Samantha Jeanne Stauffer
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, STAR Campus, 540 South College Ave, Suite 144A, Newark, DE, 19713, USA; Independence Prosthetics-Orthotics, Inc. 550 S. College Ave, Suite 111, Newark, DE, 19713, USA
| | - Ryan Todd Pohlig
- University of Delaware, Biostatistics Core, 100 Discovery Blvd, Newark, DE, 19713 USA; University of Delaware, Epidemiology Program, STAR Tower, Suite 614, Newark, DE, 19713, USA
| | - John Robert Horne
- Independence Prosthetics-Orthotics, Inc. 550 S. College Ave, Suite 111, Newark, DE, 19713, USA
| | | | - Jaclyn Megan Sions
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, STAR Campus, 540 South College Ave, Suite 144A, Newark, DE, 19713, USA.
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Kumar S, Castelino R, Rao A, Gattani S, Kumar A, Pillai A, Sehgal A, Rane P, Ramaswamy A, Dhekale R, Krishnamurthy J, Banavali S, Badwe R, Prabhash K, Noronha V, Gota V. Performance of potentially inappropriate medications assessment tools in older Indian patients with cancer. Cancer Med 2024; 13:e6797. [PMID: 38183404 PMCID: PMC10807583 DOI: 10.1002/cam4.6797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medication (PIM) use are common problems in older adults. Safe prescription practices are a necessity. The tools employed for the identification of PIM sometimes do not concur with each other. METHODS A retrospective analysis of patients ≥60 years who visited the Geriatric Oncology Clinic of the Tata Memorial Hospital, Mumbai, India from 2018 to 2021 was performed. Beer's-2015, STOPP/START criteria v2, PRISCUS-2010, Fit fOR The Aged (FORTA)-2018, and the EU(7)-PIM list-2015 were the tools used to assess PIM. Every patient was assigned a standardized PIM value (SPV) for each scale, which represented the ratio of the number of PIMs identified by a given scale to the total number of medications taken. The median SPV of all five tools was considered the reference standard for each patient. Bland-Altman plots were utilized to determine agreement between each scale and the reference. Association between baseline variables and PIM use was determined using multiple logistic regression analysis. RESULTS Of the 467 patients included in this analysis, there were 372 (79.66%) males and 95 (20.34%) females with an average age of 70 ± 5.91 years. The EU(7)-PIM list was found to have the highest level of agreement given by a bias estimate of 0.010, the lowest compared to any other scale. The 95% CI of the bias was in the narrow range of -0.001 to 0.022, demonstrating the precision of the estimate. In comparison, the bias (95%) CI of Beer's criteria, STOPP/START criteria, PRISCUS list, and FORTA list were -0.039 (-0.053 to -0.025), 0.076 (0.060 to 0.092), 0.035 (0.021 to 0.049), and -0.148 (-0.165 to -0.130), respectively. Patients on polypharmacy had significantly higher PIM use compared to those without (OR = 1.47 (1.33-1.63), p = <0.001). CONCLUSIONS The EU(7)-PIM list was found to have the least bias and hence can be considered the most reliable among all other tools studied.
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Affiliation(s)
- Sharath Kumar
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Renita Castelino
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Abhijith Rao
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Shreya Gattani
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Anita Kumar
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Anupa Pillai
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | - Arshiya Sehgal
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Pallavi Rane
- Department of StatisticsAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
| | - Anant Ramaswamy
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Ratan Dhekale
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
| | | | - Shripad Banavali
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Rajendra Badwe
- Homi Bhabha National InstituteMumbaiIndia
- Department of Surgical OncologyTata Memorial HospitalMumbaiMaharashtraIndia
| | - Kumar Prabhash
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Vanita Noronha
- Department of Medical OncologyTata Memorial HospitalMumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
| | - Vikram Gota
- Department of Clinical PharmacologyAdvanced Centre for Treatment, Research and Education in Cancer, Tata Memorial CentreNavi MumbaiIndia
- Homi Bhabha National InstituteMumbaiIndia
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9
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Amrouch C, Vauterin D, Amrouch S, Grymonprez M, Dai L, Damiano C, Calderón-Larrañaga A, Lahousse L, De Bacquer D, Lip GYH, Vetrano DL, De Smedt D, Petrovic M. Potentially inappropriate prescribing in multimorbid and polymedicated older adults with AF: A Systematic Review and Meta-Analysis. Drugs Aging 2024; 41:13-30. [PMID: 37976015 PMCID: PMC10769941 DOI: 10.1007/s40266-023-01078-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
AIM Polypharmacy in multimorbid older patients with atrial fibrillation (AF) is a risk factor for potentially inappropriate prescribing (PIP). We aimed to systematically assess the evidence on the prevalence of PIP and its impact on adverse health outcomes in this patient group. METHODS A systematic search of the published peer-reviewed literature describing the prevalence of PIP and/or its association with adverse health outcomes in multimorbid (AF plus one comorbidity) and polymedicated (≥ 2 drugs) adults ≥ 65 years was done up to March 2023. A meta-analysis of the prevalence of PIP of (direct) oral anticoagulants ((D)OACs) was conducted using a random-effects model. Leave-one-out analysis was performed with R (version 4.2.2) and RStudio (version 2022.12.0+353). RESULTS Of the 12 studies included, only one reported on the prevalence of overall PIP (65%). The meta-analysis of 10 studies assessing PIP of (D)OACs produced a pooled prevalence [95% confidence interval (CI)] of 35% [30-40%], with significant heterogeneity between the included studies (I2 95%). No statistically significant association was reported in three studies between PIP of (D)OACs, cardiovascular (CV) and all-cause mortality, hospital readmission, CV hospitalisation and stroke. Reported associations between PIP and major bleeding differed, with one study demonstrating a significant association (odds ratio 2.17; 95% CI 1.14-4.12) and the other study not showing such association. CONCLUSION This systematic review highlights the scarce evidence regarding the prevalence of PIP and its association with adverse health outcomes in multimorbid older adults with AF. Large, prospective and better-designed studies are needed.
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Affiliation(s)
- Cheima Amrouch
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Delphine Vauterin
- Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ghent, Belgium
| | - Souad Amrouch
- Department of Medicine, Antwerp University, Antwerp, Belgium
| | - Maxim Grymonprez
- Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ghent, Belgium
| | - Lu Dai
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Cecilia Damiano
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Lies Lahousse
- Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Gregory Y H Lip
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
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Ndai A, Al Bahou J, Morris E, Wang HM, Marcum Z, Hung A, Brandt N, Steinman MA, Vouri SM. Mapping potentially inappropriate medications in older adults using the Anatomical Therapeutic Chemical (ATC) classification system. J Am Geriatr Soc 2024; 72:126-138. [PMID: 38124261 DOI: 10.1111/jgs.18681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/09/2023] [Accepted: 08/28/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Potentially inappropriate medications (PIMs) in older adults are medications in which risks often outweigh benefits and are suggested to be avoided. Worldwide, many distinct guidelines and tools classify PIMs in older adults. Collating these guidelines and tools, mapping them to a medication classification system, and creating a crosswalk will enhance the utility of PIM guidance for research and clinical practice. METHODS We used the Anatomical Therapeutic Chemical (ATC) Classification System, a hierarchical classification system, to map PIMs from eight distinct guidelines and tools (2019 Beers Criteria, Screening Tool for Older Person's Appropriate Prescriptions [STOPP], STOPP-Japan, German PRISCUS, European Union-7 Potentially Inappropriate Medication [PIM] list, Centers for Medicare & Medicaid Services [CMS] High-Risk Medication, Anticholinergic Burden Scale, and Drug Burden Index). Each PIM was mapped to ATC Level 5 (drug) and to ATC Level 4 (drug class). We then used the crosswalk (1) to compare PIMs and PIM drug classes across guidelines and tools to determine the number of PIMs that were index (drug-induced adverse event) or marker (treatment of drug-induced adverse event) drug of prescribing cascades, and (2) estimate the prevalence of PIM use in older adults continuously enrolled with fee-for-service Medicare in 2018 as use cases. Data visualization and descriptive statistics were used to assess guidelines and tools for both use cases. RESULTS Out of 480 unique PIMs identified, only three medications-amitriptyline, clomipramine, and imipramine and two drug classes-N06AA (tricyclic antidepressants) and N06AB (selective serotonin reuptake inhibitors), were noted in all eight guidelines and tools. Using the crosswalk, 50% of classes of index drugs and 47% of classes of marker drugs of known prescribing cascades were PIMs. Additionally, 88% of Medicare beneficiaries were dispensed ≥1 PIM across the eight guidelines and tools. CONCLUSION We created a crosswalk of eight PIM guidelines and tools to the ATC classification system and created two use cases. Our findings could be used to expand the ease of PIM identification and harmonization for research and clinical practice purposes.
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Affiliation(s)
- Asinamai Ndai
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Julie Al Bahou
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Earl Morris
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Hsin-Min Wang
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Zach Marcum
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Anna Hung
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Nicole Brandt
- The Peter Lamy Center on Drug Therapy and Aging, University of Maryland, Baltimore, Maryland, USA
| | - Michael A Steinman
- Division of Geriatrics, Department of Medicine, University of California San Francisco and the San Francisco VA Medical Center, San Francisco, California, USA
| | - Scott Martin Vouri
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
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11
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Alotaibi FM. The current view of potentially inappropriate medications (PIMs) among older adults in Saudi Arabia: a systematic review. Front Pharmacol 2023; 14:1325871. [PMID: 38186639 PMCID: PMC10770872 DOI: 10.3389/fphar.2023.1325871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction: Potentially inappropriate medications PIMs are common among elderly population and becoming a global health issue. It has been associated with negative health consequences like preventable adverse drug reactions, hospitalization and mortality. Objectives: To investigate the most commonly potentially inappropriate medications in older adults in Saudi Arabia. Additionally, we aim to gain insights into the typical healthcare settings where healthcare providers offer services related to PIMs. Methods: This is a systematic review design using Preferred Reporting Items Systematic Reviews and Meta-Analysis (PRISMA) statement. PubMed and Google Scholar were used to search for the relevant studies using the following keywords (older adults, elderly, potentially inappropriate medications, inappropriate medications, PMIs, Saudi Arabia, Kingdom of Saudi Arabia) with no restrictions to the date of publications nor the study language. Results: Only 8 studies have met our inclusion and exclusion criteria, which was most of them were cross-sectional study design (n = 6.75%) and all of them have been conducted in hospital-based settings. In addition, the prevalence of PIMs ranged from 19% to 80% depends on the site and administration of the study. We have found that proton pump inhibitors, non-steroidal anti-inflammatory drugs, aspirin, diuretics, gastrointestinal medications, and antidepressants were the most common reported PIMs in the included studies. Conclusion: The prevalence of PIMs among the elderly in Saudi Arabia is notably high ranged from 19% to 80%, underscoring the need for additional research to assess the existing practices within this vulnerable demographic across various healthcare settings.
