Inappropriate Medication Use in Community-Residing Older Persons

Inappropriate use of medications has become an international cause for concern in geriatric patients, who are at high risk of drug-related morbidity. This study is the first attempt to determine the prevalence of inappropriate drug use in elderly Lebanese outpatients, using community pharmacy data, and to identify factors that predict potentially inappropriate drug intake in this population. Records of elderly patients aged > or =65 years were selected from different community pharmacies. Each patient profile was reviewed and to confirm patient record information, in-person interviews were conducted with elderly patients between November 2004 and May 2005 by qualified pharmacists. Based on a literature review describing guidelines for the inappropriate use of medications in the elderly, courses of therapy were assessed and classified as either appropriate or inappropriate. Courses of therapy that were judged inappropriate were further classified according to the specific area of inappropriate use (i.e. Beers' criteria, duplicate therapy, indication, dose, dose frequency including missing doses, duration and discontinuation of therapy, adverse effects, drug-drug and/or drug-disease interactions, and poor memory). Statistical analyses were performed to estimate the prevalence of inappropriate medication use and to identify potentially predictive factors of such use arising from patients' sociodemographic characteristics, health factors and drug regimen intake. A total of 350 elderly patient profiles were reviewed, from which 277 evaluable records were obtained. More than half (59.6%) of the patients taking drugs at the time of the study were taking at least one inappropriate medication. Inappropriate medication use was most frequently identified in terms of Beers' criteria (22.4%), missing doses (18.8%) or incorrect frequency of administration of drugs (13.0%). Factors predicting potentially inappropriate drug intake included female sex (65.7% vs 53.3% for males, p = 0.03) and alcohol intake (p = 0.007). There were also significant associations between the likelihood of use of an inappropriate drug and (i) increased number of medical illnesses (p < 0.00002); and (ii) consumption of an over-the-counter drug (OTC) and/or prescription drug (p = 0.048 and p = 0.0035, respectively). The likelihood of use of an inappropriate drug was higher again when patients concurrently used both OTC and prescription drugs (p < 0.0002). The present study is the first to describe and assess inappropriate medication use by elderly outpatients in the Lebanese community setting. With increasing availability of newer and more appropriate medications, use of potentially inappropriate drugs may decrease. Pharmacists have a major role to play in counselling patients about the importance of appropriate drug use.

Little empirical evidence exists regarding the influence and outcomes of inappropriate medication use among elderly nursing home residents. To identify the prevalence of inappropriate medication use among elderly patients in Georgia nursing homes using the Beers criteria and identify the relationship between inappropriate drug use and the likelihood of an adverse health outcome. A cohort design was used to review 1117 patient medical records in 15 Georgia nursing homes with a high risk of polypharmacy. Prevalence of inappropriate medication use among elderly patients, as defined by the Beers criteria, was estimated. The adverse health outcomes of hospitalizations, emergency department visits, or deaths were identified from Medicaid claims data. A total of 519 (46.5%) patients received at least one inappropriate medication and 143 (12.8%) patients experienced at least one adverse health outcome. Logistic regression revealed that the total number of medications taken (OR 1.139, 95% CI 1.105 to 1.173) significantly increased the likelihood of receiving an inappropriate drug, while having a diagnosis of "dementia" (OR 0.748, 95% CI 0.565 to 0.991) decreased the likelihood. Inappropriate medication use increased the likelihood of experiencing at least one adverse health outcome more than twofold (OR 2.34, 95% CI 1.61 to 3.40). Propoxyphene use alone was significantly associated with the occurrence of an adverse health outcome (OR 2.39, 95% CI 1.54 to 3.71). Inappropriate drug use was common in our study cohort. Inappropriate use of medication in the elderly, particularly propoxyphene, is associated with a higher risk of adverse health outcomes.

IntroductionPolypharmacy refers to the concurrent use of multiple medications, while inappropriate drug use occurs when patients take more medications than necessary or use drugs without proper indication. The elderly are...

