Abstract
Objective: The objectives of the present study were to determine the prevalence of Potentially Inappropriate Medications and Adverse Drug Reactions in older adults and to collect doctors’ responses regarding the PIM list or any other criteria to treat older adults in India.
 Methods: This was an observational study conducted in different tertiary care hospitals of two districts, Erode and Salem after obtaining approval of the Institutional Ethics Committee. A sample of 250 older adults (60 y and above) and 97 doctors were included during the study period of 6 mo from February 2019 to July 2019. Inappropriate medications were identified by using 2019 updated Beer’s criteria. The causality of the adverse events was assessed by Naranjo Adverse Drug Reaction Probability Scale.
 Results: Out of the 250 prescriptions, only 86(34.4%) of the prescriptions were appropriate and 164(65.6%) were inappropriate. The most commonly inappropriate prescribed medications were diuretics, ranitidine, and tramadol. A total of 74 ADRs was observed in 74 patients. Of these, 57(22.8%) ADRs were due to inappropriate medications listed in Beers criteria. There was a significant association between the occurrence of ADRs and the use of PIMs listed in 2019 updated Beer’s criteria [χ2 = 6.08, P = 0.013 (df = 1)].
 Conclusion: The study shows that there is a high prevalence of inappropriate medications and adverse drug reactions in hospitalized older adults. Beer’s criteria can be used as a guideline by the physicians while prescribing the drugs to the geriatric population.
Highlights
Most developed countries have accepted the chronological age of 65 y as a definition of ‘elderly’ or ‘older person’ [1]
Inappropriate prescribing in the elderly population is a major public health issue, given its direct linkage to substantial morbidity, mortality and wastage of health resources that result from adverse drug reactions [3]
A total of 690 diseases was diagnosed in 250 studied subjects, of which 73 (29.2%) patients were diagnosed with three diseases/comorbidities followed by 63 (25.2%) with four or more, 58 (23.2%) patients with two and 56 (22.4%) with one disease/co-morbidities
Summary
Most developed countries have accepted the chronological age of 65 y as a definition of ‘elderly’ or ‘older person’ [1]. In January, 1999 the Government of India adopted ‘National Policy on Older Persons’ and this policy defines ‘senior citizen’ or ‘elderly’ as a person who is of age 60 y or above. The population ageing, started in the last century with developing countries, is encircling developing countries too due to various reasons including better health care systems. There are 104 million aged persons (aged 60 y or above) in India; 53 million females and 51 million males, consistent with the population census 2011. Inappropriate prescribing in the elderly population is a major public health issue, given its direct linkage to substantial morbidity, mortality and wastage of health resources that result from adverse drug reactions [3]. Appropriateness in healthcare has been defined as “the outcomes of a process of decision making that maximizes net health gains within society’s available resources”. Appropriate prescribing associated with a reduction of over-use, under-use and misuse of treatment [4]
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