Shaping geriatric practice: evaluating Beers, PRISCUS, and European Union(7) criteria for optimal patient care. A retrospective study

Abstract

Medications whose risk of adverse drug events exceeds their expected clinical benefit when given to older patients are called potentially inappropriate medications (PIMs). The geriatric population represents about 10% of the world population and 7% of the Indian population and consumes 40% of prescription and 35% of all over-the-counter drugs. That is why it is necessary to evaluate the use of PIMs in the geriatric population. This study aimed to evaluate prescriptions for PIMs by using three pre-validated and internationally used criteria, namely the Beers criteria (2019), the European Union (EU)(7) list (2015), and the PRISCUS list (2010). A retrospective observational study began after obtaining written approval from the institutional review board. Demographic and clinical profiles and patients' complete prescriptions were recorded, and the Beers criteria (2019), the EU(7) (2015) list, and the PRISCUS list (2010) were applied. A p<0.05 was considered statistically significant. A total of 345 patients, with a mean age of 71.48 years, were included in the study. Vitamin D3 (56.81%) was frequently prescribed as medicine. According to the Beers, EU(7), and PRISCUS criteria, PIMs were 311 (11.26%), 272 (9.85%), and 105 (3.80%), respectively. Pantoprazole [20.57% Beers and 23.52% EU(7)] and glimepiride [15.43% Beers and 17.64% EU(7)] were the most inappropriate drugs. According to the PRISCUS list, piroxicam (21.9%) and etoricoxib (19.04%) were the inappropriate drugs. According to the Beers, EU(7), and PRISCUS criteria, total inappropriate prescriptions containing at least one PIM are 183 (52.04%), 174 (50.43%), and 88 (25.5%), respectively. The number of prescriptions with inappropriate medication is highly correlated with the total number of drugs prescribed per prescription (p<0.01) and the total number of fixed-dose combinations (p<0.01). Maximum PIMs were found with the Beers criteria and minimum PIMs with the PRISCUS list. This study shows that the prescription of PIMs ranges from 25.5 to 52.04%. The EU(7) list had the highest sensitivity (63.66%), while the PRISCUS list had the highest specificity (98.48%) to detect PIMs with the Beers criteria taken as a reference.