Studies have suggested that elderly patients do not always use medications appropriately. Investigations that have relied on prescription claim databases or clinical records focus on acquisition or prescription, and hypotheses must be made to assess actual consumption. Population survey data constitute an altemative way to study inappropriate use. To estimate the prevalence of potentially inappropriate use of medications in elderly patients in Québec based on self-reported use. Using a cross-sectional, general population, health survey in which self-reported medication use in the 2 days prior to the survey was recorded, we estimated the prevalence of inappropriate medication use in elderly patients (> or =65 y old) who responded. Two sets of published criteria were used to define inappropriate use: one to assess use of inappropriate drugs, and another to assess concomitant duplications and potential interactions. Of the 3400 patients surveyed, 6.5% had used > or =1 inappropriate drugs, 2.5% had > or =1 occurrences of potentially inappropriate duplication of medications, and 2.7% had > or =1 potential medication interactions. Concomitant use of at least 2 benzodiazepines was reported by 8.5% of respondents using these drugs. Use of > or =1 long-acting benzodiazepines was reported by 4.2% of the sample. Population health surveys are a useful tool for detecting potentially inappropriate medication use in the elderly. In particular, the high prevalence of inappropriate use of benzodiazepines signals a need for improved detection and intervention in this group.

Inappropriate medication use is a major problem for the elderly. Although increasing attention has been paid to inappropriate prescription medication use, most previous research has been limited to the investigation of prevalence and trends. Few studies provide the empirical evidence for the adverse effect of inappropriate medication use on health outcomes at the national level. This study is the first attempt to assess the relationship between inappropriate prescription use and health status for the elderly in the United States. Based on the 1996 Medical Expenditure Panel Survey, inappropriate medication use in a national representative elderly population was first identified using Beers criteria. A survey type of ordered probit model was then estimated to quantify the effect of inappropriate drug use on patient self-perceived health status measured using a five-point scale (poor, fair, good, very good, and excellent). After controlling for a set of possible confounding factors, it was found that individuals using inappropriate medications in Round 1 were more likely than those not using inappropriate medications to report poorer health status in Round 2. Other risk factors for poor health status include a higher number of prescriptions, being black, having low education, and having one or more chronic diseases. This study provides strong evidence of a significant adverse effect of inappropriate medication use on patient health status. These findings lend partial support to the use of Beers criteria in assessing the quality of prescribing and the appropriateness of medication use in the elderly population.

Musculoskeletal disorders are frequently associated with pain in older adults, and the use of inappropriate analgesics drugs is common. Understanding the patterns and factors of inappropriate analgesic use may help reduce its prevalence among older adults with chronic musculoskeletal pain. This cross-sectional study evaluated 215 older adults aged ≥ 60 years who experienced chronic musculoskeletal pain and used oral medication to relieve pain within the previous 3 months. Participants were recruited through home visits using the community health register in Ban Phru, Hat Yai District, Songkhla Province (Southern Thailand) between July and December 2023. Analgesic use was determined by directly inspecting the drugs that participants were taking within the previous 3 months, regardless of whether they were prescribed or self-purchased. The name, dose, and source of each medication were recorded and cross-checked with the 2023 American Geriatrics Society Beers Criteria to identify potentially inappropriate drugs. This approach enabled differentiation into three patterns of inappropriate analgesic drug use: potentially inappropriate medication use, overtreatment, and undertreatment. Factors associated with the inappropriate use of analgesic drugs were analysed using multivariate logistic regression analysis. Inappropriate analgesic drug use was prevalent in 66.5%. Regarding the prevalence rates by pattern, potentially inappropriate, overtreatment, and undertreatment were prevalent in 71.3%, 24.5%, and 33.6%, respectively. Non-prescribed polypharmaceutical packs (adjusted odds ratio [aOR] [95% confidence interval {CI}] = 11.45 [3.32, 72.15], P < 0.001) and pain interfering with enjoyment of life (aOR [95% CI] = 1.16 [1.04, 1.30], P = 0.007) were significantly associated with inappropriate analgesic drug use. Inappropriate analgesic use was common, affecting 66.5% of community-dwelling older adults with chronic musculoskeletal pain. Non-prescribed polypharmaceutical packs and pain interference were significant predictors of inappropriate use. These findings underscore the influence of inappropriate self-medication, suggesting the need for greater attention from healthcare providers to promote safe and rational analgesic use in this population.

