Potentially inappropriate medications in older patients based on Beers criteria: a cross-sectional study of a family medicine practice in Saudi Arabia.

Atheer Alturki,Ghassan Watfa,Hajer Almudaiheem,Tareef Alaama,Ahmed Al-Jedai,Yousef Alomran

doi:10.3399/bjgpopen20x101009

Abstract

BackgroundThe use of potentially inappropriate medications (PIMs) is an important issue in older patients who are at risk of adverse drug events.AimTo determine the prevalence of PIM use, according to Beers criteria, among an older population (aged ≥65 years) in a large family medicine setting, and to identify the associated risks.Design & settingA prospective cross-sectional study of patients aged ≥65 years was conducted from June 2017 to June 2018 at the Family and Community Medicine (FCM) clinics of King Saud Medical City (KSMC) in Riyadh, Saudi Arabia.MethodThis cross-sectional study included patients aged ≥65 years who were seen at new appointments or followed-up at the FCM clinics of KSMC in Riyadh, Saudi Arabia. Data were collected by extensive face-to-face interviews and from the patients’ medical records.ResultsA total of 270 older patients aged 72.41 ±6.23 years (mean ±standard deviation [SD]) were included in the present study. The prevalence of PIMs was 60.7% (n = 164). Multivariate analyses identified three independent variables associated with PIMs: incremental age per 5 years (odds ratio [OR] 1.47, 95% confidence intervals [CI] = 1.15 to 1.88; P = 0.002), female sex (OR 1.95, 95% CI = 1.10 to 3.42; P = 0.021), and polypharmacy (OR 8.21, 95% CI = 4.58 to 14.7; P<0.001). The most common PIMs used were 39.4% related to proton pump inhibitors (PPI), 25.2% to diuretics (other than spironolactone), 10.6% to non-steroidal anti-inflammatory drugs (NSAIDs), and 8.7% to aspirin use.ConclusionThis study showed high prevalence of PIMs. Increasing age, female sex, and polypharmacy were found to be significant risk factors for PIM use. The frequency of morbidities was not significantly different among patients with PIMs compared to those without PIMs, except for hypertension and osteoarthritis, which were more common in the PIMs group. The present study reinforces the importance of comprehensive medication management and reviews.

Highlights

Inappropriate medication usage is an issue among older patients, those who have concomitant morbidities
Multivariate analyses identified three independent variables associated with potentially inappropriate medications (PIMs): incremental age per 5 years, female sex, and polypharmacy
The most common PIMs used were 39.4% related to proton pump inhibitors (PPI), 25.2% to diuretics, 10.6% to non-steroidal anti-inflammatory drugs (NSAIDs), and 8.7% to aspirin use

Summary

Introduction

Inappropriate medication usage is an issue among older patients (aged ≥65 years), those who have concomitant morbidities. It has been reported that the adverse drug events related to PIMs are associated with the rate of hospitalisation.[6] The use of inappropriate medications in this population has been shown to cause approximately 5% of hospital admissions.[7] a further study has shown interacting medications leading to adverse drug reactions in up to 35% of older outpatients, and 40% of inpatients with inappropriate medication use.[8] The Beers criteria were developed by Mark H Beers in 1991 at the University of California, Los Angeles, with subsequent updates. The use of potentially inappropriate medications (PIMs) is an important issue in older patients who are at risk of adverse drug events

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