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Affiliation(s)
- Fawaz M. Alotaibi
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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12
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Nishikawa T, Sakata N, Sugiyama T, Tamiya N. Dispensing by Family Pharmacists as a Potential Factor in Pharmacist-initiated Prescription Change: A Retrospective Observational Study. J Epidemiol 2023; 33:618-623. [PMID: 36503903 PMCID: PMC10635808 DOI: 10.2188/jea.je20220165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND No studies in Japan have examined whether dispensing by family pharmacists, who are incentivized by reimbursement to provide continuous and exclusive medication management, results in prescription changes. Our primary objective was to identify the variables affecting prescription changes, particularly to investigate dispensing by family pharmacists as a possible factor. METHODS We identified 333,503 records of pharmacy claims data from patients aged 65 years or older who received medication instructions at outpatient pharmacies at Tsukuba, a medium-sized city near Tokyo, between April 2018 and March 2019. We extracted data on dispensing by family pharmacists, number of medicines, patient sex, patient age, and pharmacy category. A multilevel modified Poisson regression analysis was performed to analyze the correlation between dispensing by family pharmacists and pharmacist-initiated prescription change. RESULTS Dispensing by family pharmacists was 1.37 times more likely to involve a record of prescription change than dispensing by non-family pharmacists. Older age, female sex, polypharmacy, and small-scale pharmacies were also found to be factors. CONCLUSION This study indicated that dispensing by family pharmacists was a potential factor for pharmacist-initiated prescription changes that may prevent excessive medication and limit pharmacological interactions. Since the likelihood of inappropriate prescriptions being issued varies from hospital to hospital, subsequent studies should take into account the quality of each institution.
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Affiliation(s)
- Takakiyo Nishikawa
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Nobuo Sakata
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Takehiro Sugiyama
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
- Institute for Global Health Policy, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
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13
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Hui JH, Parikh S, Kouladjian O'Donnell L, Mcinerney B, Dillon L, Poojary S, Crabtree A. Pharmacist-led medication review in a residential in-reach service leads to deprescribing. Australas J Ageing 2023; 42:675-682. [PMID: 37198738 DOI: 10.1111/ajag.13215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 03/15/2023] [Accepted: 04/29/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To examine the effect of a pharmacist-led medication review on deprescribing medications in a Residential In-Reach (RIR) service which provides acute care substitution to residential aged care residents. METHODS A pre-post observational study was conducted. Patient characteristics and admission and discharge medications were collected over two 3-month phases before (prephase) and after (postphase) the introduction of a pharmacist who performed a comprehensive medication review and provided deprescribing recommendations. The Screening Tool of Older Persons' Prescriptions (STOPP) version 2 was used to identify potentially inappropriate medications (PIMs). The Drug Burden Index (DBI) was used to measure cumulative anticholinergic and sedative medication burden. Outcome of deprescribing was measured by the reduction in the number of PIMs, DBI scores and proportion of polypharmacy from admission to discharge. RESULTS The prephase included 59 patients (mean age 87.3 years, 63% female), and the postphase included 88 patients (mean age 87.3 years, 63% female). There was a significant reduction in the mean number of PIMs (pre +0.05 ± 2.59 vs. post -0.78 ± 2.32, p = 0.04) and median DBI (pre -0.004 ± 0.17 vs. post -0.07 ± 0.2, p = 0.03) in postphase compared to prephase. The proportion of polypharmacy at discharge was reduced in the postphase (pre-100% vs. post-90%, p = 0.01). The most deprescribed PIMs as measured by STOPP in postphase were drugs without indication, cardiovascular system drugs and gastrointestinal system drugs. CONCLUSIONS The introduction of a pharmacist-led medication review in RIR service was associated with a significant reduction in the mean number of PIMs, median DBI and polypharmacy. Future studies are needed to determine whether deprescription is sustained to examine correlations to long-term patient outcomes.
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Affiliation(s)
- Jia Hao Hui
- Department of Home, Acute and Community, Alfred Health, Melbourne, Victoria, Australia
| | - Seema Parikh
- Department of Home, Acute and Community, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lisa Kouladjian O'Donnell
- Departments of Clinical Pharmacology and Ageing, Kolling Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Brigid Mcinerney
- Department of Pharmacy, Alfred Health, Melbourne, Victoria, Australia
| | - Louise Dillon
- Department of Home, Acute and Community, Alfred Health, Melbourne, Victoria, Australia
| | - Suma Poojary
- Department of Home, Acute and Community, Alfred Health, Melbourne, Victoria, Australia
| | - Amelia Crabtree
- Department of Home, Acute and Community, Alfred Health, Melbourne, Victoria, Australia
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14
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Albayrak A, Demirbaş H. Evaluation of potentially inappropriate medications use and medication complexity in elderly patients applying to community pharmacy in Turkey. BMC Geriatr 2023; 23:655. [PMID: 37833671 PMCID: PMC10571236 DOI: 10.1186/s12877-023-04381-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Older adults often use multiple medicines to manage comorbidities well or to prevent associated complications. This study aims to determine polypharmacy, the use of potentially inappropriate medications (PIMs) using the 2019 Beers Criteria and to determine the Medication Regimen Complexity Index (MRCI) score. It also aims to identify factors associated with the presence of PIMs and the MRCI score. METHODS This cross-sectional study was carried out between 6 and 2023 and 5 May 2023 in a community pharmacy in Turkey. Elderly patients over 65 years of age, who used at least one drug, and who came to the pharmacy for any reason were included in the study. PIMs were determined according to the 2019 Beers Criteria. The Turkish validated version of the MRCI was used to determine the medication complexity score. RESULTS 200 patients were included in this study. 59.5% of the patients were female and the median age was 70 (IQR, 66-74.75). Polypharmacy was detected in 33% of patients. The use of PIMs was determined in 63.5% of the patients. The median of the MRCI score was 11 (IQR, 7-15). The number of chronic diseases and drugs, presence of polypharmacy, MRCI score and mental disorders were found to be significantly higher in those with PIMs than in those without (p < 0.05). Having less than eight years of education, presence of polypharmacy, the presence of comorbidity (diabetes mellitus, cardiovascular disease, thyroid, chronic obstructive pulmonary disease (COPD), asthma and mental disorders) were associated with significantly higher MRCI scores (p < 0.05). CONCLUSIONS According to the results of our study, it was found that the elderly patients who came to the pharmacy had low MRCI scores, but had high PIMs use. Community pharmacists have an important role in identifying inappropriate drug use, so they should be trained to develop skills in identifying and reducing PIMs in older patients.
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Affiliation(s)
- Aslınur Albayrak
- Department of Clinical Pharmacy, Faculty of Pharmacy, Suleyman Demirel University, Isparta, Turkey.
| | - Halil Demirbaş
- Faculty of Pharmacy, Suleyman Demirel University, Isparta, Turkey
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15
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Kosirova S, Urbankova J, Klimas J, Foltanova T. Assessment of potentially inappropriate medication use among geriatric outpatients in the Slovak Republic. BMC Geriatr 2023; 23:567. [PMID: 37715169 PMCID: PMC10504736 DOI: 10.1186/s12877-023-04260-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Potentially inappropriate medication (PIM) use is a highly prevalent problem among older people, making it challenging to improve patient safety. The aim of this study was to assess the use of PIMs among geriatric outpatients (OUTs) in the Slovak Republic according to the EU(7) PIM list and to identify the differences in PIM prescriptions among general practitioners (GPs), internists (INTs) and geriatricians (GERs). METHODS In total, 449 patients (65 years and older) from 4 medical centres who were in the care of GPs (32.5%), INTs (22.7%) or GERs (44.8%) were included in this retrospective analysis. Data were collected from 1.12.2019-31.3.2020. PIMs were identified according to the EU(7) PIM list from patients' records. PIM prescriptions by GPs, INTs and GERs were assessed. All obtained data were statistically analysed. RESULTS Polypharmacy (68.8% of patients), and PIM use (73% of patients) were observed. The mean number of all prescribed drugs was 6.7 ± 0.2 drugs per day/patient. The mean number of prescribed PIMs was 1.7 ± 0.1 PIMs per day/patient. Drugs from Anatomical Therapeutic Chemical (ATC) classes C, N and A accounted for the greatest number of PIMs. Significantly higher numbers of prescribed drugs as well as PIMs were prescribed by GPs than INTs or GERs. There were 4.2 times higher odds of being prescribed PIMs by GPs than by GERs (p < 0.001). CONCLUSIONS Polypharmacy and overprescription of PIMs were identified among geriatric patients in our study. We found a positive relationship between the number of prescribed drugs and PIMs. The lowest odds of being prescribed PIMs were observed among those who were in the care of a geriatrician. The absence of geriatricians and lack of information about PIMs among general practitioners leads to high rates of polypharmacy and overuse of potentially inappropriate medications in geriatric patients in the Slovak Republic.
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Affiliation(s)
- Stanislava Kosirova
- Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University Bratislava, Odbojarov 10, Bratislava, 83104, Slovak Republic
| | - Jana Urbankova
- Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University Bratislava, Odbojarov 10, Bratislava, 83104, Slovak Republic
| | - Jan Klimas
- Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University Bratislava, Odbojarov 10, Bratislava, 83104, Slovak Republic
| | - Tatiana Foltanova
- Faculty of Pharmacy, Department of Pharmacology and Toxicology, Comenius University Bratislava, Odbojarov 10, Bratislava, 83104, Slovak Republic.
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16
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Falemban AH. Medication-Related Problems and Their Intervention in the Geriatric Population: A Review of the Literature. Cureus 2023; 15:e44594. [PMID: 37795072 PMCID: PMC10545972 DOI: 10.7759/cureus.44594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
In order to implement the principles of providing clinically and economically effective care, the current state of healthcare must be evaluated, and challenges must be addressed. As part of a physician's role in such a context, one tool consists of identifying medication-related problems (MRPs) and accordingly implementing best practices and innovative strategies to improve patient healthcare outcomes. The geriatric population is expected to have passed through the natural ageing process and experienced several physiological and biological changes that impact their bodies and lives. In the presence of geriatric syndromes and the increased number of medications consumed, the risk of MRPs such as polypharmacy, potentially inappropriate medication (PIM), adverse events, drug-drug interactions, and risk of non-adherence increases. Different interventions that focus on practical and perceptual barriers have been studied, and different tools to define clinically important prescribing problems relating to PIM have been established. The Beers Criteria and STOPP (Screening Tool of Older Persons' Prescriptions)/START (Screening Tool to Alert to Right Treatment) criteria are the most widely used sets of explicit PIM criteria; however, they are still limited in Saudi Arabia. These tools should be considered in clinical settings to improve healthcare outcomes in the geriatric population, and the clinical relevance of enhancing medication should also be explored from the point of view of both the patient and healthcare practitioners.
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Affiliation(s)
- Alaa H Falemban
- Department of Pharmacology and Toxicology, Umm Al-Qura University, Makkah, SAU
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17
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Sichieri K, Trevisan DD, Barbosa RL, Secoli SR. Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study. SAO PAULO MED J 2023; 142:e2022666. [PMID: 37531493 PMCID: PMC10393373 DOI: 10.1590/1516-3180.2022.0666.r1.190523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/06/2023] [Accepted: 05/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use. OBJECTIVE To estimate the incidence and factors associated with PIMs use in intensive care units. DESIGN AND SETTING Historical cohort study was conducted in a high-complexity hospital in Brazil. METHODS A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a "Patient Safety Project" database. A Chi-square test, Student's t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%. RESULTS According to Beers' criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43). CONCLUSIONS Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.