Objectives: Polypharmacy is an important condition that causes adverse outcomes such as drug-drug interactions, falls, increased hospitalizations and mortality.In our study, we aimed to evaluate polypharmacy and inappropriate medication use according to two different criteria in home care patients.Materials and Methods: Our observational and cross-sectional, single-center study included all patients who receive home health care service from our unit and agree to participate.A face-to-face information form was carried out to measure the patients' socio-demographic characteristics, drug use, and level of knowledge about the use of drugs.Inappropriate medication use was evaluated using Beers and STOPP criteria.Results: 179 individuals, most of whom were female (n=124; 69.2%), participated in this study.The mean age was 83,54 7.53.The mean number of chronic diseases was 2.14.The average number of drugs was 5.80 3.18.There was a relationship between polypharmacy and high education level and being married (p=0.005;p=0.007).There was a statistically significant relationship between the number of chronic diseases and the number of drugs used (p>0.001).Inappropriate medication use was present in 66 (36.8%) patients and the most frequently used inappropriate drugs were antipsychotics (n=38; 21.2%) according to Beers criteria.According to the STOPP criteria, inappropriate medication use was present in 33 (18.4%) patients, and the most common inappropriate drug use was NSAIDs (n=5; 2.7%). Conclusion:Rates of polypharmacy and inappropriate medication use according to both criteria were found to be high.Physicians should plan the drugs used in this group carefully.

Use of inappropriate medications by the elderly is a public health concern with potentially serious health consequences. Research indicates relatively high rates of inappropriate prescription drug usage for older whites and African Americans. However, rates for older Mexican Americans are unknown. To examine the prevalence and predictors of inappropriate prescription medication use by older Mexican Americans. A cross-sectional study of 3050 Mexican Americans aged > or =65 years living in the southwestern US was conducted. In-home interviews in 1993 and 1994 assessed prescription medication use. Descriptive statistics and logistic regression models were used to estimate prevalence and risk of inappropriate prescription drug use. Approximately 12% (n = 365) of the sample had used at least 1 of 32 potentially inappropriate prescription medications within 2 weeks of the baseline assessment. Four drugs, chlorpropamide, propoxyphene, amitriptyline, and dipyridamole, accounted for 54% of all inappropriate prescribing. Unmarried subjects, those with >/=1 chronic diseases, high depressive symptoms, frequent physician visits, and combined Medicaid and Medicare insurance were more likely to have used at least 1 of the 32 potentially inappropriate drugs. The prevalence of inappropriate medication use is lower in older Mexican Americans than in similar white and African American populations. More studies are needed on the pattern of inappropriate prescribing over time and on intervention programs to reduce potentially adverse health outcomes in older Mexican Americans most at risk.

Inappropriate drug use in hospitalized elderly patients of medicine and cardiology departments at a tertiary care hospital of Northeast India

Introduction: This study aims to evaluate potentially inappropriate medication (PIM) use, the association of PIM use, and activities of daily living in 65 years and older home care patients. Method: The study included 322 patients aged 65 and over who applied to Home Care Unit. Consent was obtained from those who agreed to participate in the study. A questionnaire containing demographic data, drug use information, and Katz Daily Living Activities Index was used which was prepared by the researcher in this study. The drugs used by the patients were evaluated according to the 2015 Beers criteria and inappropriate active substances were detected. The data were defined by statistical analyzes such as mean, percentage, standard deviation, and frequency. Chi-squared test and Student's t-test were used in the analysis. The significance level was accepted as p&amp;lt;0.05. Results: The mean age of the patients was 80.2±8.2 years, and 63.4% (n=204) were female. 70.5% (n=227) of the elderly have three or more chronic diseases. The most common diseases were hypertension (56.2%), diabetes (30.0%), and heart failure (29.8%). 79.2% (n=255) of the group uses four or more drugs. 83.3% (n=260) of the patients get help to use the drugs. 51.6% (n=166) of the patients were fully dependent on activities of daily living and 3.4% (n=11) were fully independent, the level of dependency increases with age (p&amp;lt;0.05). The PIM rate was 61.5% in patients. PIM use was found to be significantly higher in those with more disease, in those who used more drugs, and in females (p&amp;lt;0.05). No relationship was found between inappropriate medication use and addiction level. Conclusion: In this study, it was found that more than half of home care patients aged 65 and over had inappropriate drug use. It was determined that inappropriate medication use increased with polypharmacy, and polymorbidity, and there was no correlation between addiction levels.

