Potentially inappropriate anticholinergic medication use in community-dwelling older adults: a national cross-sectional study.

Potentially inappropriate anticholinergic medication use in older adults with dementia

Beers revised: Drugs not to use in older adults

Updated Beers Criteria: A more comprehensive guide to medication safety in older adults

2019 AGS Beers Criteria for older adults

Few studies have examined racial differences in potentially inappropriate medication use. The objective of this study was to examine racial disparities in using prescription and/or nonprescription anticholinergics, a type of potentially inappropriate medication, over time. Longitudinal. Data from the Health, Aging, and Body Composition Study (years 1, 5, and 10). Three thousand fifty-five community-dwelling older adults, both blacks and whites, at year 1. Highly anticholinergic medication use per the 2012 American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Blacks represented 41.4% of the participants at year 1. At year 1, 13.4% of blacks used an anticholinergic medication compared with 17.8% of whites, and this difference persisted over the ensuing 10-year period. Diphenhydramine was the most common anticholinergic medication reported at baseline and year 5, and meclizine at year 10, for both races. Controlling for demographics, health status, and access to care factors, blacks were 24% to 45% less likely to use any anticholinergics compared with whites over the years considered (all P < 0.05). The use of prescription and/or nonprescription anticholinergic medications was less common in older blacks than whites over a 10-year period, and the difference was unexplained by demographics, health status, and access to care.

A - 101 Anticholinergic Drug Use in Older Adults with Dementia: a Systematic Review

Commentary on the New American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Geriatric people particularly those with multiple co-morbid condition may result in polypharmacy which can be associated with use of potentially inappropriate medication. This study aims to understand about prescription pattern and to find out inappropriate medication used in geriatric patients using Beer's criteria 2012. A cross sectional study was conducted from May 2018 to Aug 2018 in Koshi Zonal Hospital in Biratnagar. Data of all elderly patients greater above or equal to 60 years those were admitted to General Medical Ward during this period was analyzed. Eighty-six percent of the prescriptions were appropriate and 14% were inappropriate. Seventy-seven percent of drugs belong to Group I of Beer's criteria (Potentially inappropriate medication use in older adults), 23% of drugs belong to Group III (Potentially inappropriate medication to be used with caution in older adults) and no drugs fall under Group II (Potentially inappropriate medication use in older adults due to Drug-Disease or Drug-Syndrome interactions that may exacerbate the disease or syndrome) of Beer's criteria. Potentially inappropriate medication was found out to be 14%. The use of inappropriate medications can be avoided using Beer's criteria 2012 which is important clinical tool that can be used by physicians, pharmacist and other health care professionals.

The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults is widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a regular cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2023 update, an interprofessional expert panel reviewed the evidence published since the last update (2019) and based on a structured assessment process approved a number of important changes including the addition of new criteria, modification of existing criteria, and formatting changes to enhance usability. The criteria are intended to be applied to adults 65 years old and older in all ambulatory, acute, and institutionalized settings of care, except hospice and end-of-life care settings. Although the AGS Beers Criteria® may be used internationally, it is specifically designed for use in the United States and there may be additional considerations for certain drugs in specific countries. Whenever and wherever used, the AGS Beers Criteria® should be applied thoughtfully and in a manner that supports, rather than replaces, shared clinical decision-making.

The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a 3-year cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2019 update, an interdisciplinary expert panel reviewed the evidence published since the last update (2015) to determine if new criteria should be added or if existing criteria should be removed or undergo changes to their recommendation, rationale, level of evidence, or strength of recommendation. J Am Geriatr Soc 67:674-694, 2019.

Polypharmacy and inappropriate medication use in older adults is a major public health problem associated with morbidity and mortality. Aging is associated with metabolic changes and decreased drug clearance, increased drug-drug interactions, prescribing cascades, and potentially inappropriate medication (PIM) use. The purpose of this study was to evaluate the association between a common geriatric syndromes and PIM use among older adults. Study participants were recruited among patients admitted to Istanbul Medical School Geriatrics outpatient clinic between June 2000 and June 2014 and were evaluated retrospectively by a geriatrician using the patients' records according to Beers 2012 criteria. Among the 667 enrolled patients, 421 (63.1%) were women and 246 (36.9%) were men. The use of PIM was not associated with age or sex. Polypharmacy (OR 4.86, 95% CI 3.25-7.27, p < 0.001), malnutrition (OR 2.69, 95% CI 1.52-4.76, p = 0.001), depression (OR 2.61, 95% CI 1.7-3.95, p < 0.001), presence of fall in the previous year (OR 2.24, 95% CI 1.51-3.32, p < 0.001), and dementia (OR 1.69, 95% CI 1.08-2.65, p = 0.021) were independently associated with the use of PIM. The results of our study suggest that PIM use is independently associated with presence of polypharmacy, malnutrition, depression, falls and dementia in older outpatients. Identifying the association of inappropriate medication use with common geriatric syndromes in older people can help to prevent, delay, and reduce PIM use and related adverse health outcomes.