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Affiliation(s)
- Karina Sichieri
- Nurse and Doctoral Student, Hospital Universitário (HU),
Universidade de São Paulo (USP), São Paulo (SP), Brazil
| | - Danilo Donizetti Trevisan
- PhD. Nurse and Assistant Professor, Universidade Federal de São
João Del Rei (UFSJ), Divinópolis (MG), Brazil
| | - Ricardo Luís Barbosa
- PhD. Mathematics and Assistant Professor, Universidade Federal
de Uberlândia (UFU), Monte Carmelo (MG), Brazil
| | - Silvia Regina Secoli
- PhD. Nurse and Senior Professor, Graduate Program in Adult
Health Nursing, School of Nursing, Universidade de São Paulo (USP), São Paulo
(SP), Brazil
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18
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Jabri FF, Liang Y, Alhawassi TM, Johnell K, Möller J. Potentially Inappropriate Medications in Older Adults-Prevalence, Trends and Associated Factors: A Cross-Sectional Study in Saudi Arabia. Healthcare (Basel) 2023; 11:2003. [PMID: 37510444 PMCID: PMC10379671 DOI: 10.3390/healthcare11142003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Potentially inappropriate medications (PIMs) in older adults are associated with drug-related problems, adverse health consequences, repeated hospital admissions and a higher risk of mortality. In Saudi Arabia and some Arab countries, studies of PIMs among large cohorts of older adults are limited. This study aimed to determine the prevalence of PIMs, trends and associated factors among outpatient older adults in Saudi Arabia. (2) Methods: A cross-sectional study was carried out. Over three years (2017-2019), data on 23,417 people (≥65 years) were retrieved from outpatient clinics in a tertiary hospital in Riyadh, Saudi Arabia. PIMs were assessed using the 2019 Beers Criteria. Covariates included sex, age, nationality, number of dispensed medications, and number of diagnoses. A generalized estimating equation model was used to assess trends and factors associated with PIMs. (3) Results: The prevalence of PIMs was high and varied between 57.2% and 63.6% over the study years. Compared with 2017, the prevalence of PIMs increased significantly, with adjusted odds ratios (OR) (95% confidence interval (95% CI)) of 1.23 (1.18-1.29) and 1.15 (1.10-1.21) for 2018 and 2019, respectively. Factors associated with being prescribed PIMs included ≥5 dispensed medications (OR_adjusted = 23.91, 95% CI = 21.47-26.64) and ≥5 diagnoses (OR_adjusted = 3.20, 95% CI = 2.88-3.56). Compared with females, males had a lower risk of being prescribed PIMs (OR_adjusted = 0.90, 95% CI = 0.85-0.94); (4) Conclusions: PIMs were common with an increasing trend among older adults in Saudi Arabia. A higher number of dispensed medications, increased number of diagnoses and female sex were associated with being prescribed PIMs. Recommendations on how to optimize prescriptions and implement de-prescribing strategies are urgently needed.
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Affiliation(s)
- Fouad F Jabri
- Department of Biostatistics, Epidemiology and Public Health, College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GPH, 171 77 Stockholm, Sweden
| | - Yajun Liang
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GPH, 171 77 Stockholm, Sweden
| | - Tariq M Alhawassi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, C8 Medicinsk Epidemiologi och Biostatistik, 171 77 Stockholm, Sweden
| | - Jette Möller
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GPH, 171 77 Stockholm, Sweden
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19
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Alwhaibi M. Inappropriate Medications Use and Polypharmacy among Older Adults with Anxiety Disorder. J Clin Med 2023; 12:4195. [PMID: 37445226 DOI: 10.3390/jcm12134195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Elderly with mental health conditions usually use multiple medications, which predisposes them to inappropriate use of medications, which is defined as medications that should be avoided due to their risk; this outweighs their benefit given that safer alternatives are available. This study aimed to examine potentially inappropriate medication use among older patients with anxiety disorder. METHODS This study used a cross-sectional retrospective study design using twelve months of data extracted from the Electronic Health Record (EHR) database for older adults diagnosed with anxiety disorder and treated in the ambulatory care setting. Potentially inappropriate medications (PIMs) use was evaluated using the 2019 Beers criteria. Descriptive statistics were used to describe the sample. Pearson's chi-square tests (for categorical variables) and t-tests (for continuous variables) were utilized to measure the differences in independent variables between patients with and without PIMs. Binary logistic regression was used to examine the associations between PIMs use and identify potential factors for PIMs use among older adults with anxiety disorder. Analyses were performed using the Statistical Analysis Software version 9.4 (SAS® 9.4). RESULTS The study sample includes 371 older adults (age ≥ 65 years) with anxiety disorder; their average age was (72.1 ± 5.8) years. PIMs use was highly prevalent among older adults with anxiety (66.6%). About 35.6% of the study sample used one PIM, 22.6% used two PIMs, and 8.4% used three PIMs. The most frequently prescribed PIMs were NSAIDs and gastrointestinal agents. The adjusted regression analysis found that PIMs use was less likely among men than women. In addition, PIMs use was more likely among women with diabetes, cancer, and polypharmacy. CONCLUSIONS Future studies on strategies and interventions rationing PIMs use in older adults with anxiety disorder are necessary given the high prevalence of PIMs and polypharmacy within this population.
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Affiliation(s)
- Monira Alwhaibi
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh 11149, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11149, Saudi Arabia
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Alwhaibi M, Alkofide H. Potentially Inappropriate Medications Use among Older Adults with Dyslipidaemia. J Clin Med 2023; 12:4063. [PMID: 37373754 DOI: 10.3390/jcm12124063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/05/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Since older patients with dyslipidemia frequently receive many prescriptions, medication errors are typical and expected in this population. This risk has increased by using potentially inappropriate medications. The 2019 Beers criteria were used in this study to investigate potentially inappropriate medication use among older individuals with dyslipidemia. METHODS A cross-sectional retrospective analysis used data from electronic medical records from an ambulatory-care environment. Patients with dyslipidemia who were older adults (>65 years old) were included. To describe and find potential determinants of potentially inappropriate medication usage, descriptive statistics and logistic regression were employed. RESULTS This study included 2209 older adults (age ≥ 65) with dyslipidemia. The mean age was 72.1 ± 6.0 years, and the majority of the study sample had hypertension (83.7%) and diabetes (61.7%), and around 80.0% were using polypharmacy. The prevalence of potentially inappropriate medications to be avoided among older adults with dyslipidemia was 48.6%. A high risk of potentially inappropriate medication usage was found in older patients with dyslipidemia who had polypharmacy and comorbid diabetes, ischemic heart disease, and anxiety. CONCLUSIONS This study showed that the number of medications prescribed and the presence of concurrent chronic health conditions are important indicators of the risk of potentially inappropriate medications in ambulatory older patients with dyslipidemia.
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Affiliation(s)
- Monira Alwhaibi
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh 11149, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11149, Saudi Arabia
| | - Hadeel Alkofide
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11149, Saudi Arabia
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Chang CT, Teoh SL, Rajan P, Lee SWH. Explicit potentially inappropriate medications criteria for older population in Asian countries: A systematic review. Res Social Adm Pharm 2023:S1551-7411(23)00281-4. [PMID: 37277240 DOI: 10.1016/j.sapharm.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Explicit potentially inappropriate medications (PIM) criteria are commonly used to identify and deprescribe potentially inappropriate prescriptions among older patients. Most of these criteria were developed specifically for the Western population, which might not be applicable in an Asian setting. The current study summarizes the methods and drug lists to identify PIM in older Asian people. METHODS A systematic review of published and unpublished studies were carried out. Included studies described the development of explicit criteria for PIM use in older adults and provided a list of medications that should be considered inappropriate. PubMed, Medline, EMBASE, Cochrane CENTRAL, CINAHL, PsycINFO, and Scopus searches were conducted. The PIMs were analyzed according to the general conditions, disease-specific conditions, and drug-drug interaction classes. The qualities of the included studies were assessed using a nine-point evaluation tool. The kappa agreement index was used to evaluate the level of agreement between the identified explicit PIM tools. RESULTS The search yielded 1206 articles, and 15 studies were included in our analysis. Thirteen criteria were identified in East Asia and two in South Asia. Twelve out of the 15 criteria were developed using the Delphi method. We identified 283 PIMs independent of medical conditions and 465 disease-specific PIMs. Antipsychotics were included in most of the criteria (14/15), followed by tricyclic antidepressants (TCAs) (13/15), antihistamines (13/15), sulfonylureas (12/15), benzodiazepines (11/15), and nonsteroidal anti-inflammatory drug (NSAIDs) (11/15). Only one study fulfilled all the quality components. There was a low kappa agreement (k = 0.230) between the included studies. CONCLUSION This review included 15 explicit PIM criteria, which most listed antipsychotics, antidepressants, and antihistamines as potentially inappropriate. Healthcare professionals should exercise more caution when dealing with these medications among older patients. These results may help healthcare professionals in Asian nations to create regional standards for the discontinuation of potentially harmful drugs for elderly patients.
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Affiliation(s)
- Chee Tao Chang
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia; Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Malaysia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Malaysia; School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
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Daunt R, Curtin D, O'Mahony D. Polypharmacy stewardship: a novel approach to tackle a major public health crisis. THE LANCET. HEALTHY LONGEVITY 2023; 4:e228-e235. [PMID: 37030320 DOI: 10.1016/s2666-7568(23)00036-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 04/10/2023] Open
Abstract
With growing global concern regarding medication-related harm, WHO launched a global patient safety challenge, Medication Without Harm, in March, 2017. Multimorbidity, polypharmacy, and fragmented health care (ie, patients attending appointments with multiple physicians in various health-care settings) are key drivers of medication-related harm, which can result in negative functional outcomes, high rates of hospitalisation, and excess morbidity and mortality, particularly in patients with frailty older than 75 years. Some studies have examined the effect of medication stewardship interventions in older patient cohorts, but focused on a narrow spectrum of potentially adverse medication practices, with mixed results. In response to the WHO challenge, we propose the novel concept of broad-spectrum polypharmacy stewardship, a coordinated intervention designed to improve the management of multimorbidities, taking into account potentially inappropriate medications, potential prescribing omissions, drug-drug and drug-disease interactions, and prescribing cascades, aligning treatment regimens with the condition, prognosis, and preferences of the individual patient. Although the safety and efficacy of polypharmacy stewardship need to be tested with well designed clinical trials, we propose that this approach could minimise medication-related harm in older people with multimorbidities exposed to polypharmacy.
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Affiliation(s)
- Ruth Daunt
- Department of Medicine, School of Medicine, University College Cork, and Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Denis Curtin
- Department of Medicine, School of Medicine, University College Cork, and Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Denis O'Mahony
- Department of Medicine, School of Medicine, University College Cork, and Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
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Cannon I, Robinson-Barella A, McLellan G, Ramsay SE. From Drugs to Dry Mouth: A Systematic Review Exploring Oral and Psychological Health Conditions Associated with Dry Mouth in Older Adults with Polypharmacy. Drugs Aging 2023; 40:307-316. [PMID: 36943673 DOI: 10.1007/s40266-023-01017-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Approximately 60% of older adults complain of dry mouth, which may be associated with polypharmacy, common in this population. Existing studies have reported treatment approaches to dry mouth but do not address long-term preventative measures that would more positively benefit the health and well-being of older adults. OBJECTIVE We aimed to explore the consequences of dry mouth, associated with polypharmacy, on the physical and psychological health of older adults in order to establish the importance of preventing dry mouth. METHODS This systematic review was conducted of studies reporting health conditions of dry mouth, in relation to polypharmacy in older adults (aged ≥ 65 years). MEDLINE, EMBASE, PsycINFO and CINAHL databases were searched using keywords such as 'polypharmacy', 'dry mouth', 'oral health' and 'quality of life' (PROSPERO: CRD42021288945). Joanna Briggs Institute critical appraisal tools were used to assess study quality. RESULTS Of the 6852 citations screened, nine studies (cross-sectional, n = 8; longitudinal, n = 1) were included that comprised 37,459 participants (mean age range 68.5-85.0 years). Studies were published between 2005 and 2019. Because of the heterogeneity of reported study outcomes, a narrative synthesis was undertaken. The health conditions identified in this review were categorised as 'physical' or 'psychological'. The main physical health conditions reported in the studies related to dental health, such as tooth loss, and functional impairments, such as swallowing difficulties. An increase in the number of medicines taken, from 0 to 5, decreased the number of natural teeth remaining from 16 (standard deviation [SD] ± 9) to 12 (SD ± 8), respectively. Additionally, the number of dental complications increased from 1 (SD ± 2) to 2 (SD ± 2) as the number of medicines increased from 1 to ≥ 3. There was a paucity of studies (n = 2) that investigated psychological health conditions of dry mouth among older adults, with depression identified as a significant issue among older adults with dry mouth (where the reported prevalence was as high as 64%). An additional six psychological health conditions were identified: self-consciousness, feeling tense, difficulty relaxing, irritability, difficulty completing tasks and feeling less satisfied in life. CONCLUSIONS High levels of physical health conditions of dry mouth are observed in older adults and, to a lesser extent, psychological health conditions. These conditions can negatively affect quality of life. There remains a need to prevent dry mouth and the adverse health conditions associated with it in older adults. The modifiable nature of polypharmacy could be targeted to minimise, and potentially prevent, dry mouth. The optimisation of medication regimes to effectively treat chronic conditions, but also limit the likelihood of dry mouth, is a practical approach. Dry mouth prevention should be a priority and polypharmacy can pave the way for prevention strategies, avoiding the need to treat dry mouth.