To review currently available literature applying the Beers criteria for inappropriate medication use in the elderly to prescribing practices in various settings. Key words including inappropriate, Beers, medication, prescribing, elderly, geriatric, and criteria were used to search MEDLINE records from January 1992 to June 1999. Eight relevant studies were found that applied the Beers criteria in various healthcare settings. Each study was examined for methodologic issues, criteria used, prevalence, nature and extent of inappropriate medication use, and factors associated with their use. Despite the methodologic differences, the review revealed some consistent patterns across healthcare settings. This review has shown that: (1) most of the researchers modified the Beers criteria to examine inappropriate medication use in the elderly; (2) studies using patient-based prevalence showed that between nearly one in four (23.5%) and one in seven (14.0%) elderly patients received an inappropriate medication as defined by either the Beers list of 20 inappropriate medications or the Modified Beers list; (3) the majority of these patients received one inappropriate agent; and (4) long-acting benzodiazepines, dipyridamole, propoxyphene, and amitriptyline were among the most frequently prescribed inappropriate medications. Univariate analyses indicated that women, patients >80 years old, and Medicaid patients appeared to receive more inappropriate medications than others; however, multivariate analyses found that only a higher number of medications was consistently associated with inappropriate medication use. Inappropriate prescribing or use trends are noteworthy because they were observed despite methodologic differences. The findings can be instrumental in developing targeted interventions to influence future prescribing practices. More research is needed to address the national trends and healthcare impact of inappropriate drug use in the elderly.

The criteria for inappropriate drug use developed by Beers have been widely used in drug utilization reviews to assess the quality of prescribing, but there is still inconclusive evidence that these criteria can impact on patient outcomes. The aim of the present study was to evaluate the relationship between the use of inappropriate drugs and measures of physical performance, muscle strength and functional status in an elderly population (80+ years). Data are from the baseline evaluation of 364 subjects enrolled in the ilSIRENTE study, a prospective cohort study performed in a mountain community living in the Sirente geographic area (L'Aquila, Abruzzo) in Central Italy. Physical performance was assessed using the physical performance battery score (SPPB), which is based on three timed tests: 4-m walking speed, balance and chair stand tests. Muscle strength was measured by hand grip strength. Inappropriate drug use was defined by the 2003 Beers criteria. Analyses of covariance were performed to evaluate the relationship of inappropriate drugs with physical function. In the unadjusted model, all of the physical performance, muscle strength and functional measures showed significant associations with inappropriate drug use. Following adjustment for potential confounders, which included age, gender, physical activity level, cognitive performance scale, comorbidity, lung diseases and diabetes, these associations were still statistically significant for the physical performance battery score [non-users inappropriate drugs: 7.0; standard error (SE): 0.1; users inappropriate drugs: 6.1; SE: 0.2; p = 0.007] The 4-m walking speed, physical performance battery score and Total Activities of Daily Living (ADL) scale score showed worsening results among subjects using two inappropriate medications compared with subjects using one inappropriate drug or none at all. The use of inappropriate medication (as defined by Beers 2003 criteria) was found to be common among the elderly Italian study cohort living in the community. Our results suggest that among old-old subjects the use of inappropriate drugs is associated with impaired physical performance.

