Abstract
Background: Age-related comorbidities prone older adults to polypharmacy and to an increased risk of potentially inappropriate medication (PIM) use. This work aims to analyze the concordance and overlap among the EU(7)-PIM list, 2019 Beers criteria, and Screening Tool of Older Person’s Prescriptions (STOPP) version 2 criteria and also to analyze the prevalence of PIM.Methods: A retrospective cohort study was conducted on older inpatients of an internal medicine ward. Demographic, clinical, and pharmacological data were collected, during March 2020. After PIM identification by the EU(7)-PIM list, Beers criteria, and STOPP v2 criteria, the concordance and overlap between criteria were analyzed. A descriptive analysis was performed, and all the results with a p-value lower than 0.05 were considered statistically significant.Results: A total of 616 older patients were included in the study whose median age was 85 (Q1–Q3) (78–89) years. Most of the older patients were male (51.6%), and the median (Q1–Q3) number of days of hospitalization was 17 (13–22) days. According to the EU(7)-PIM list, Beers criteria, and STOPP criteria, 79.7, 92.0, and 76.5% of older adults, respectively, used at least one PIM. A poor concordance (<63.4%) among criteria was observed. An association between PIM and the number of prescribed medicines was found in all applied criteria. Moreover, an association between the number of PIMs and diagnoses of endocrine, nutritional, and metabolic diseases, mental, behavioral, and neurodevelopmental disorders, and circulatory system diseases and days of hospitalization was observed according to Beers criteria, and that with diseases of the circulatory system and musculoskeletal system and connective tissue was observed according to STOPP criteria.Conclusion: Despite the poor concordance between the EU(7)-PIM list, 2019 Beers, and STOPP v2 criteria, this work highlights the need for more studies in inpatients to develop strategies to facilitate the identification of PIM to decrease the high prevalence of PIM in hospitalized patients. The poor concordance among criteria also highlights the need to develop new tools adapting the existing criteria to medical ward inpatients.
Highlights
potentially inappropriate medication (PIM) are medicines in which the potential risk of occurrence of adverse drug reactions (ADRs) may be greater than the clinical benefit (Renom-Guiteras et al, 2015) that can be driven from their use, when there is scientific evidence of alternatives that may be safer, so it becomes essential to optimize the prescription of medicines in aged population (Renom-Guiteras et al, 2015; Grina and Briedis, 2017)
A retrospective cohort study was performed to examine the overlap and concordance between the European Union (EU)(7)-PIM list, 2019 American Geriatric Society (AGS) Beers criteria, and Screening Tool of Older Person’s Prescriptions (STOPP) v2 criteria on the detection of PIM among older inpatients of an internal medicine ward of a first-level hospital belonging to the NUTS II (Nomenclatura das Unidades Territoriais para Fins Estatísticos/Nomenclature of Territorial Units for Statistics) area of Portugal defined by the Regional Administration of Health Center (Administração Regional de Saúde do Centro/ ARS-C)
Because multiple comorbidities are frequent among internal medicine inpatients, a tool focusing on geriatric internal medicine patients should be implemented to alert the physician to an eventual PIM prescription
Summary
Age-related pharmacokinetic and pharmacodynamics changes cause a decrease in the ability to adapt to external environment alterations, increased susceptibility to the disease, a lesser capacity to recovery that causes a modified response to medications, greater susceptibility to the occurrence of adverse drug reactions (ADRs) (Alvis and Hughes, 2015; Gutierrez Valencia et al, 2016; Giardina et al, 2018), and an upsurge need for health resources (Stegemann et al, 2010).Polypharmacy, the use of five or more medicines (Lee et al, 2020), is quite common in patients with multiple comorbidities and is considered a factor for functional decline in older adults, which increases the chance of medication-related problems (Garcia-Caballero et al, 2018; Lee et al, 2020). Polypharmacy is associated with increased consumption of potentially inappropriate medication (PIM) (Oktora et al, 2020) In this context, medicines are considered appropriate for older adults, when there is a clear, evidence-based indication that these medicines are generally well tolerated and have a favorable benefit/risk ratio in older adults (Laroche et al, 2019). We sought to analyze the concordance and overlap between the EU(7)-PIM list, 2019 Beers criteria, and Screening Tool of Older Person’s Prescriptions (STOPP) version 2 (v2) criteria in the identification of PIM in older adult inpatients in a general internal medicine ward. This work aims to analyze the concordance and overlap among the EU(7)-PIM list, 2019 Beers criteria, and Screening Tool of Older Person’s Prescriptions (STOPP) version 2 criteria and to analyze the prevalence of PIM
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