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Affiliation(s)
- India Cannon
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Anna Robinson-Barella
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gillian McLellan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Keller MS, Qureshi N, Albertson E, Pevnick J, Brandt N, Bui A, Sarkisian CA. Comparing risk prediction models aimed at predicting hospitalizations for adverse drug events in community dwelling older adults: a protocol paper. RESEARCH SQUARE 2023:rs.3.rs-2429369. [PMID: 36711695 PMCID: PMC9882666 DOI: 10.21203/rs.3.rs-2429369/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background The objective of this paper is to describe the creation, validation, and comparison of two risk prediction modeling approaches for community-dwelling older adults to identify individuals at highest risk for adverse drug event-related hospitalizations. One approach will use traditional statistical methods, the second will use a machine learning approach. Methods We will construct medication, clinical, health care utilization, and other variables known to be associated with adverse drug event-related hospitalizations. To create the cohort, we will include older adults (≥ 65 years of age) empaneled to a primary care physician within the Cedars-Sinai Health System primary care clinics with polypharmacy (≥ 5 medications) or at least 1 medication commonly implicated in ADEs (certain oral hypoglycemics, anti-coagulants, anti-platelets, and insulins). We will use a Fine-Gray Cox proportional hazards model for one risk modeling approach and DataRobot, a data science and analytics platform, to run and compare several widely used supervised machine learning algorithms, including Random Forest, Support Vector Machine, Extreme Gradient Boosting (XGBoost), Decision Tree, Naïve Bayes, and K-Nearest Neighbors. We will use a variety of metrics to compare model performance and to assess the risk of algorithmic bias. Discussion In conclusion, we hope to develop a pragmatic model that can be implemented in the primary care setting to risk stratify older adults to further optimize medication management.
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Affiliation(s)
| | | | | | | | | | - Alex Bui
- David Geffen School of Medicine: University of California Los Angeles David Geffen School of Medicine
| | - Catherine A Sarkisian
- David Geffen School of Medicine: University of California Los Angeles David Geffen School of Medicine
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Alfahmi AA, Curtain CM, Salahudeen MS. Assessment of Knowledge, Attitude and Practices of the Hospital and Community Pharmacists in Saudi Arabia (Jeddah) towards Inappropriate Medication Use in Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1635. [PMID: 36674385 PMCID: PMC9863709 DOI: 10.3390/ijerph20021635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 06/17/2023]
Abstract
In Saudi Arabia, the older adult population is growing and is projected to increase three-fold by 2030. Potentially inappropriate medications (PIMs) are harmful to older adults' and have a direct impact on clinical, health and economic outcomes. Pharmacists have a vital role in medication tailoring for older adults as multidisciplinary team members. However, there is also a paucity of research regarding pharmacists' participation in detecting and avoiding PIMs use among older adults in Saudi Arabia. A cross-sectional, self-administered survey was conducted to assess the knowledge, practices, and attitude of pharmacists from seven hospitals and ten community pharmacies in Jeddah, Saudi Arabia. The survey comprised three sections; (i) identifying participants' general characteristics, (ii) assessing their knowledge of PIMs use in older adults and (iii) examining the pharmacist's attitude towards the procedures followed in dispensing for older adults. Inferential and descriptive statistics were used to analyse the survey data. A total of 157 community and hospital pharmacists participated in this study. Most of them dispensed medication weekly to older adults (85.4%), and 43.3% had relevant work experience of six to ten years. Though 44.6% of the participants were aware of PIMs that older adults should avoid, only 10.8% claimed adequate knowledge about PIMs. From the given three clinical case scenarios, a minority of pharmacists (21.7%) chose the correct answers, with a mean score of 2.38 ± 2.91 (95% CI 2.35-3.15). Participants who claimed to have knowledge of PIMs had a significantly higher mean score than those who did not, 4.59 ± 2.81 25 (95% CI 2.35-2.61). A minority of the pharmacists (14.7%) used screening tools such as STOPP, Beers criteria, or Medication Appropriateness Index (MAI) to detect PIMs in older adults. No statistically significant differences were detected when comparing the levels of knowledge of pharmacists with 1 to 5 years of practice to pharmacists with 6 to 15 and more years of experience (p = 0.431). Pharmacists' knowledge, attitude and practices toward PIMs use in older adults in Saudi Arabia should be improved. The application of PIMs detection tools such as STOPP/START or Beers criteria currently has no place in day-to-day pharmacists' roles in Saudi Arabia. Therefore, concerned stakeholders should develop educational programs to improve pharmacists' knowledge of PIMs and promote the effective use of PIM screening tools such as Beers and STOPP criteria in their practice.
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Ali S, Curtain CM, Peterson GM, Salahudeen MS. Exploring Australian pharmacists' perceptions and practices towards reducing the risk of medicines-related harm in aged care residents. Front Pharmacol 2023; 14:1131456. [PMID: 36937858 PMCID: PMC10014529 DOI: 10.3389/fphar.2023.1131456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/20/2023] [Indexed: 03/05/2023] Open
Abstract
Background: Older people living in residential aged care facilities frequently experience medicines-related harm. Evidence regarding the perception and practices towards reducing these harms may facilitate the development of customised educational programs for pharmacists providing services in RACFs. Objective: To explore Australian pharmacists' opinions and practices towards reducing the risk of medicines-related harm in aged care residents. Methods: An online survey was developed based on a literature review, expert opinion, and feedback from pharmacists providing services in RACFs. A web link for the survey was shared via professional pharmacy organisations and social media groups with Australian pharmacists providing services in RACFs. Results: A total of 209 pharmacists participated in the survey. Of these, 76% (n = 158) were residential medication management review embedded pharmacists, and 24% (n = 51) were supply pharmacists for RACFs. Most pharmacists believed that medicines-related harm is common in residents (n = 174, 83%), yet few agreed that pharmacists have enough time to participate in medicines-related harm reduction services (n = 60, 28%). There was a high level of agreement regarding the key risk factors (e.g., inappropriate medicines, anticholinergic drug use, and transitions of care) and potential strategies (e.g., embedded pharmacists in RACFs, educating aged care staff, and collaborative pharmacist-led medication reviews) for reducing medicines-related harm in residents. Conclusion: Pharmacists agreed that older residents often experience medicines-related harm, but they did not frequently participate in medicines-related harm reduction services. Initiatives to engage pharmacists in team-based harm reduction services and educate aged care staff regarding safe medication management may improve residents' safety and health outcomes.
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Wojt IR, Lau ECY, Cairns R, Tan ECK. Poisonings in Older People with Dementia: A Systematic Scoping Review and Meta-Analysis. J Alzheimers Dis 2023; 95:1351-1370. [PMID: 37694366 DOI: 10.3233/jad-230246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Older people with dementia are at a particularly high risk of poisonings and their subsequent harms. OBJECTIVE This review aimed to describe the key agents, incidence, risk factors, and disposition of poisonings in people with dementia reported in the literature. METHODS Medline, Embase, CINAHL, and PsycINFO databases were searched from 1 September 2001 to 1 September 2021. Terms for dementia, poisonings, and older adults formed the search concepts. Quantitative studies published in English, describing poisonings in older people with dementia, including Alzheimer's disease, were included. Two investigators independently assessed articles for eligibility and extracted relevant data. A meta-analysis of the incidence of poisonings in people with dementia across studies was performed. RESULTS Of 4,579 articles, 18 were included for final synthesis. Nervous system medications were implicated in over half of all medicinal poisonings, with anti-dementia agents, benzodiazepines, and opioids the most common classes. The non-medicinal agents frequently associated with poisonings were personal care and household products. The yearly incidence of poisoning varied across definitions of poisoning from 3% for International Classification of Disease-defined poisonings to 43% for adverse drug event-defined poisonings. Several risk factors were identified, including multimorbidity, psychotropic medication use, and living in residential care. Where described, up to one in five poisonings resulted in hospitalisation and in death. CONCLUSIONS Poisonings are common in people with dementia, involving commonly prescribed medications or easily accessible substances. Given the significant outcomes associated, further research is required to better understand these poisonings and improve public health strategies to reduce the occurrence of this preventable harm.
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Affiliation(s)
- Ilsa R Wojt
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Edward C Y Lau
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Rose Cairns
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, New South Wales, Australia
| | - Edwin C K Tan
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Jang S, Kang HJ, Kim Y, Jang S. Association of potentially inappropriate medications and need for long-term care among older adults: a matched cohort study. BMC Geriatr 2022; 22:972. [PMID: 36522694 PMCID: PMC9756678 DOI: 10.1186/s12877-022-03681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND With an increase in the aging population, the number of older adults who require long-term care (LTC) is growing, enhancing drug-related issues. The reduced capacity of LTC users to precisely utilize medical services poses additional challenges owing to restrictions in daily activities. We compared older adults who required LTC with those who did not require LTC to confirm differences in the use of potentially inappropriate medications (PIMs), frequently used PIMs, and associating factors in Korea. METHODS Using the Korean National Health Insurance Service cohort data, adults aged ≥ 65 years as of 2017 who were LTC beneficiaries (at home and LTC facilities) were selected and matched 1:1 with a control group (LTC non-beneficiaries). PIM was defined based on the 2019 American Society of Geriatrics Beers criteria. PIM use and medical resource utilization according to LTC requirements were compared for one year after the index date. After correcting for other confounding variables, differences in the risk of PIM use on person-based according to LTC eligibility were assessed using multivariate logistic regression. RESULTS Among the 13,251 older adults requiring LTC in 2017, 9682 were matched with counterparts and included. Among those who received an outpatient prescription including PIM at least once yearly, 83.6 and 87.6% were LTC beneficiaries and LTC non-beneficiaries, respectively (p < 0.001). Using the number of outpatient prescriptions as the baseline, 37.2 and 33.2% were LTC beneficiaries and LTC non-beneficiaries, respectively (p < 0.001). In both groups, elevated PIM use depended on increased medical resource utilization, as shown by increased outpatient visits and medical care institutions visited. Adjusting other influencing factors, the need for LTC did not significantly associated with PIM use (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.84-1.04); the number of drugs consumed (3-4: OR 1.42, 95% CI 1.25-1.61; 5-9: OR 2.24, 95% CI 1.98-2.53; 10 and more: OR 3.72, 95% CI 3.03-4.55; reference group: 2 and less), frequency of visits (7-15: OR 1.95, 95% CI 1.71-2.23; 16-26: OR 3.51, 95% CI 3.02-4.07; 27-42: OR 5.84, 95% CI 4.84-7.05; 43 and more: OR 10.30, 95% CI 8.15-13.01; reference group: 6 and less), and visits to multiple medical care institutions (3-4: OR 1.96, 95% CI 1.76-2.19; 5 and more: OR 3.21, 95% CI 2.76-3.73; reference group: 2 and less) emerged as primary influencing factors. PIMs mainly prescribed included first-generation antihistamines, benzodiazepines, and Z-drugs in both groups; quetiapine ranked second-highest among LTC beneficiaries. CONCLUSIONS The LTC demand did not significantly associated with PIM utilization. However, the number of drugs consumed, and the pattern of medical resource use were important factors, regardless of LTC requirements. This highlights the need to implement comprehensive drug management focusing on patients receiving polypharmacy and visiting multiple care institutions, regardless of LTC needs.
