Abstract
BackgroundThe elderly are frequently exposed to drug related problems causing hospitalizations and increased costs of care. Information about Romanian prescribing practices among the elderly and potential medication associated- risks is lacking. The objective of this study was to identify and compare the most frequent potentially inappropriate medications (PIM) recommended to ambulatory and institutionalized Romanian elderly, through an observational retrospective design.MethodsAll reimbursed medications prescribed to a sample of ambulatory elderly accessing two community pharmacies and all medications recommended to a group of institutionalized elderly (urban facilities, Romania, same month) were analyzed. The STOPP/START criteria and the PRISCUS list were used for PIM identification and for classification as misprescribed, underprescribed or overprescribed -subtypes.ResultsThe analysis involved 345 prescriptions recommended to ambulatory elderly and 91 medical files available for the institutionalized patients. The ambulatory elderly had a mean age of 74.8 years old and were daily exposed to a median number of 3 prescribed medications. The institutionalized elderly were older (mean age 80.77) received 8 medications daily and 69 % of them were functionally dependent. Cardiovascular and neuropsychiatric indications were the most frequent: 64.34 % and 18.55 % of the ambulatory prescriptions, 93.40 % and 41.75 % of the institutionalized patients’ medical files. 159 PIM were identified on 34.49 % of the ambulatory prescriptions. 82.41 % of the institutionalized patients’ medical files contained 140 PIM. The potential underprescribing of cardiovascular therapies was the most frequent PIM category on the ambulatory prescriptions (55.34 % of all PIM), while for the institutionalized patients’ medical files, the misprescribed and overprescribed PIM were those predominantly represented (62.14 % and 27.14 % of all PIM). In both subgroups of data, NSAIDs (56.66 % of ambulatory prescriptions and 35.63 % of institutionalized patients’ data) and benzodiazepines (26.66 % of ambulatory prescriptions and 24.13 % of institutionalized patient’s data) were predominantly misprescribed. Anticholinergics were rarely used (0.62 % of total PIM from ambulatory prescriptions, 2.14 % of total PIM from institutionalized patients’ data).ConclusionsThe PIM identified in both elderly groups suggested potential risks for the occurrence of adverse events specific to the elderly population. Larger studies, both observational and interventional, are needed to ensure a safer therapeutic approach.
Highlights
The elderly are frequently exposed to drug related problems causing hospitalizations and increased costs of care
The potentially inappropriate medications (PIM) identified in both elderly groups suggested potential risks for the occurrence of adverse events specific to the elderly population
The potentially inappropriate medications (PIM) and the corresponding phenomenon of potentially inappropriate prescribing (PIP) refer to the use of medications identified through various studies as factors that expose the elderly patient to safety or efficacy drug-related problems (DRP)
Summary
The elderly are frequently exposed to drug related problems causing hospitalizations and increased costs of care. The literature suggests three subtypes for PIM: misprescribed PIM involving medications with an increased risk for side effects or drug-interactions in the elderly, underprescribed PIM relating to the absence of medications proved to be effective for preventive or curative indications in the elderly, and overprescribed PIM relating to the use of therapies lacking therapeutic benefit [6, 7]. Such PIM can be identified in an individual therapeutic plan, using published explicit criteria consisting of lists of medications to avoid, to use cautiously or to actively recommend to the elderly. The simultaneous use of several such instruments was suggested as a more efficient method for PIM detection in elderly populations different from those used as validation group for the original criteria [16]
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