Longitudinal prevalence of potentially inappropriate medicines and potential prescribing omissions in a cohort of community-dwelling older people.

Frank Moriarty,Rose Anne Kenny,Caitriona Cahir,Tom Fahey,Kathleen Bennett

doi:10.1007/s00228-015-1815-1

Abstract

PurposeThis study aims to compare the prevalence of potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) using several screening tools in an Irish community-dwelling older cohort, to assess if the prevalence changes over time and to determine factors associated with any change.MethodsThis is a prospective cohort study of participants aged ≥65 years in The Irish Longitudinal Study on Ageing (TILDA) with linked pharmacy claims data (n = 2051). PIM and PPO prevalence was measured in the year preceding participants’ TILDA baseline interviews and in the year preceding their follow-up interviews using the Screening Tool for Older Persons’ Prescriptions (STOPP), Beers criteria (2012), Assessing Care of Vulnerable Elders (ACOVE) indicators and the Screening Tool to Alert doctors to Right Treatment (START). Generalised estimating equations were used to determine factors associated with change in prevalence over time.ResultsDepending on the screening tool used, between 19.8 % (ACOVE indicators) and 52.7 % (STOPP) of participants received a PIM at baseline, and PPO prevalence ranged from 38.2 % (START) to 44.8 % (ACOVE indicators), while 36.7 % of participants had both a PIM and PPO. Common criteria were aspirin for primary prevention (19.6 %) and omission of calcium/vitamin D in osteoporosis (14.7 %). Prevalence of PIMs and PPOs increased at follow-up (PIMs range 22–56.1 %, PPOs range 40.5–49.3 %), and this was associated with patient age, female sex, and numbers of medicines and chronic conditions.ConclusionsSub-optimal prescribing is common in older patients. Ongoing prescribing review to optimise care is important, particularly as patients get older, receive more medicines or develop more illnesses.Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-015-1815-1) contains supplementary material, which is available to authorized users.

Highlights

Medicines are the most common healthcare intervention worldwide, and despite providing many benefits, they carry potential risks which can lead to patient harm [1]
Depending on the screening tool used, between 19.8 % (ACOVE indicators) and 52.7 % (STOPP) of participants received a potentially inappropriate medicines (PIMs) at baseline, and potential prescribing omissions (PPOs) prevalence ranged from 38.2 % (START) to 44.8 % (ACOVE indicators), while 36.7 % of participants had both a PIM and PPO
Outside of specific potentially inappropriate prescribing (PIP) screening tools, the Assessing Care of Vulnerable Elders (ACOVE) indicators were developed by the Research and Development (RAND) Corporation to assess the overall quality of care of older people [13]

Summary

Introduction

Medicines are the most common healthcare intervention worldwide, and despite providing many benefits, they carry potential risks which can lead to patient harm [1]. PIP can be determined implicitly on the basis of clinician’s judgement, the majority of research has determined it explicitly using published criteria/screening tools, a large number of which have been developed [5]. The earliest such tool was Beers criteria, first published in 1991 as a list of drugs to be avoided in older nursing home residents [6]. Several ACOVE indicators relate to PIMs and PPOs, and these have been assessed for use as a PIP screening tool and have good inter-rater reliability [14, 15]

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