Appropriate prescribing in the elderly: Current perspectives

The association between healthcare expenditures and potentially inappropriate medication use in hospitalized older adults in Ethiopia

BACKGROUND

Evidence shows that potentially inappropriate medication (PIM) use in older adults significantly increases the utilization of healthcare resources. PIM is widely prescribed in older adults, however little is known about its association with healthcare resource utilization in Africa, particularly Ethiopia. Therefore, the primary aim of this study was to examine the presence of an association between healthcare expenditure and the frequency of PIM used.

METHODS

This observational study was conducted from 06 September 2021 to 30 December 2022. A total of 151 hospitalized older adult patients were included in the study. The data collection format was designed to capture relevant information. STATA V.15.0 was used for analysis. Descriptive statistics and a generalized linear model regression were conducted. Statistical significance was set at a p-value < 0.05. The findings are presented in tables, figures, and text.

RESULTS

The total healthcare expenditure was higher in PIM users (385,368.6 ETB) than in non-PIM users (131,267.7 ETB). The median expenditures for medical supplies (p = 0.025), investigations (p = 0.033), and total healthcare expenditure (p = 0.023) were significantly higher in patients with two and more PIMs than in those with no or one PIM. However, after model adjustment, the total healthcare expenditure was not significantly different across the frequency of PIMs used. Number of medications (adjusted B = 0.068, 95% CI: 0.035, 0.101, p < 0.001) and taking blood and blood-forming organ class of medication (adjusted B = 0.151, 95% CI: 0.005, 0.297, p = 0.042) were associated with higher total healthcare expenditure, whereas the total healthcare expenditure was significantly lower in those patients with diseases of the nervous system (adjusted B = -0.307, 95% CI: -0.502, -0.112, p = 0.002) and respiratory system (adjusted B = -0.196, 95% CI: -0.327, -0.065, p = 0.003).

CONCLUSION

The total healthcare expenditure is nearly three times higher in PIM users. However, its association with the frequency of PIM use was not statistically significant in the final model. Deprescribing medications after evaluating the benefit-risk ratio may help to reduce the healthcare expenditures of older adult patients. Further similar, adequately powered, comparative study is also warranted to identify the actual effect of PIM use on healthcare expenditures in the local context.

Potentially inappropriate medicine use and predicting risk factors in hospitalized older adult patients: findings of a prospective observational study from Ethiopia

BACKGROUND

Older patients are fragile and more susceptible to medication-related problems requiring a strict assessment of their medicine list. The present study was conducted with the intention to assess the quality use of medicines in older adult patients by detecting potentially inappropriate medicine use and its predictive risk factors.

METHODS

This prospective cross-sectional study involved 162 older medical patients admitted to Jimma Medical Center. A data abstraction format is employed to capture relevant information. Each patient was assessed for the presence of potentially inappropriate medicine using the 2019 American Geriatrics Associations Beers Criteria. Descriptive statistics and logistic regression analysis were conducted using STATA 15.0. A p value < 5% was considered a cutoff point for declaring statistical significance.

RESULTS

Over the hospital stay, 103 (63.6%) participants were on polypharmacy (5-9 concurrent medicines per patient), while 16 (9.9%) were on hyper polypharmacy (≥ 10 concurrent medicines per patient). On medicine use assessment using the Beers criteria, at least one potentially inappropriate medicine was detected in 118 (73%) participants. Overall, 191 potentially inappropriate medicines (range, 0 to 4) were identified, and 27 (14.1%) of these were associated with avoiding recommendations. Furosemide [83 (43%)], tramadol [26 (14.5%)], and spironolactone [22 (11.4%)] were the top three most frequent potentially inappropriate medicines identified. In terms of mode of prescription, 187 (96.9%) potentially inappropriate medicines were prescribed on a scheduled basis. Older adult patients with thrombocytopenia had a lower probability of taking potentially inappropriate medicine, while the odds of potentially inappropriate medicine use were 7.35 times higher in patients diagnosed with heart failure.

CONCLUSIONS

Nearly three-fourths of the participants had potentially inappropriate medicine in their medicine list. Therefore, generating local evidence on the clinical, economic, and humanistic consequences may help in determining whether the Beers criteria should be taken into account when prescribing medicine to older adults. Interventions targeting older adult patients with heart failure might reduce inappropriate medicine use.

The relation between second-generation antipsychotics and laxative use in elderly patients with schizophrenia

BACKGROUND

We aimed to investigate factors associated with concomitant laxative use among elderly patients with schizophrenia, discharged on second-generation antipsychotics (SGAs), from two large public psychiatric hospitals in Taiwan.

METHODS

Elderly patients with schizophrenia who were discharged between 2006 and 2019 and received SGA monotherapy at discharge were included in the analysis. Multivariate logistic regression was used to identify factors associated with regular laxative use at discharge. The Cochrane-Armitage trend test was used to evaluate whether significant time trends existed for rates of laxative use at discharge.

