Abstract
Potentially inappropriate prescribing is the prescribing of a medication that may cause more harm than benefit, the elderly population aged 65 years or older is more prone to potentially inappropriate prescribing because of alterations in their physiology, pharmacokinetics, and pharmacodynamics as well as polypharmacy and comorbidities, Beers list is a screening tool that help doctors to detect potentially inappropriate prescribing in geriatric patients and is designed to solve this problem, the aim of this study is to measure the prevalence of potentially inappropriate prescribing among psychiatric patients using the Beers criteria as an assessment tool and find the relationship between duration of hospitalization, comorbidities and polypharmacy with potentially inappropriate prescribing in elderly.
 This cross-sectional study was carried out using electronic medical records in Ibn Rushud psychiatry and addiction hospital in Baghdad and 369 patients were included. The mean age of the patients was (68.59 ± 3.75 years) and 177 (48%) of them had comorbidities, 100 (27.1%) of them had polypharmacy and 17 (4.6%) stayed in the hospital for more than 3 weeks, the most used drug classes were antipsychotics in (39.9%) of patients and benzodiazepines in (17.6%) of patients.
 The prevalence of potentially inappropriate prescribing according to Beers criteria was found to be 74.3% among study patients, the most prevalent inappropriately used drug class was benzodiazepines, and there was a significant association between the prescribing of a potentially inappropriate medication with gender (p=0.018), with comorbidities (p=0.022), and a very significant association with polypharmacy (p<0.001)
Highlights
The study revealed that 78.9% of male patients in this study received psychotropic medications inappropriately, with statistically significant association (P=0.018) between gender of patients and prescription of inappropriate psychotropic medications, this study found a statistically significant association (P=0.022) between the presence of comorbidities and potentially inappropriate medications (PIMs) prescription, and there was a highly significant association between polypharmacy and being prescribed a potentially inappropriate medication (P
There are several factor that lead to the high prevalence of Potentially inappropriate prescribing (PIP) in 74.3% of this study patients such as: most patients admitted due to acute psychological conditions or agitation which in turn required aggressive therapeutic plans to improve patient’s condition, combined with the lack of safer alternative interventions which lead to the increased use of anxiolytics, hypnotics and antipsychotic injections; other factors that may have caused a false increase in PIPs is due to a flaw in the criteria itself for not providing a rule regarding a duration of medication use to be considered inappropriate which lead to many medications used only once by the patients to be counted as potentially inappropriate[13,14,15,16]
The second major result of this study is that benzodiazepines was the most prevalent PIM used, this is similar to other studies such as (M Gutiérrez-Valencia et al, 2017)(14) in Spain which measured the impact of hospitalization on PIP and found Benzodiazepines as the most inappropriately prescribed medication, other studies concerning elderly patients treated with psychotropic medications in Spain such as
Summary
Inappropriate prescribing (PIP) can be defined as the prescribing of a medication that the risk of adverse drug reaction may outweigh the benefit of the medication especially if there is a safer alternative available[1].The elderly population which is aged 65 years or older has been increasing rapidly, since the last century are very susceptible to the problem of PIP because of the alterations in their pharmacodynamics and pharmacokinetics as well as other drug-related problems such as polypharmacy and having multiple co-morbid diseases [2,3].There are many consequences of PIP, including increased adverse drug events such as cognitive impairment, falls and fractures which can lead to increase emergency room visits and prolonged hospitalization and increased health care use and cost[4,5,6]. It is challenging to prescribe for geriatric patients with mental disorders because there are many factors influencing prescribing options that can cause alterations in pharmacokinetics such as changes in renal clearance, liver metabolic activity, brain volume, lean body mass and albumin binding this can lead to increased sensitivity to drugs effect especially in the central nervous system [7]. Patients with mental disorders may be less able to express their discomfort or drugrelated problems such as side effects especially in patients with dementia, they may communicate their discomfort as aggression or agitation[9]. This miscommunication may be perceived as worsening of their mental disease rather than a drug-related adverse effect. The geriatric population are often excluded from most clinical trials, typically clinical trials conducted in adult population include patients between the ages of 18 and 64 years which causes a limited evidence base for medication use and safety in this population[10,11]
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