Differences in the prescribing of potentially inappropriate medicines in older Australians: comparison of community dwelling and residential aged care residents

Hosam Bony,Ian P Todd,Helen A Loffler,Megan E Corlis,Vijayaprakash Suppiah,Gregory K Scarlett,Elizabeth D Hotham,Renae A Lloyd,Lauren J Corre,Jacquie M Tsimbinos

doi:10.1038/s41598-020-66991-x

Abstract

Potentially inappropriate medications (PIMs) can contribute to morbidity through exacerbations or progression of existing conditions among older people. In order to characterize the prevalence of PIMs according to the Beers Criteria in older Australians, three hundred and eleven participants were recruited from three residential aged care facilities (RACFs) and two hundred and twenty participants from three community pharmacies in South Australia for a retrospective audit of medication administration charts and community pharmacy dispensing histories. Although a similar number of participants were prescribed at least one PIM (P = 0.09), the average number of PIMs was significantly greater in the RACF cohort (1.96 vs 1.26, P < 0.05). Additionally, PIMs prescribed as pro re nata (PRN) in the RACF cohort had a significantly low administration rate compared to prescription rate (19.7% vs 40.7%). The mean number of PIMs within each cohort was statistically significant (RACF = 1.93 vs CDOA = 1.26, P < 0.05). RACF residents were at a slightly greater risk of being prescribed more than one PIM compared to those within the community. Routine medication reviews by pharmacists embedded in RACFs and within the community could be utilised to detect PIMs before such harm occurs.

Highlights

Inappropriate medications (PIMs) can contribute to morbidity through exacerbations or progression of existing conditions among older people
All analyses were conducted with the residential aged care facilities (RACFs) cohort as a whole
One of the barriers identified for hindering deprescribing of Potentially inappropriate medications (PIMs) by clinicians is the lack of time and degree of effort to conduct a full medication review[46]

Summary

Introduction

Inappropriate medications (PIMs) can contribute to morbidity through exacerbations or progression of existing conditions among older people. Medication prescribing and management in older people can be complex, with longer life expectancies, and the high rate of chronic disease amongst Australians over 65 years all contributing to increasing polypharmacy[1,2]. A significant association has been described between the number of medications prescribed and the likelihood of potentially inappropriate medications (PIMs)[9]. Under-prescribing, mis-prescribing or over-prescribing[10,11] can all be described as inappropriate, with instances including: medications that cause more harm than benefit, prescribing at a frequency, duration or dose above or below what is recommended, medications with a high risk of drug interactions, therapeutic duplications and omissions of clinically indicated medications[12,13]. On occasions polypharmacy is appropriate, it may still increase the potential for drug interactions and adverse drug reactions, which can contribute to low medication adherence, high healthcare costs and poorer unisa.edu.au www.nature.com/scientificreports/

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