Prescribing Pattern of Drugs in Geriatrics Patients Using Beers Criteria.

Beers revised: Drugs not to use in older adults

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

Inappropriate medications are often used in older adults despite their unfavourable risk-to-benefit profile. Although many of the medications in the American Geriatrics Society (AGS) Beers list are potentially inappropriate because of their anticholinergic properties, little is known regarding the nature and extent of potentially inappropriate anticholinergic medication use in older adults. To determine the prevalence of, and factors associated with, potentially inappropriate anticholinergic medication use in the older population. A retrospective, cross-sectional study was conducted, involving older adults (aged 65 years and older), using 2009-2010 Medical Expenditure Panel Survey (MEPS) data. The 2012 AGS Beers Criteria were used to define potentially inappropriate anticholinergic medications on the basis of the list of medications to avoid using in older adults irrespective of the diagnosis. Descriptive analyses were used to examine the nature and extent of potentially inappropriate anticholinergic medication use. Multivariable logistic regression within the conceptual framework of the Andersen Behavioral Model was used to identify the factors associated with potentially inappropriate anticholinergic use in older adults. According to the MEPS, there were 78.60 million older adults in the USA; an estimated 7.51 million (9.56 %) of these older adults used potentially inappropriate anticholinergic medications in 2009-2010. The most frequently used potentially inappropriate anticholinergics were cyclobenzaprine, promethazine, amitriptyline, hydroxyzine and dicyclomine. Multivariable regression analyses revealed that female sex, residing in the South and the presence of anxiety disorder increased the likelihood of receiving potentially inappropriate anticholinergic medications, whereas older adults aged 75-84 or ≥ 85 years, and those with over 15 years of education, had a decreased likelihood of receiving potentially inappropriate anticholinergic medications. The study found that approximately one in ten older adults used potentially inappropriate anticholinergic medications. Several predisposing, enabling and need factors were associated with the use of potentially inappropriate anticholinergic medications. Concerted efforts are needed to optimize potentially inappropriate anticholinergic medication use in older adults.

2019 AGS Beers Criteria for older adults

Commentary on the New American Geriatric Society Beers Criteria for Potentially Inappropriate 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.

Optimizing Medication Use in Older Adults

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.

ObjectiveTo analyze the prevalence of potentially inappropriate medication use in older adults and develop a nomogram for predicting the individualized risk for potentially inappropriate medication use.MethodsA retrospective cross-sectional study was conducted using prescription data from older adults who visited the Hefei Third People's Hospital between May 2022 and May 2024. The 2019 Beers Criteria and Chinese criteria for Determining Potentially Inappropriate Medication Use in Older Adults in China were used to identify potentially inappropriate medication use. We conducted univariate and multivariate logistic regression analyses to identify the factors associated with potentially inappropriate medication use and developed a nomogram model to predict the individualized risk of potentially inappropriate medication use.ResultsAmong the 475 older adults included, 195 (41.05%) had at least one incidence of potentially inappropriate medication use (total 288 occurrences). Medications considered as potentially inappropriate were most commonly used (88.72%), followed by medications to be used with caution (6.67%), potentially inappropriate drug-drug interactions (1.54%), and medications potentially inappropriate for patients with certain diseases or syndromes (2.05%). Benzodiazepines, rapid/short-acting insulin, proton pump inhibitors, and amitriptyline were the most frequently used potentially inappropriate medications. Independent risk factors for potentially inappropriate medication use included: (a) age ≥70 years; (b) diabetes mellitus; (c) hypertension; (d) coronary heart disease; (e) sleep disorders; (f) ≥3 comorbidities; and (g) use of ≥4 medications. The nomogram showed moderate discriminative ability (concordance index =0.738) with good calibration and minimal overfitting.ConclusionAdvanced age, multiple chronic conditions, and polypharmacy are key predictors of potentially inappropriate medication in older adults. Enhanced monitoring and personalized medication management may help reduce the risk of potentially inappropriate medication use in this population.

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.

Updated 2012 Beers Criteria: What’s Noteworthy and Cautionary?

Inappropriate medication use is a major problem for the elderly. Although increasing attention has been paid to inappropriate prescription medication use, most previous research has been limited to the investigation of prevalence and trends. Few studies provide the empirical evidence for the adverse effect of inappropriate medication use on health outcomes at the national level. This study is the first attempt to assess the relationship between inappropriate prescription use and health status for the elderly in the United States. Based on the 1996 Medical Expenditure Panel Survey, inappropriate medication use in a national representative elderly population was first identified using Beers criteria. A survey type of ordered probit model was then estimated to quantify the effect of inappropriate drug use on patient self-perceived health status measured using a five-point scale (poor, fair, good, very good, and excellent). After controlling for a set of possible confounding factors, it was found that individuals using inappropriate medications in Round 1 were more likely than those not using inappropriate medications to report poorer health status in Round 2. Other risk factors for poor health status include a higher number of prescriptions, being black, having low education, and having one or more chronic diseases. This study provides strong evidence of a significant adverse effect of inappropriate medication use on patient health status. These findings lend partial support to the use of Beers criteria in assessing the quality of prescribing and the appropriateness of medication use in the elderly population.

Tapering Recommendations for Benzodiazepines

Objectives: Potentially inappropriate medication (PIM) use is associated with increased morbidity and mortality in chronic kidney disease (CKD). However, there is a paucity of data on how hospitalization affects PIM use in older adults with CKD. Therefore, we aimed to measure the impact of hospitalization on PIM use in older CKD patients, and identify factors predicting PIM use.Methods: A retrospective cohort study was conducted in older adults (≥65 years) with CKD admitted to an Australian tertiary care hospital over a 6 month period. PIM use was measured, upon admission and at discharge, using the Medication Appropriateness Index (MAI) and Beers criteria (2015 version) for medications recommended to be avoided in older adults and under certain conditions.Results: The median age of the 204 patients was 83 years (interquartile range (IQR): 76–87 years) and most were men (61%). Overall, the level of PIM use (MAI) decreased from admission to discharge (median [IQR]: 6 [3–12] to 5 [2–9]; p < .01]). More than half of the participants (55%) had at least one PIM per Beers criterion on admission, which was reduced by discharge (48%; p < .01). People admitted with a higher number of medications (β 0.72, 95% CI 0.56–0.88) and lower eGFR values (β − 0.11, 95% CI −0.18 to −0.04) had higher MAI scores after adjusting for age, sex and Charlson’s comorbidity index.Conclusions: PIMs were commonly used in older CKD patients. Hospitalization was associated with a reduction in PIM use, but there was considerable scope for improvement in these susceptible individuals.

Potentially inappropriate anticholinergic medication use in older adults with dementia