The aim was to investigate the prevalence of potentially inappropriate medication use among older people in Sweden according to five different published sets of explicit criteria from Europe and the US. This was a nationwide cross-sectional, register-based study across the whole of Sweden in 2008. All individuals aged 65 years and older were included (n = 1 346 709, both community-dwelling and institutionalized persons). We applied all drug-specific criteria included in the 2012 Beers Criteria, the Laroche's list, the PRISCUS list, the NORGEP criteria and the Swedish National Board of Health and Welfare criteria. The main outcome was the potentially inappropriate drug use according to each set of criteria, separately and combined. Multivariate logistic regression models were used to identify individual factors associated with the use of potentially inappropriate drugs. The prevalence of potentially inappropriate medication use varied between the explicit criteria from 16% (NORGEP criteria) to 24% (2012 Beers criteria). Overall, 38% of the older people were exposed to potentially inappropriate drug use by at least one of the five sets of criteria. While controlling for other possible covariates, female gender, institutionalization and polypharmacy were systematically associated with inappropriate drug use, regardless of the set of explicit criteria we considered. Although explicit criteria for inappropriate drug use among older people have been reported to be quite different in their content, they provide similar measures of the prevalence of potentially inappropriate drug use at the population level.

This study investigates drug utilization and estimates the prevalence of potentially inappropriate drug use in a Turkish population aged 70 years or older. A cross-sectional study was carried out on a total of 1019 participants who accepted face-to-face questionnaires in home interviews in Istanbul. All medications used in the three weeks prior to the study were recorded. Some major risk factors that might influence the use of inappropriate medication such as socio-demographic characteristics and concomitant disease such as depression and dementia were also questioned. Inappropriate drug use was assessed using the Beers criteria. Among the 1019 participants, 903 (88.6%) had been using at least one medication during the last three weeks. The average number of medications used was 2.9 +/- 2.0. The most frequently drugs used were cardiovascular drugs (39.9%), followed by analgesics/anti-inflammatory drugs (16.2%), vitamin/mineral preparations (10.6%) and central nervous system drugs (10.2%). Of the 1,019 participants, 9.8% were using one potentially inappropriate medication and one patient was using two inappropriate drugs. The most common of these drugs were reserpine (23.7%), dipyridamole (21.8%), antihistamines (14.8%), and benzodiazepines (10.9%). Only age and total number of medications were associated with potentially inappropriate drugs in the multivariate analysis. This study revealed that drug utilization and the prevalence of inappropriate medication use in the elderly were lower than in published reports from most developed countries. Furthermore, polypharmacy and higher age were the main risk factors for potentially inappropriate drug use in the elderly.

Several studies have observed a higher rate of inappropriate drug use in elderly women than in elderly men, although few have focused explicitly on sex differences. Also, educational level (a measure of socioeconomic status) has been associated with both polypharmacy and inappropriate drug use in the elderly population, which could explain sex differences in inappropriate drug use. To investigate whether sex is associated with inappropriate drug use in a large general population of older people, after adjustment for age, socioeconomic status (ie, educational level), and comorbidity (ie, number of drugs). We conducted an analysis of data on sex, age, dispensed drugs, and education for people aged 75-89 years who were registered in the Swedish Prescribed Drug Register between July and October 2005 (N = 645,429). The main outcome measures were the filling of prescriptions for anticholinergic drugs or long-acting benzodiazepines, concurrent use of 3 or more psychotropic drugs, and potentially serious drug-drug interactions. Potentially inappropriate drug use was more common in women (24.6%) than in men (19.3%). More women than men were exposed to all types of inappropriate drug use, except for potentially serious drug-drug interactions. Logistic regression analysis showed that women were more likely to be exposed to potentially inappropriate drug use than were men (OR 1.24; 95% CI 1.23 to 1.26) after adjustment for age, education, and number of drugs (used as a proxy for comorbidity). In particular, female sex was highly associated with inappropriate psychotropic use (eg, long-acting benzodiazepines: adjusted OR [ORadjusted] 1.45; 95% CI 1.42 to 1.49; >3 psychotropic drugs: ORadjusted 1.50; 95% CI 1.47 to 1.53). In contrast, women had a lower probability of potentially serious drug-drug interactions than did men (ORadjusted 0.81; 95% CI 0.80 to 0.83). Inappropriate drug use in the elderly should be monitored separately for women and men. Our results suggest that neither socioeconomic status nor comorbidity seem to explain sex differences in inappropriate drug use. Future research in other large study populations is needed for investigation of other explanations behind these sex differences.