Abstract
Purpose: The aim of the present study was to develop and validate a Potentially Inappropriate Medications (PIM) list and alternative therapies for treatment of pain and inflammation in older people adapted to the Brazilian context. Methods: A preliminary PIM list suitable for the Brazilian market was developed on the basis of three published international PIM lists [Beers 2015, Screening Tool of Older People’s Potentially Inappropriate Prescriptions - 2015, European Union (7) PIM list]. We used the modified Delphi technique (two-round) to validate concerns of use and alternative therapies related to PIM for treatment of pain and inflammation in older adults ≥65 years in Brazil. The panel involved nine Brazilian experts in geriatric pharmacotherapy. All items with mean Likert scale score ≥4.0 (agree) and the lower limit of 95% confidence interval ≥4.0 were considered validated in this study. Results: At the end of the consensus process, 94 (65.3%) items of 144 were validated. In total, consensus was reached for 33/35 (94.3%) concerns about drugs that should be avoided in older patients regardless of diagnosis, for 22/23 (95.7%) concerns about drugs that should be avoided in older patients with specific conditions or diseases, for 11/23 (47.8%) with special considerations of use, and for 28/63 (44.4%) of therapeutic alternatives. Conclusion: Although these criteria are not designed to replace clinical judgement, PIM and alternative therapies lists can be useful to inform prescribers, pharmacists, and health care planners and may serve as a starting point for safe and effective use of medications in older people.
Highlights
The process of aging in a population is accompanied by a rising prevalence of chronic and degenerative diseases and, a higher incidence of conditions characterised by pain and inflammation (Horgas, 2017)
The aim of the present study was to develop and validate a Potentially inappropriate medication (PIM) list for the treatment of pain and inflammation and their respective alternative therapies based on the three international PIM lists recently updated [Beers, STOPP, and EU(7) PIM list], applicable to Brazilian elderly individuals (Renom-Guiteras et al, 2015; American Geriatrics Society Beers Criteria Update Expert P., 2015; O’Mahony et al, 2015)
When a medication class was listed in a published PIM list, we identified all medications belonging to the class that were available in Brazil
Summary
The process of aging in a population is accompanied by a rising prevalence of chronic and degenerative diseases and, a higher incidence of conditions characterised by pain and inflammation (Horgas, 2017). Several explicit criteria have identified medications that are considered inappropriate for the treatment of pain and inflammation in older people (McLeod et al, 1997; Gallagher et al, 2008; Winit-Watjana et al, 2008; Holt et al, 2010; Kim et al, 2010; American Geriatrics Society Beers Criteria Update Expert P, 2012; Chang et al, 2012; Mann et al, 2012; Clyne et al, 2013; Renom-Guiteras et al, 2015; American Geriatrics Society Beers Criteria Update Expert P., 2015; Kim et al, 2015; O’Mahony et al, 2015; Oliveira et al, 2016) These tools were developed by expert consensus and provide an accessible resource for health professionals in different settings
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