Prevalence of Potentially Inappropriate Medication use in older drivers

Guohua Li,Linda L Hill,David Strogatz,Carolyn Diguiseppi,David P Merle,Thelma J Mielenz,Cheng Shiun Leu,Abigail Gordon,Marian E Betz,Stanford Chihuri,Barbara H Lang,Howard F Andrews,David W Eby,Lisa J Molnar,Vanya C Jones

doi:10.1186/s12877-019-1287-8

Abstract

BackgroundPotentially Inappropriate Medication (PIM) use has been studied in a variety of older adult populations across the world. We sought to examine the prevalence and correlates of PIM use in older drivers.MethodsWe applied the American Geriatrics Society 2015 Beers Criteria to baseline data collected from the “brown-bag” review of medications for participants of the Longitudinal Research on Aging Drivers (LongROAD) study to examine the prevalence and correlates of PIM use in a geographically diverse, community-dwelling sample of older drivers (n = 2949). Proportions of participants who used one or more PIMs according to the American Geriatrics Society 2015 Beers Criteria, and estimated odds ratios (ORs) and 95% confidence intervals (CIs) of PIM use associated with participant characteristics were calculated.ResultsOverall, 18.5% of the older drivers studied used one or more PIM. The most commonly used therapeutic category of PIM was benzodiazepines (accounting for 16.6% of the total PIMs identified), followed by nonbenzodiazepine hypnotics (15.2%), antidepressants (15.2%), and first-generation antihistamines (10.5%). Compared to older drivers on four or fewer medications, the adjusted ORs of PIM use were 2.43 (95% CI 1.68–3.51) for those on 5–7 medications, 4.19 (95% CI 2.95–5.93) for those on 8–11 medications, and 8.01 (95% CI 5.71–11.23) for those on ≥12 medications. Older drivers who were female, white, or living in urban areas were at significantly heightened risk of PIM use.ConclusionAbout one in five older drivers uses PIMs. Commonly used PIMs are medications known to impair driving ability and increase crash risk. Implementation of evidence-based interventions to reduce PIM use in older drivers may confer both health and safety benefits.Trial registrationNot applicable.

Highlights

Inappropriate Medication (PIM) use has been studied in a variety of older adult populations across the world
In addition to the list of Potentially Inappropriate Medication (PIM) that should generally be avoided in older adults, the Beers Criteria includes medications that should be avoided in older adults with specific diseases or syndromes
The Beers Criteria was originally designed as a clinical tool for reducing PIM use and related harms in nursing home residents, it has evolved into an integral part of healthcare policy and best practice in geriatrics [3], and is applicable to all older adults except those in palliative and end-of-life care

Summary

Introduction

Inappropriate Medication (PIM) use has been studied in a variety of older adult populations across the world. The Beers Criteria lists potentially inappropriate medications (PIMs) that should generally be avoided in older adults because they are ineffective or their risk of adverse effects outweighs the benefit. In the past two decades, numerous studies have used the Beers Criteria to examine the prevalence of PIM use and associated health consequences in different population groups, such as residents of long-term care facilities, ambulatory care patients, patients filling prescriptions at pharmacies, and community-dwelling older adults [3, 4]. Use of PIMs in older adults has been recognized as an important cause of adverse drug reactions [11, 12] and excess healthcare costs [13], and has been linked to increased risk of hospitalization and death [4]

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