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Affiliation(s)
- Suhyun Jang
- grid.256155.00000 0004 0647 2973College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoe‑Ro, Yeonsu‑Gu, Incheon, 21936 Republic of Korea
| | - Hee-Jin Kang
- grid.256155.00000 0004 0647 2973College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoe‑Ro, Yeonsu‑Gu, Incheon, 21936 Republic of Korea ,Clinical Development Division, Kangstem Biotech Co., Ltd, 512 Teheran-ro, Gangnam-Gu, Seoul, 06179 Republic of Korea
| | - Yeji Kim
- grid.264381.a0000 0001 2181 989XDepartment of Statistics, Graduate School, Sungkyunkwan University, 25-2, Seonggyungwan-Ro, Jongno-Gu, Seoul, 03063 Republic of Korea
| | - Sunmee Jang
- grid.256155.00000 0004 0647 2973College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoe‑Ro, Yeonsu‑Gu, Incheon, 21936 Republic of Korea
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Linsky AM, Kressin NR, Stolzmann K, Pendergast J, Rosen AK, Bokhour BG, Simon SR. Direct-to-consumer strategies to promote deprescribing in primary care: a pilot study. BMC PRIMARY CARE 2022; 23:53. [PMID: 35317734 PMCID: PMC8939089 DOI: 10.1186/s12875-022-01655-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/28/2022] [Indexed: 11/21/2022]
Abstract
Background Deprescribing, or the intentional discontinuation or dose-reduction of medications, is an approach to reduce harms associated with inappropriate medication use. We sought to determine how direct-to-patient educational materials impacted patient-provider discussion about and deprescribing of potentially inappropriate medications. Methods We conducted a pre-post pilot trial, using an historical control group, at an urban VA medical center. We included patients in one of two cohorts: 1) chronic proton pump inhibitor users (PPI), defined as use of any dose for 90 consecutive days, or 2) patients at hypoglycemia risk, defined by diabetes diagnosis; prescription for insulin or sulfonylurea; hemoglobin A1c < 7%; and age ≥ 65 years, renal insufficiency, or cognitive impairment. The intervention consisted of mailing medication-specific patient-centered EMPOWER (Eliminating Medications Through Patient Ownership of End Results) brochures, adapted to a Veteran patient population, two weeks prior to scheduled primary care appointments. Our primary outcome – deprescribing – was defined as clinical documentation of target medication discontinuation or dose-reduction. Our secondary outcome was documentation of a discussion about the target medication (yes/possible vs. no/absent). Covariates included age, sex, race, specified comorbidities, medications, and utilization. We used chi-square tests to examine the association of receiving brochures with each outcome. Results The 348 subjects (253 intervention, 95 historical control) were primarily age ≥ 65 years, white, and male. Compared to control subjects, intervention subjects were more likely to have deprescribing (36 [14.2%] vs. 4 [4.2%], p = 0.009) and discussions about the target medication (31 [12.3%] vs. 1 [1.1%], p = 0.001). Conclusions Targeted mailings of EMPOWER brochures temporally linked to a scheduled visit in primary care clinics are a low-cost, low-technology method associated with increases in both deprescribing and documentation of patient-provider medication discussions in a Veteran population. Leveraging the potential for patients to initiate deprescribing discussions within clinical encounters is a promising strategy to reduce drug burden and decrease adverse drug effects and harms.
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Pharmacotherapy Problems in Best Possible Medication History of Hospital Admission in the Elderly. PHARMACY 2022; 10:pharmacy10050136. [PMID: 36287456 PMCID: PMC9610174 DOI: 10.3390/pharmacy10050136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022] Open
Abstract
Transfer of care is a sensitive process, especially for the elderly. Polypharmacy, potentially inappropriate medications (PIMs), drug-drug interactions (DDIs), and renal risk drugs (RRDs) are important issues in the elderly. The aim of the study was to expand the use of the Best Possible Medication History (BPMH) and to evaluate polypharmacy, PIMs, DDIs, and inappropriately prescribed RRDs on hospital admission, as well as to determine their mutual relationship and association with patients’ characteristics. An observational prospective study was conducted at the Internal Medicine Clinic of Clinical Hospital Dubrava. The study included 383 elderly patients. Overall, 49.9% of patients used 5−9 prescription medications and 31.8% used 10 or more medications. EU(7)-PIMs occurred in 80.7% (n = 309) of the participants. In total, 90.6% of participants had ≥1 potential DDI. In total, 43.6% of patients were found to have estimated glomerular filtration rate < 60 mL/min/1.73 m2, of which 64.7% of patients had one or more inappropriately prescribed RRDs. The clinical pharmacist detected a high incidence of polypharmacy, PIMs, DDIs, and inappropriately prescribed RRDs on hospital admission. This study highlights the importance of early detection of pharmacotherapy problems by using the BPMH in order to prevent their circulation during a hospital stay. The positive correlations between polypharmacy, PIMs, DDIs, and inappropriately prescribed RRDs indicate that they are not independent, but rather occur simultaneously.
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Nagata N, Nishijima S, Miyoshi-Akiyama T, Kojima Y, Kimura M, Aoki R, Ohsugi M, Ueki K, Miki K, Iwata E, Hayakawa K, Ohmagari N, Oka S, Mizokami M, Itoi T, Kawai T, Uemura N, Hattori M. Population-level Metagenomics Uncovers Distinct Effects of Multiple Medications on the Human Gut Microbiome. Gastroenterology 2022; 163:1038-1052. [PMID: 35788347 DOI: 10.1053/j.gastro.2022.06.070] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND & AIMS Medication is a major determinant of human gut microbiome structure, and its overuse increases the risks of morbidity and mortality. However, effects of certain commonly prescribed drugs and multiple medications on the gut microbiome are still underinvestigated. METHODS We performed shotgun metagenomic analysis of fecal samples from 4198 individuals in the Japanese 4D (Disease, Drug, Diet, Daily life) microbiome project. A total of 759 drugs were profiled, and other metadata, such as anthropometrics, lifestyles, diets, physical activities, and diseases, were prospectively collected. Second fecal samples were collected from 243 individuals to assess the effects of drug initiation and discontinuation on the microbiome. RESULTS We found that numerous drugs across different treatment categories influence the microbiome; more than 70% of the drugs we profiled had not been examined before. Individuals exposed to multiple drugs, polypharmacy, showed distinct gut microbiome structures harboring significantly more abundant upper gastrointestinal species and several nosocomial pathobionts due to additive drug effects. Polypharmacy was also associated with microbial functions, including the reduction of short-chain fatty acid metabolism and increased bacterial stress responses. Even nonantibiotic drugs were significantly correlated with an increased antimicrobial resistance potential through polypharmacy. Notably, a 2-time points dataset revealed the alteration and recovery of the microbiome in response to drug initiation and cessation, corroborating the observed drug-microbe associations in the cross-sectional cohort. CONCLUSION Our large-scale metagenomics unravels extensive and disruptive impacts of individual and multiple drug exposures on the human gut microbiome, providing a drug-microbe catalog as a basis for a deeper understanding of the role of the microbiome in drug efficacy and toxicity.
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Affiliation(s)
- Naoyoshi Nagata
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan; Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Suguru Nishijima
- Computational Bio-Big Data Open Innovation Lab., National Institute of Advanced Industrial Science and Technology, Tokyo, Japan; Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan; Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany.
| | - Tohru Miyoshi-Akiyama
- Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasushi Kojima
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Moto Kimura
- Department of Clinical Research Strategic Planning Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ryo Aoki
- Institute of Health Sciences, Ezaki Glico Co., Ltd., Osaka, Japan
| | - Mitsuru Ohsugi
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan; Diabetes and Metabolism Information Center, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kohjiro Ueki
- Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kuniko Miki
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan; Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Eri Iwata
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Kayoko Hayakawa
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Masashi Mizokami
- Genome Medical Sciences Project, Research Institute, National Center for Global Health and Medicine, Chiba, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Naomi Uemura
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Tokyo, Japan
| | - Masahira Hattori
- Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan; Laboratory for Microbiome Sciences, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
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Hamidah KF, Rahmadi M, Meutia F, Kriswidyatomo P, Rahman FS, Izzah Z, Zulkarnain BS, Aminde LN, Alderman CP, Yulistiani, Suprapti B. Prevalence and factors associated with potentially inappropriate medication and medication complexity for older adults in the emergency department of a secondary teaching hospital in Indonesia. Pharm Pract (Granada) 2022; 20:2735. [PMID: 36793915 PMCID: PMC9891774 DOI: 10.18549/pharmpract.2022.4.2735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/19/2022] [Indexed: 12/13/2022] Open
Abstract
Background Older adults experience progressive decline in various organs and changes in pharmacokinetics and pharmacodynamics of the drugs in the body which lead to an increased risk of medication-related problems. Potentially inappropriate medications (PIMs) and medication complexity are key factors contributing to adverse drug events in the emergency department (ED). Objective To estimate the prevalence and investigate the risk factors of PIMs and medication complexity among older adults admitted to the ED. Methods A retrospective observational study was conducted among patients aged > 60 years admitted to the ED of Universitas Airlangga Teaching Hospital in January - June 2020. PIMs and medication complexity were measured using the 2019 American Geriatrics Society Beers Criteria® and Medication Regimen Complexity Index (MRCI), respectively. Results A total of 1005 patients were included and 55.0% (95% confidence interval [CI]: 52 - 58%) of them received at least one PIM. Whereas, the pharmacological therapy prescribed to older adults had a high complexity index (mean MRCI 17.23 + 11.15). Multivariate analysis showed that those with polypharmacy (OR= 6.954; 95% CI: 4.617 - 10.476), diseases of the circulatory system (OR= 2.126; 95% CI: 1.166 - 3.876), endocrine, nutritional, and metabolic diseases (OR= 1.924; 95% CI: 1.087 - 3.405), and diseases of the digestive system (OR= 1.858; 95% CI: 1.214 - 2.842) had an increased risk of receiving PIM prescriptions. Meanwhile, disease of the respiratory system (OR = 7.621; 95% CI: 2.833 - 15.150), endocrine, nutritional and metabolic diseases (OR = 6.601; 95% CI: 2.935 - 14.847), and polypharmacy (OR = 4.373; 95% CI: 3.540 - 5.401) were associated with higher medication complexity. Conclusion In our study, over one in every two older adults admitted to the ED had PIMs, and a high medication complexity was observed. Endocrine, nutritional and metabolic disease was the leading risk factors for receiving PIMs and high medication complexity.