RESULTS

A total of 2591 elderly patients with schizophrenia were discharged during the study period, and 1727 of 2591 patients who met the inclusion criteria were included for analysis. Of these 1727 patients, 732 (42.4%) also received concomitant laxatives. Female gender, mood stabiliser use and concomitant diabetes mellitus were found to be associated with increased laxative use. Among SGAs, clozapine was associated with the highest rate of laxative use, followed by zotepine, quetiapine, olanzapine and risperidone. Additionally, risperidone, amisulpride, aripiprazole, paliperidone and sulpiride were associated with comparable rates of laxative use. Laxative use rates grew over time from 30.8% in 2006 to 46.6% in 2019 (z = 4.83, P < 0.001).

CONCLUSIONS

Laxative use is common in elderly schizophrenia patients treated with SGAs. In cases of clinically significant constipation, switching to an SGA with a lower risk for constipation, or discontinuing the use of mood stabilisers should be considered, if clinically feasible.

Problems associated with effective pharmacotherapy of the elderly patients (geriatrics): A review

The worlds older population is growing dramatically. At the same time, ensuring an appropriate high standard of living for the elderly by reducing of morbidity and disability of geriatric patients is one of the main objectives of the modern healthcare system. However, changes associated with body aging necessitate application of novel approaches to the correction of pharmacotherapy and usage of specialized dosage forms. Such medicinal products provide both an appropriate therapeutic effect and facilitate their use. Presented review considers several features of pharmacotherapy of geriatric patients.

Patterns of Medication Errors Involving Older Adults Reported to the French Medication Error Guichet

OBJECTIVES

The aims of the study were to describe medication errors (MEs) involving older adults reported to the French Medication Error Guichet and to compare them with MEs in younger adults, in each of the hospital and community settings.

METHODS

Retrospective secondary data analysis of MEs reported throughout 2013 to 2017 was performed. Descriptive and multivariate analyses were performed to compare actual and potential ME reports between older adults (aged ≥60 y) and younger adults (aged ≥18, <60 y).

RESULTS

We analyzed 4979 reports. In older adults, both in hospital (n = 1329) and community (n = 1264) settings, antithrombotic agents were frequently reported in MEs and were significantly more likely to be associated with reported MEs in older adults compared with younger adults. In hospital setting, antibacterials for systemic use (adjusted odds ratio [aOR] = 1.87, 95% confidence interval [CI] = 1.19-2.93) and antineoplastic agents (aOR = 2.22, 95% CI = 1.34-3.69), whereas in community setting, psycholeptics (aOR = 1.43, 95% CI = 1.04-1.98) and drugs used in diabetes (aOR = 6.01, 95% CI = 3.21-11.2) were more likely to be associated with reported MEs in older adults. In both settings, wrong dose and wrong drug were the most frequently reported error types in older adults; however, wrong technique error type (aOR = 2.06, 95% CI = 1.30-3.28) in hospital setting and wrong patient (aOR = 2.17, 95% CI = 1.30-3.60) in community setting were more likely to be associated with reported MEs in older adults.

CONCLUSIONS

We identified specific ME patterns for older adults, including antithrombotic agents in both settings; antibacterials for systemic use, antineoplastic agents, and wrong technique in hospital setting; and psycholeptics, drugs used in diabetes, and wrong patient in community setting. These findings inform future studies investigating population-specific medication safety strategies.

An evaluation of the appropriateness of prescribing and frailty in elderly patients using STOPP criteria and Frailty Index in tertiary care teaching hospital

People above 65 years of age would amount to 10.7% of total population of India by 2021. India has acquired the label of ‘an ageing nation’ with 7.7% of its population being more than 60 years old. Geriatric patients are exposed to potentially inappropriate medications (PIMs) thus strategies to improve quality of life and safety of prescribing is needed. One such explicit criteria tool is ‘Screening Tool of Older person’s Potentially inappropriate Prescriptions’ (STOPP) criteria. For older individuals, frailty plays a decisive role. Frailty assessment is useful for identification of risk stratifications to assist in clinical decision makings. Hence, this study is aimed to assess the percentage of PIM using STOPP criteria and correlation between PIMS and Frailty Index (FI) in elderly patients in our setting. An observational study was done in 60 patients in department of medicine at tertiary care teaching hospital. Demographic details, diagnosis and current medications were recorded in Microsoft excel 2016. PIMs based on STOPP criteria version 2 and FI suggested by Searle et al. was calculated and analyzed. Spearman rank correlation test was used to check the correlation between FI and PIM. Out of 60 prescriptions, 21 prescriptions with PIM were found. Most common drugs prescribed as PIM were Aspirin, calcium, ceftriaxone, multivitamin B complex and furosemide. FI was analyzed by using 34 variables. Value of FI was between 0.03 to 0.17. Spearman Rank correlation test showed direct low degree of significant correlation between FI and PIM with correlation (r) value of 0.1602 (P value=0.02). 35% of prescriptions were having at least one PIM in our study and we found that there was direct association between FI and PIM which will help us to reduce potential medication errors, drug interactions and adverse reactions.

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

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.