Older adults are especially susceptible to adverse effects of inappropriate medication therapy, and anticholinergic medications are common culprits for cognitive dysfunction due to their action on the central nervous system. Medication therapy management (MTM) interventions can aid in deprescribing and reducing inappropriate medication use in older adults. However, there is sparse literature on the long-term sustainability of these interventions. To (a) investigate whether the deprescribing of anticholinergic medications during an 8-week randomized controlled trial (RCT) of a targeted MTM intervention is sustained at 1-year postintervention follow-up and (b) compare anticholinergic utilization trends in the study population with a large sample of similar individuals not exposed to the intervention. Participants in the targeted MTM (tMTM) RCT had normal cognition or mild cognitive impairment and were recruited from enrollees in a longitudinal study at the University of Kentucky Alzheimer's Disease Center (ADC) and thus have pertinent medical information gathered approximately annually. In this posttrial observational follow-up, sustainability of the anticholinergic deprescribing intervention was assessed in participants in the RCT, and anticholinergic medication use trends were described from the RCT baseline (which occurred immediately following an ADC visit) to the next annual visit in all participants. Mean change in anticholinergic burden from RCT baseline to the next annual visit was estimated using analysis of covariance, and participants were compared with 2 external samples. Anticholinergic burden was measured using the Anticholinergic Drug Scale (ADS). The odds of decreasing baseline anticholinergic burden and number of total and strong anticholinergic medications at the follow-up study time point was assessed using logistic regression. Of the deprescribing changes made during the initial RCT, 50% were sustained after 1 year. Participants in the tMTM trial reported decreases in the use of anticholinergic antihistamines and bladder agents (-6.5 and -4.4%, respectively), but there was no change in the use of anticholinergic agents targeted at the central nervous system. While the anticholinergic burden of RCT participants decreased over 1 year (adjusted mean ADS change [95% CI] = -0.33 [-0.72, 0.07]), it was not different than the change observed in 2 external samples at the trial center (-0.20 [-0.42, 0.02]) and nationally (-0.33 [-0.39, -0.26]). There were no statistically significant differences between trial participants and external samples in the odds of decreasing anticholinergic burden nor in decreasing the number of total, or strongly anticholinergic, medications at the 1-year follow-up. This study demonstrates that the sustainability of deprescribing is limited to the period of intervention, rather than affording lasting effects even over periods as short as 1 year, which was demonstrated not only in the small group of RCT participants but also by comparison with external groups. Future work should extend the duration of intervention and follow-up periods for MTM interventions to allow further insights regarding the sustainability of deprescribing efforts in older adults. The original trial was supported by a pilot study award from the University of Kentucky Center for Clinical and Translational Sciences (UL1TR000117). Additional support for this study was provided by the National Institutes of Health/National Institute on Aging (R01 AG054130). Jicha reports contract research for Esai, Biohaven, Alltech, Suven, Novartis, and Lilly. The other authors have nothing to disclose.

Optimizing Medication Use in Older Adults

Adverse drug reactions are a common cause of potentially avoidable harm, particularly in older adults. To evaluate the feasibility and efficacy of a pilot multifactorial intervention to reduce potentially inappropriate medication (PIM) use in older adults. We conducted a phase 2, feasibility, open-label study in the ambulatory setting of an integrated healthcare network in Buenos Aires, Argentina. We recruited primary care physicians (PCPs) and measured PIM use in a sample of their patients (65years or older). Educational workshops for PCPs were organized with the involvement of clinician champions. Practical deprescribing algorithms were designed based on Beers criteria. Automatic email alerts based on specific PIMs recorded in each patient's electronic health record were used as a reminder tool. PCPs were responsible for deprescribing decisions. We randomly sampled 879 patients taking PIMs from eight of the most commonly used drug classes at our institution and compared basal (6months prior to the intervention) and final (12months after) prevalence of PIM use using a test of proportions. There was a significant reduction (p < 0.05) in all drug classes evaluated. Non-Steroidal Anti-Inflammatory Drugs (basal prevalence 5.92%; final 1.59%); benzodiazepines (10.13%; 6.94%); histamine antagonists (7.74%; 3.07%); opioids (2.16%; 1.25%); tricyclic antidepressants (8.08%; 4.10%); muscle relaxants (7.74%; 3.41%), anti-hypertensives (3.53%; 1.82%) and oxybutynin (2.96%; 1.82%). The absolute reduction in the overall prevalence was 8.5 percentage points (relative reduction of 51.4%). This multifactorial intervention is feasible and effective in reducing the use of potentially inappropriate medication in all drug classes evaluated.

BackgroundMultimorbidity, polypharmacy, and potentially inappropriate medication use in older adults are prevalent and affect their quality of life. This study investigates the interrelationship between potentially inappropriate medication use, comorbidity, and quality of life among older adults in Iran.MethodsThis cross-sectional study was conducted on 500 older adults in Isfahan City, Iran. The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, a health-related quality-of-life questionnaire for older adults, and the Charlson Comorbidity Index were used to gather data.ResultsOur findings related to older adults living in the Isfahan community showed that the prevalence of PIM was 61.6%, and the most common drug category was painkillers. The average quality of life score was (0.86 ± 0.08), and the worst category was related to sleep status. The average score of the CCI was 3.63 ± 1.40, with the most frequent diseases being hyperlipidemia, hypertension, and diabetes. After adjusting for confounding variables, a negative relationship between CCI (B = -0.009 [SE = 0.0027], P < 0.001) and PIM (B = -0.03 [SE = 0.007], P < 0.001) with quality of life was observed.ConclusionPotentially inappropriate medication uses and comorbidities are high in our older population, and these variables are negatively associated with quality of life in this population. There are few family physicians trained in geriatrics in Iran. Policymakers should pay attention to these issues.