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Affiliation(s)
- Khusnul Fitri Hamidah
- Department of Pharmacy, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia.
| | - Mahardian Rahmadi
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.
| | - Farah Meutia
- Master of Clinical Pharmacy Program, Faculty of Pharmacy, Universitas Airlangga Surabaya, Indonesia.
| | - Prihatma Kriswidyatomo
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Emergency Department, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia.
| | - Firman Suryadi Rahman
- Doctoral Program of Public Health, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia.
| | - Zamrotul Izzah
- Department of Pharmacy, Universitas Airlangga Teaching Hospital, Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia. Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | | | - Leopold N Aminde
- School of Medicine, Griffith University, Gold Coast, QLD, Australia.
| | - Christopher Paul Alderman
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.
| | - Yulistiani
- Department of Pharmacy, Universitas Airlangga Teaching Hospital, Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.
| | - Budi Suprapti
- Department of Pharmacy, Universitas Airlangga Teaching Hospital, Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.
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Guillot J, Rentsch CT, Gordon KS, Justice AC, Bezin J. Potentially inappropriate medication use by level of polypharmacy among US Veterans 49-64 and 65-70 years old. Pharmacoepidemiol Drug Saf 2022; 31:1056-1074. [PMID: 35780391 PMCID: PMC9464694 DOI: 10.1002/pds.5506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/29/2022] [Accepted: 06/27/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Potentially inappropriate medications (PIMs) are medications contra-indicated in particular circumstances. We sought to characterize PIMs by level of polypharmacy by age, sex, and race/ethnicity. METHODS We performed a cross-sectional drug dispensing study using electronic health records available through the US Department of Veterans Affairs. We extracted pharmacy fill and refill records during fiscal year 2016 (i.e., October 1, 2015-September 30, 2016) for all patients aged 49-70 who accessed care in the preceding fiscal year. PIMs were defined by the combined Beers and Laroche (henceforth Beers Laroche) criteria used for older patients and the PROMPT criteria used for middle-aged. RESULTS In the 1 499 586 patients aged 49-64, PIMs prevalence by PROMPT in patients with 0-4, 5-9, and ≥10 medications was 14.0%, 62.2%, and 86.1%, respectively, and by Beers Laroche was 14.3%, 63.4%, and 85.7%, respectively. In the 1 249 119 patients aged 65-70, PIMs prevalence by Beers Laroche was 14.8%, 59.9%, and 83.3%, and by PROMPT was 13.9%, 57.4%, and 82.0%, respectively. Meaningful differences in prevalence were shown by sex and race/ethnicity according to both set of criteria (e.g. PROMPT in patients with 5-9 medications: 66.1% women vs. 59.3% men; standardized-mean-differences [SMD] = 0.14; 61.7% of White vs. 54.5% of non-White; SMD = 0.15). The most common PIMs were digestive, analgesic, antidiabetic, and psychotropic medications. CONCLUSION Prevalence of PIMs was high and increased with polypharmacy. Beers Laroche and PROMPT provided similar estimations inside and outside their target age, suggesting that PIMs are common among those with polypharmacy regardless of age.
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Affiliation(s)
- Jordan Guillot
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06511, USA
- Univ. Bordeaux, INSERM, BPH, U1219, Team Pharmacoepidemiology, CHU de Bordeaux, Service de Pharmacologie médicale, Pôle de Santé Publique, F-33000 Bordeaux, France
- Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, Bordeaux, France
| | - Christopher T Rentsch
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06511, USA
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Kirsha S Gordon
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06511, USA
| | - Amy C Justice
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06511, USA
- Yale School of Public Health, New Haven, CT, US, 06511
| | - Julien Bezin
- Univ. Bordeaux, INSERM, BPH, U1219, Team Pharmacoepidemiology, CHU de Bordeaux, Service de Pharmacologie médicale, Pôle de Santé Publique, F-33000 Bordeaux, France
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Quality Use of Medicines Indicators and Associated Factors in Residential Aged Care Facilities: Baseline Findings from the Pharmacists in RACF Study in Australia. J Clin Med 2022; 11:jcm11175189. [PMID: 36079117 PMCID: PMC9457045 DOI: 10.3390/jcm11175189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Prescribing potentially inappropriate medications (PIMs), including antipsychotics and benzodiazepines, has been used as an indicator of the quality use of medicines in residential aged care facilities (RACFs). PIMs are associated with an increased risk of falls and hospitalisations in the elderly. The purpose of this study is to assess the extent of prescribing of PIMs in RACFs at baseline in the Pharmacists in residential aged care facilities (PiRACF) study and examine the association of resident and system factors with the number of PIMs. A cross-sectional analysis of 1368 participants from 15 Australian RACFs was performed to detect PIMs using the American Geriatrics Society 2019 Beers® criteria. Most residents (68.1%) were taking at least one regular PIM; 16.9% were taking regular antipsychotics and 11.1% were taking regular benzodiazepines. Long-term proton pump inhibitors were the most frequent class of PIMs. History of falls and higher Charlson Comorbidity Index were associated with an increased number of prescribed PIMs, while dementia diagnosis and older age (85 years or more) were associated with decreased number of PIMs (p-value <0.05). Residents in facilities with lower nurse-to-resident ratios were more likely to have an increased number of PIMs (p value = 0.001). This study indicates that potentially inappropriate prescribing is common in RACFs and interventions to target residents at highest risk are needed.
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Lee GB, Etherton-Beer C, Hosking SM, Pasco JA, Page AT. The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review. Ther Adv Drug Saf 2022; 13:20420986221100117. [PMID: 35814333 PMCID: PMC9260603 DOI: 10.1177/20420986221100117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022] Open
Abstract
In the context of an ageing population, the burden of disease and medicine use is
also expected to increase. As such, medicine safety and preventing avoidable
medicine-related harm are major public health concerns, requiring further
research. Potentially suboptimal medicine regimens is an umbrella term that
captures a range of indicators that may increase the risk of medicine-related
harm, including polypharmacy, underprescribing and high-risk prescribing, such
as prescribing potentially inappropriate medicines. This narrative review aims
to provide a background and broad overview of the patterns and implications of
potentially suboptimal medicine regimens among older adults. Original research
published between 1990 and 2021 was searched for in MEDLINE, using key search
terms including polypharmacy, inappropriate prescribing, potentially
inappropriate medication lists, medication errors, drug interactions and drug
prescriptions, along with manual checking of reference lists. The review
summarizes the prevalence, risk factors and clinical outcomes of polypharmacy,
underprescribing and potentially inappropriate medicines. A synthesis of the
evidence regarding the longitudinal patterns of polypharmacy is also provided.
With an overview of the existing literature, we highlight a number of key gaps
in the literature. Directions for future research may include a longitudinal
investigation into the risk factors and outcomes of extended polypharmacy,
research focusing on the patterns and implications of underprescribing and
studies that evaluate the applicability of tools measuring potentially
inappropriate medicines to study settings.
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Affiliation(s)
- Georgie B Lee
- Epi-Centre for Healthy Ageing, Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, HERB-Building Level 3, C/- University Hospital Geelong, 285 Ryrie Street, P.O. Box 281, Geelong, VIC 3220, Australia
| | | | - Sarah M Hosking
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Julie A Pasco
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Amy T Page
- WA Centre for Health and Ageing, The University of Western Australia, Crawley, WA, Australia
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DAL Ş, UÇAR N, ALTIPARMAK Ö, SANCAR M, OKUYAN B. Medication Review in Turkish Older Adults at Community Pharmacy: A Pilot Study by Using Medication Appropriateness Index. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.1012114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: The study aimed to evaluate medication review in older adults (≥65 years) at a community pharmacy by identifying the prevalence of potentiality inappropriate medication and calculating medication appropriateness index.
Methods: This descriptive study was carried out in a community pharmacy for six months. The older adults (≥65 years) using one or more medications were included. During clinical pharmacist-led medication review; the medication appropriateness index was calculated for each medication of older adults. Potentially inappropriate medications were evaluated according to the 2019 American Geriatrics Society Beers Criteria®.
Result: Among a hundred older adults, 46.0% were female. The median age of the patients was 75.5 (IQR, 68.0-78.8). The median number of medications was 9.0 (7.0-10.0). Polypharmacy has been detected in 97.0% of the patients. At least one potentially inappropriate medication was detected in 63.0% of them. The median score of medication appropriateness index score was 53.0 (IQR: 38.6-67.9).
Conclusion: To best our knowledge, this is the first study of clinical pharmacist-led medication review by calculating the medication appropriateness index carried out at a community pharmacy in Turkey. There was a high rate of potentially inappropriate medication with a higher score of medication appropriateness in older adults. This study highlights the importance of medication review led by the clinical pharmacist at community pharmacy to optimize medication usage in older adults.
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Assiri GA, Alanazi BM, AlRuthia Y. The Prevalence of High-Risk Prescribing of Oral Non-Steroidal Anti-Inflammatory Drugs in Primary Healthcare: A Single-Centre Retrospective Chart Review Study. Healthcare (Basel) 2022; 10:healthcare10050867. [PMID: 35628004 PMCID: PMC9142064 DOI: 10.3390/healthcare10050867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022] Open
Abstract
The quality and safety of prescribed drugs can be assessed using prescribing safety indicators (PSIs). This study aimed to estimate the prevalence of PSIs of oral non-steroidal anti-inflammatory drugs (NSAIDs) at primary care clinics of a tertiary care hospital in Saudi Arabia and to identify the risk factors associated with positive PSIs for patients. In this retrospective chart review study, data from the medical records of 450 patients aged ≥18 years, who were prescribed oral NSAIDs, were reviewed and collected manually. Seven PSIs were chosen and defined as follows: prescription of an oral NSAID to any patient with a peptic ulcer; aged ≥75 years; aged ≥65 years with a glomerular filtration rate <60; heart failure; co-prescribed warfarin; co-prescribed aspirin or clopidogrel; or co-prescribed angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker and a diuretic. Patients with positive indicators are at risk of harm from high-risk prescribing. The overall period prevalence of PSIs is 153/450 (34%; 95% CI 29.60−38.39). The overall proportion of PSIs is 202/431 (46.9%; 95% CI 42.12−51.61). The most common safety indicators were for NSAIDs prescribed to patients with heart failure and patients aged ≥65 years with a glomerular filtration rate <60. The elderly and patients using polypharmacy are at increased risk of having at least one positive PSI (OR 5.22; 95% CI 3.32−8.21, p-value < 0.001 and OR 2.97; 95% CI 1.17−7.55, p-value 0.022, respectively). Patients at risk of harm from high-risk NSAID prescriptions are common in primary care. The elderly and patients on polypharmacy are at increased risk of having at least one positive PSI. Therefore, when NSAIDs are prescribed, it is recommended to weigh the benefits versus the risks for high-risk patients, such as the elderly and those with multiple-drug therapy.
