Patient- and Prescriber-Related Factors Associated with Potentially Inappropriate Medications and Drug-Drug Interactions in Older Adults.

Suhyun Jang,Sohyun Jeong,Sunmee Jang

doi:10.3390/jcm10112305

Abstract

We aimed to evaluate the prevalence of potentially inappropriate medication (PIM) use and drug–drug interactions (DDIs) in older adults and their associated factors. This cross-sectional study used National Health Insurance data of older adults in South Korea. The 2015 AGS Beers Criteria were used to classify PIM use and DDIs. The associations of PIM use and DDIs with patient- and prescriber-related factors were evaluated using multiple logistic regression. Of the older adults who received at least one outpatient prescription (N = 1,277,289), 73.0% and 13.3% received one or more prescriptions associated with PIM use or DDIs, respectively. Chlorphenamine was most commonly associated with PIM, followed by diazepam. Co-prescriptions of corticosteroids and NSAIDs accounted for 82.8% of DDIs. Polypharmacy and mainly visiting surgeons or neurologists/psychiatrists were associated with a higher likelihood of prescriptions associated with PIM use or DDIs. Older age, high continuity of care (COC), and mainly visiting a hospital were associated with a lower likelihood of PIM use or DDIs. Prescriptions associated with PIM use and DDIS were more frequent for low COC patients or those who mainly visited clinics; therefore, patients with these characteristics are preferred intervention targets for reducing prescriptions associated with PIM use and DDIs.

Highlights

With the global population aging and the concomitant increase in chronic diseases, older populations may have an increased likelihood of multimorbidity [1]
potentially inappropriate medication (PIM) use in older adults causes adverse drug reactions, which may result in falls, fractures, hospitalization, and death; it complicates the treatment regimen and increases health care costs [4,5,6]
This study investigated the prevalence of PIM use and drug–drug interactions (DDIs) in Korean older adults using the 2015 Beers Criteria

Summary

Introduction

With the global population aging and the concomitant increase in chronic diseases, older populations may have an increased likelihood of multimorbidity [1]. Drug therapy is the most relevant therapeutic intervention in medicinal care; older adults with multimorbidity are likely to receive multiple drug treatments (polypharmacy [2]). Polypharmacy is defined differently depending on the study, but several studies have defined it as taking more than five drugs simultaneously [3]. Polypharmacy may increase the complexity of the dosing regimen, which may be problematic in patients with cognitive problems. This increases the risk of the prescription of potentially inappropriate medications (PIMs). PIM use in older adults causes adverse drug reactions, which may result in falls, fractures, hospitalization, and death; it complicates the treatment regimen and increases health care costs [4,5,6]

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Discussion

Conclusion