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Suzuki Y, Shiraishi N, Komiya H, Sakakibara M, Akishita M, Kuzuya M. Potentially inappropriate medications increase while prevalence of polypharmacy / hyperpolypharmacy decreases in Japan: a comparison of nationwide prescribing data. Arch Gerontol Geriatr 2022; 102:104733. [DOI: 10.1016/j.archger.2022.104733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 11/02/2022]
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Kok W, Haverkort E, Algra Y, Mollema J, Hollaar V, Naumann E, de van der Schueren M, Jerković-Ćosić K. The association between polypharmacy and malnutrition(risk) in older people: A Systematic Review. Clin Nutr ESPEN 2022; 49:163-171. [DOI: 10.1016/j.clnesp.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/15/2022] [Accepted: 03/05/2022] [Indexed: 11/30/2022]
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Varavithya V, Tirapat C, Rojpibulstit P, Poovichayasumlit P, Prasert V, Vatcharavongvan P. Potentially inappropriate medication use and the hospitalization rate among Thai elderly patients: a retrospective cohort study. Eur J Clin Pharmacol 2022; 78:847-855. [DOI: 10.1007/s00228-021-03269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/18/2021] [Indexed: 11/03/2022]
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Okoro RN, Idris AI. Older adults’ exposure to anticholinergic medications: Implications for pharmaceutical care for Nigerian older adults. THE JOURNAL OF MEDICINE ACCESS 2022; 6:27550834221112753. [PMID: 36204529 PMCID: PMC9483949 DOI: 10.1177/27550834221112753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/22/2022] [Indexed: 11/15/2022]
Abstract
Introduction: Anticholinergic medications which are commonly prescribed to older adults can
produce more pronounced adverse effects compared to the younger
population. Objectives: To investigate the prevalence of polypharmacy, describe the prescription
patterns of anticholinergic medications, determine the prevalence of
exposure to high-risk anticholinergic cognitive burden (ACB) medications,
and identify the potential predictors of exposure to high-risk ACB
medications in older adults in a Nigerian secondary hospital. Methods: This cross-sectional study that included older adults prescribed at least one
anticholinergic medication was conducted at a secondary care hospital in
Nigeria. The study data were initially summarized using descriptive
statistics, whereas multivariable logistic regression analysis was used to
identify the potential predictors of exposure to high-risk ACB medications.
In this study, the cumulative ACB scores were dichotomized into low risk
(score 1–2) and high risk (score ⩾ 3). A p value less than
0.05 was considered to be statistically significant. Results: A total of 256 older adults were included in this study; 113 (44.1%) had
polypharmacy, whereas 26.6% (188/256) were exposed to high-risk ACB
medications. Of a total of 391 anticholinergic medications used by the
population, furosemide (36.57%) was the most commonly prescribed. The
adjusted multivariable logistic regression analysis indicated that patients
who had acute diseases were 2.5 times (adjusted odds ratio (AOR) = 2.49, 95%
confidence interval (CI): 1.40–4.45) more likely to be exposed to high-risk
ACB medications than those with chronic diseases. Conclusion: The study demonstrates a high prevalence of polypharmacy and exposure to
high-risk ACB medications suggesting the need for pharmaceutical care in
this high-risk population. Older adults’ exposure to high-risk ACB
medications was significantly associated with prescriptions for acute
diseases.
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Affiliation(s)
- Roland Nnaemeka Okoro
- Department of Clinical Pharmacy and Pharmacy Administration, University of Maiduguri, Maiduguri, Nigeria
| | - Algoni Idris Idris
- Department of Clinical Pharmacy and Pharmacy Administration, University of Maiduguri, Maiduguri, Nigeria
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Alshammari H, Al-Saeed E, Ahmed Z, Aslanpour Z. Prevalence and Predictors of Potentially Inappropriate Medications Among Patients Aged ≥65 Years on Hospital Admissions in Kuwait. Clin Interv Aging 2022; 17:1025-1036. [PMID: 35822127 PMCID: PMC9271279 DOI: 10.2147/cia.s328693] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/11/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Potentially inappropriate medications are major health concerns for patients aged ≥65 years. To investigate the prevalence of potentially inappropriate medications, Beer's criteria can be used. We estimated the prevalence of potentially inappropriate medications prescription among patients aged ≥65 years admitted to Kuwait's largest hospital and identified the predictors of prescribing a potentially inappropriate medication. METHODS A cross-sectional study was conducted retrospectively using inpatient records from the medical department at the Hospital in Kuwait from 1 January 2019 to 31 December 2019. The latest version of Beer's criteria was used to identify potentially inappropriate medications in patients' medical records. Data were analyzed descriptively to estimate the prevalence of potentially inappropriate medications and to describe participant characteristics. The predictors of potentially inappropriate medications prescribing were determined using binary logistic regression. RESULTS A total of 423 medical records of patients were collected. The mean age of the patients admitted was 76 ± 7 years, and 222 of them (52.5%) were women. Upon hospital admission, potentially inappropriate medication was prevalent in 58.4% of patients. The most prevalent potentially inappropriate medications identified were proton pump inhibitors (27.3%), diuretics (21.5%), antipsychotic agents (9%), selective serotonin reuptake inhibitors (5%), and methyldopa (4%). Polypharmacy, Alzheimer's disease, depression, irritable bowel syndrome, hypothyroidism, chronic kidney disease were predictors of potentially inappropriate medications prescription. CONCLUSION A high prevalence of potentially inappropriate medication prescription was observed among patients aged ≥65 years admitted to a hospital in Kuwait. The most likely predictor of potentially inappropriate medication prescription was polypharmacy.
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Affiliation(s)
- Hesah Alshammari
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Correspondence: Hesah Alshammari, Department of Clinical and Pharmaceutical sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK, Email
| | - Eman Al-Saeed
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Zamzam Ahmed
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Zoe Aslanpour
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Alwhaibi M. Potentially Inappropriate Medications Use among Older Adults with Comorbid Diabetes and Hypertension in an Ambulatory Care Setting. J Diabetes Res 2022; 2022:1591511. [PMID: 35586116 PMCID: PMC9110241 DOI: 10.1155/2022/1591511] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 04/22/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aims to estimate the prevalence of PIMs use and its associated factors among older adults with comorbid diabetes and hypertension. METHODS A cross-sectional retrospective study was used, including 1,853 older adults (age ≥65 years) with diabetes and hypertension who visited an ambulatory care setting. The study objectives were to estimate the prevalence and factors associated with PIMs use based on the 2019 American Geriatric Society (AGS) Beers criteria. RESULTS Almost one out of two individuals had PIMs used, with the average number of medications taken being seven. 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, anxiety, and polypharmacy. CONCLUSIONS Given the higher PIMs use among older adults with diabetes and hypertension comorbidities, tailored strategies and interventions to minimize PIMs use in this population are warranted.
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Affiliation(s)
- Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Abdelwahed AA, El-Dahiyat F, Aljawamis D, Al Ajimi J, Bin Rafeea KJ. Potentially inappropriate medications in older adults according to Beers criteria 2019: Prevalence and risk factors. Int J Clin Pract 2021; 75:e14715. [PMID: 34378294 DOI: 10.1111/ijcp.14715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/02/2021] [Accepted: 08/08/2021] [Indexed: 11/29/2022] Open
Abstract
AIM Older patients are more prone to receive potentially inappropriate medications (PIMs) that are better to be avoided or dose adjusted to protect them from their unnecessary or harmful use. This study aims to detect the prevalence of PIMs among older patients discharged from Tawam hospital according to Beers criteria 2019. Moreover, the common risk factors of the older patients may subject them to PIMs use. METHODS A retrospective charts review study of older patients ≥65 years who were prescribed 5 or more medications and were discharged from Tawam hospital from 1 October 2018 to 31 December 2018. Each patient's medical record was scanned to detect PIMs. (PIMs) were classified according to Beers criteria 2019, and the predictors of PIMs were also assessed. RESULTS A total of 502 older patients (51.6% females and 48.4% males) medical charts were reviewed. The prevalence of PIMs among the study population was 34.7%. Antipsychotics (27.5%) and sulphonylurea's (16.8%) were among the most common avoided PIMs. Anticoagulants (40%) and ranitidine (35%) were the most PIMs based on the kidney function of the patient. Female gender [OR 1.8; 95% CI (1.22-2.66), P < .05] and increasing number of medications [OR 1.08; 95% CI (1.03-1.14), P < .05] were the independent predictors of PIMs. CONCLUSION Based on the prevalence of PIMs among older patients, it is recommended to revise each patient's medications prescription to avoid inappropriate prescribing and hence decrease the prevalence of PIMs.
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Affiliation(s)
| | - Faris El-Dahiyat
- Clinical Pharmacy Program, College of Pharmacy, Al Ain University, Al Ain, UAE
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Yasky AF, Zawawi AH. Characterization of potentially inappropriate medication prescriptions for the elderly in primary care and hospital settings. J Family Med Prim Care 2021; 10:3111-3115. [PMID: 34660455 PMCID: PMC8483109 DOI: 10.4103/jfmpc.jfmpc_271_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/24/2021] [Accepted: 05/06/2021] [Indexed: 11/04/2022] Open
Abstract
Background Polypharmacy cannot be defined numerically due to its varied definitions, and inclusion of comorbidities aggravates the dilemma, creating challenges for the healthcare system and the patients' course of treatment. The introduction of the potentially inappropriate medication (PIM) list developed by the American Geriatrics Society (AGS) (AGS Beers Criteria®; updated in 2019) was deemed a solution. However, several risk factors are associated with PIMs, including increased emergency room visits, hospitalization and mortality, and a decline in daily activity. Differences in PIM prescription rates have been reported; however, with the recent Beers criteria update, the number of patients exposed to PIMs is expected to increase significantly due to the addition of new medications to the list. Objectives This study aimed to describe the characteristics of PIM prescriptions for the elderly in primary care and hospital settings. Methods Medications for elderly patients prescribed in our hospital between 2016 and 2019 were reviewed and sorted based on Beers criteria to identify patients with the most PIMs. Correlations were made between gender and facility. Results This study included 40,168 patients (51% males). The total and average numbers of PIM per elderly patient were 260,753 and 6.5, respectively. Proton pump inhibitors were prescribed the most, followed by nonsteroidal anti-inflammatory drugs. Conclusions We found that increasing numbers of PIMs are prescribed to the elderly in our healthcare facilities. Therefore, further recommendations from local geriatric communities and the implementation of reminders for physicians through electronic prescription systems are needed to decrease the rate of prescribed PIMs.
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Affiliation(s)
- Adel F Yasky
- Department of Family Medicine, King Abdulaziz Medical City, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Alia H Zawawi
- Department of Family Medicine, King Abdulaziz Medical City, Assistant Professor College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Tesfaye BT, Tessema MT, Yizengaw MA, Bosho DD. Potentially inappropriate medication use among older adult patients on follow-up at the chronic care clinic of a specialized teaching hospital in Ethiopia. A cross-sectional study. BMC Geriatr 2021; 21:530. [PMID: 34620116 PMCID: PMC8496040 DOI: 10.1186/s12877-021-02463-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Older adult patients are prone to potentially inappropriate medication use (PIMU); its use has been associated with multiple adverse consequences. As a result, it is crucial to determine the magnitude and factors associated with PIMU. The present study was mainly aimed to determine and assess the magnitude and predictors of potentially inappropriate medication use in older adult patients on follow-up at the chronic care clinic of Jimma medical center. Methods A retrospective cross-sectional study was conducted involving 219 patients aged 65 years and above on treatment follow-up. Data was collected using a checklist. The 2019 updated American Geriatric Society (AGS) Beers Criteria® and Screening Tool of Older People’s Potentially Inappropriate Prescriptions criteria and Screening Tool to Alert Doctors to Right Treatment (STOPP/START) criteria (version 2) were employed to assess PIMU. SPSS IBM (v22) was used for data entry and analysis. Categorical variables were described using frequency and percentage, whereas continuous variables were described using mean with standard deviation (SD) or median with interquartile range (IQR). Logistic regression was conducted to identify predictors of PIMU. Results The average number of medications prescribed per patient was 4.0 (IQR = 2.0). At least one PIMU was identified in 182 (83.1%) and 99 (45.2%) patients, based on Beers and STOPP criteria, respectively. Additionally, potential prescription omission (PPO) was observed in 24 (10.9%) patients. The risk of Beers PIMU was increased with age [AOR = 1.21, p < 0.001], hypertension [AOR = 4.17, p < 0.001], and polypharmacy [AOR = 14.10, p < 0.001], while a decrease in the risk was noted in patients with a diagnosis of ischemic stroke [AOR = 0.133, p = 0.01] and asthma [AOR = 0.03, p < 0.001]. Using STOPP criteria, hypertension [AOR = 2.10, p = 0.04], diabetes mellitus [AOR = 2.26, p = 0.04], ischemic heart disease [AOR = 2.84, p = 0.04], peripheral neuropathy [AOR = 10.61, p < 0.001], and polypharmacy [AOR = 6.10, p < 0.001] significantly increased the risk of PIMU. Conclusions Regardless of the screening tool used to assess, the present study revealed PIMU in the large proportion of the participants. Multiple medication use and certain disease condition had increased the probability of PIMU. Hence, it is imperative to use screening tools for reviewing medications prescribed in older adult patients to ensure safety of medication therapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02463-9.
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Affiliation(s)
- Behailu Terefe Tesfaye
- School of Pharmacy, Department of Clinical Pharmacy, Institute of Health, Faculty of Health Sciences, Jimma University, P.O.BOX: 378, Jimma, Ethiopia.
| | - Mihret Terefe Tessema
- School of Pharmacy, Institute of Health, Faculty of Health Sciences, Jimma University Medical Center, P.O.BOX: 378, Jimma, Ethiopia
| | - Mengist Awoke Yizengaw
- School of Pharmacy, Department of Clinical Pharmacy, Institute of Health, Faculty of Health Sciences, Jimma University, P.O.BOX: 378, Jimma, Ethiopia
| | - Dula Dessalegn Bosho
- School of Pharmacy, Department of Clinical Pharmacy, Institute of Health, Faculty of Health Sciences, Jimma University, P.O.BOX: 378, Jimma, Ethiopia
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Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T. Frailty and potentially inappropriate medications using the 2019 Beers Criteria: findings from the Australian Longitudinal Study on Women's Health (ALSWH). Aging Clin Exp Res 2021; 33:2499-2509. [PMID: 33449339 DOI: 10.1007/s40520-020-01772-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/03/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Frailty is an essential consideration with potentially inappropriate medications (PIMs), especially among older women. AIMS This study determined the use of potentially inappropriate medications according to frailty status using the Beers Criteria 2019, identified medications that should be flagged as potentially inappropriate and harmful depending on individual health factors, and determined the association between frailty and PIMs, adjusted for characteristics associated with PIMs. METHODS This prospective longitudinal study included 9355 participants aged 77-82 years at baseline (2003). Frailty was measured using the FRAIL (fatigue, resistance, ambulation, illness and loss of weight) scale. Generalised estimating equations using log-binomial regressions determined the association between frailty and risk of using PIMs. RESULTS Among participants who were frail and non-frail at baseline, the majority used ≥ 3 PIMs (74.2% and 58.5%, respectively). At 2017, the proportion using ≥ 3 PIMs remained constant in the frail group (72.0%) but increased in the non-frail group (66.0%). Commonly prescribed medications that may be potentially inappropriate in both groups included benzodiazepines, proton-pump inhibitors and non-steroidal anti-inflammatory drugs, and risperidone was an additional contributor in the non-frail group. When adjusted for other characteristics, frail women had a 2% higher risk of using PIMs (RR 1.02; 95% CI 1.01, 1.03). CONCLUSION Given that the majority of frail women were using medications that may have been potentially inappropriate, it is important to consider both frailty and PIMs as indicators of health outcomes, and to review the need for PIMs for women aged 77-96 years who are frail.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
- International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
| | - Julie Byles
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Syed Shahzad Hasan
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Nicholas Egan
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Therese Kairuz
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
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Yüksel GH, Ozaydin FN, Ozaydin AN. Potentially Inappropriate Medication Use in Older People: A Cross-sectional Study Using Beers Criteria. Curr Drug Saf 2021; 17:121-128. [PMID: 34315386 DOI: 10.2174/1574886316666210727153124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 05/09/2021] [Accepted: 05/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The use of Potentially Inappropriate Medications (PIMs) is common and negatively affects elderly health and disease prognosis. OBJECTIVE This study aims to analyze the frequency of PIMs in the elderly health records registered to a family health center and to identify risk factors, prescription/nonprescription distribution, distribution by healthcare institutions, number of doctors visits, and health literacy. METHODS In this cross-sectionalstudy, a stratified sampling method was used to select individuals aged ≥ 65 years. The health records of the participants up to the last 12 months were examined, and medicines used by participants were evaluated according to Beers 2019 criteria. RESULTS Most of the participants (89.7%, n:183) had PIMs in health records. The mean number of PIMs used by the elderly was 2.9±1.9(min:0, max:8). A positive linear relationship was observed between multimorbidity and the number of PIMs (p=0.001). There was no significant difference in terms of PIMs frequency among healthcare institutions. Prescription and nonprescription PIMs were found to belong to the same drug groups (Pain relievers and stomach medications). A linear and significant correlation was found between the number of PIMs and doctor visits (p=0.047). CONCLUSION The doctor should examine prescription and over-the-counter medications used by the elderly during the visit. It will be useful to establish a warning system stating that PIMs are available while registering the medications in the electronic system. So, it will be possible for health authorities to re-evaluate the treatment and replace PIMs with rational drug options.
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Affiliation(s)
| | - Fuat Nihat Ozaydin
- Elderly Care Program, Istanbul Okan University, Vocational School of Health Service, Istanbul, Turkey
| | - Ayse Nilufer Ozaydin
- Department of Public Health, Marmara University School of Medicine, Istanbul, Turkey
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Galanter W, Eguale T, Gellad W, Lambert B, Mirica M, Cashy J, Salazar A, Volk LA, Falck S, Shilka J, Van Dril E, Jarrett J, Zulueta J, Fiskio J, Orav J, Norwich D, Bennett S, Seger D, Wright A, Linder JA, Schiff G. Personal Formularies of Primary Care Physicians Across 4 Health Care Systems. JAMA Netw Open 2021; 4:e2117038. [PMID: 34264328 PMCID: PMC8283562 DOI: 10.1001/jamanetworkopen.2021.17038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE More conservative prescribing has the potential to reduce adverse drug events and patient harm and cost; however, no method exists defining the extent to which individual clinicians prescribe conservatively. One potential domain is prescribing a more limited number of drugs. Personal formularies-defined as the number and mix of unique, newly initiated drugs prescribed by a physician-may enable comparisons among clinicians, practices, and institutions. OBJECTIVES To develop a method of defining primary care physicians' personal formularies and examine how they differ among primary care physicians at 4 institutions; evaluate associations between personal formularies and patient, physician, and practice site characteristics; and empirically derive and examine the variability of the top 200 core drugs prescribed at the 4 sites. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted at 4 US health care systems among 4655 internal and family medicine physicians and 4 930 707 patients who had at least 1 visit to these physicians between January 1, 2017, and December 31, 2018. EXPOSURES Personal formulary size was defined as the number of unique, newly initiated drugs. MAIN OUTCOMES AND MEASURES Personal formulary size and drugs used, physician and patient characteristics, core drugs, and analysis of selected drug classes. RESULTS The study population included 4655 primary care physicians (2274 women [48.9%]; mean [SD] age, 48.5 [4.4] years) and 4 930 707 patients (16.5% women; mean [SD] age, 51.9 [8.3] years). There were 41 378 903 outpatient prescriptions written, of which 9 496 766 (23.0%) were new starts. Institution median personal formulary size ranged from 150 (interquartile range, 82.0-212.0) to 296 (interquartile range, 230.0-347.0) drugs. In multivariable modeling, personal formulary size was significantly associated with panel size (total number of unique patients with face-to-face encounters during the study period; 1.2 medications per 100 patients), physician's total number of encounters (5.7 drugs per 10% increase), and physician's sex (-6.2 drugs per 100 patients for female physicians). There were 1527 unique, newly prescribed drugs across the 4 sites. Fewer than half the drugs (626 [41.0%]) were used at every site. Physicians' prescribing of drugs from a pooled core list varied from 0% to 100% of their prescriptions. CONCLUSIONS AND RELEVANCE Personal formularies, measured at the level of individual physicians and institutions, reveal variability in size and mix of drugs. Similarly, defining a list of commonly prescribed core drugs in primary care revealed interphysician and interinstitutional differences. Personal formularies and core medication lists enable comparisons and may identify outliers and opportunities for safer and more appropriate prescribing.
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Affiliation(s)
- William Galanter
- Department of Medicine, University of Illinois at Chicago, Chicago
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago
| | | | - Walid Gellad
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | | | | | - John Cashy
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | | | | | - Suzanne Falck
- Department of Medicine, University of Illinois at Chicago, Chicago
| | - John Shilka
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago
| | - Elizabeth Van Dril
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago
| | - Jennie Jarrett
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago
| | - John Zulueta
- Department of Psychiatry, University of Illinois at Chicago, Chicago
| | | | - John Orav
- Mass General Brigham, Boston, Massachusetts
| | | | | | | | | | - Jeffrey A. Linder
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Meraya AM, Banji OJ, Khobrani MA, Alhossan A. Evaluation of psychotropic medications use among elderly with psychiatric disorders in Saudi Arabia. Saudi Pharm J 2021; 29:603-608. [PMID: 34194267 PMCID: PMC8233536 DOI: 10.1016/j.jsps.2021.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 04/13/2021] [Indexed: 12/02/2022] Open
Abstract
AIMS Potentially inappropriate psychotropic medications (PIPMs) prescribed to older adults with psychiatric disorders can inadvertently affect their health. The use of standards and guidelines can ensure prudent prescribing and minimize the risk of morbidities. This study assessed the pattern and prevalence of prescription of PIPMs to older individuals in outpatient psychiatric settings in Saudi Arabia, using the updated 2015 Beers criteria, as well as the probability of polypharmacy. METHODS The study was conducted in the outpatient psychiatric clinics of the only psychiatric hospital in Jazan region of Saudi Arabia. A retrospective cross-sectional review of electronic medical records was undertaken during 2018 to assess PIPM use and psychotropic polypharmacy. Descriptive statistics were generated and associations between PIPM use and baseline characteristics were assessed using multivariable logistic regression. RESULTS Overall, 68% of 1300 older adults received PIPMs, and 77.7% were on psychotropic polypharmacy. Amitriptyline, chlorpromazine, and trifluoperazine were extensively prescribed. Paroxetine (1.2%) and benzodiazepines were prescribed to a smaller proportion of the patients. Elderly with schizophrenia (AOR = 0.046, p < 0.001) and anxiety (AOR = 0.530, p = 0.036) were significantly less likely to have PIPMs than those with dementia. Likewise, elderly with depression and anxiety were less likely to have psychotropic polypharmacy as compared to those with dementia. CONCLUSION A substantial number of the elderly received PIPMs possibly based on implicit criteria. It is therefore important to provide mental health care providers in the region with educational programs to increase their awareness of PIPMs.
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Affiliation(s)
- Abdulkarim M. Meraya
- Department of Clinical Pharmacy, Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Saudi Arabia
| | - Otilia J.F. Banji
- Department of Clinical Pharmacy, Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Saudi Arabia
| | - Moteb A. Khobrani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Saudi Arabia
| | - Abdulaziz Alhossan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Saudi Arabia
- Corporate of Pharmacy Services, King Saud University Medical City, Saudi Arabia
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