Beers Criteria Research Articles

Use of potentially inappropriate psychotropic medicines among older adults in 23 residential aged care facilities in Australia: a retrospective cohort study

BackgroundPsychotropic medications are frequently utilised in residential aged care facilities (RACFs). Longitudinal medication administration data can offer crucial insights into the potential inappropriate use of psychotropic medicines (PIPMs), guiding future quality improvement initiatives. This study aimed to determine the prevalence and predictors of PIPMs use and assess variation in PIPMs use by facility for residents of RACFs.MethodsWe conducted a retrospective longitudinal cohort study using routinely collected electronic health data (2020–2021) relating to 3064 residents from 23 RACFs in New South Wales, Australia. The study included permanent residents aged ≥ 65 years and median length of stay was 483 days. The prevalence of PIPMs use was estimated using updated Beers criteria 2023. The extent of exposure to PIPMs was measured using two metrics i.e., number of days residents were exposed to PIPMs and the proportion of days covered by PIPMs. We used logistic regression model to determine factors associated with PIPM use. Funnel plots to visualised variation in PIPMs use across facilities.ResultsIn total 40% (n = 1224) residents used at least one PIPM and 10% (n = 302) used ≥ 2. The most frequently used PIPMs categories were benzodiazepines and Z-drugs (27.4%), followed by first and second generation antipsychotics (17.2%). Certain diagnoses (dementia, pain, depression, anxiety, and endocrine disorders) were associated with the increased use of PIPMs. For example, residents with dementia were 1.94 times more likely to use ≥ 2 PIPMs (OR 1.94; 95% CI 1.50–2.51). The prevalence of at least one PIPM by residents in each facility ranged from 23.3 to 57.0% across facilities. The overall median number of days residents were exposed to PIPMs were 91 days (IQR 6-320) while the median proportion of days covered by at least one PIPM was 39.3% (IQR 2.6–86.6%).ConclusionsResidents in aged care facilities showed a high rate of PIPMs use with substantial variation across facilities. Quality improvement initiatives which target inappropriate psychotropic medication use are necessary, particularly considering the link between psychotropic drug use and adverse events such as falls.

Prevalence, determinants, and health outcomes of potentially inappropriate medication use according to the 2023 Beers criteria among hospitalised older patients

BackgroundThis study aims to determine the prevalence, determinants, and rehospitalisation outcomes of potentially inappropriate medication (PIM) use among hospitalised older patients. Design and participantsThis retrospective cohort study analysed older patients admitted to a tertiary care hospital from 2021 to 2023. We evaluated PIM prescriptions using the 2023 Beers criteria, classifying the patients as PIM users or non-users. We assessed the prevalence of PIM use, identified its determinants, and investigated the association between PIM use and rehospitalisation for any reason within one year of discharge, as well as the related length of stay and total medical costs. ResultsThe study comprised 20,629 hospitalised older patients with a mean age of 71.17 ± 8.14 years, 50.21% of whom were women. PIM usage was prevalent among 91.32% of the patients. The determinants of PIM use included being female, having a longer hospital stay, an increasing number of prescribed drugs, and three or more chronic conditions. However, the use of PIM did not significantly increase the risk of rehospitalisation (adjusted hazard ratios = 1.02; 95% CI = 0.87–1.19), length of stay (adjusted mean difference [aMD] = 0.35 days; 95% CI = -1.31 to 2.01 days), or cost of medical care (aMD = 2,039 Baht; 95% CI = -9,824 to 13,901 Baht). ConclusionsThe use of PIMs among hospitalised older patients remains alarmingly high and is strongly correlated with the number of prescribed drugs. However, no significant link was found between PIM use and rehospitalisation outcomes within a one-year period.

De-Med—a tool to identify and classify potentially inappropriate medication according to Beers criteria, STOPP, and FORTA: a cross-sectional study

Abstract Objective A significant number of older adults are affected by the use of potentially inappropriate medications (PIMs), leading to various adverse outcomes, such as increased physical and cognitive impairment, frailty, hospitalization, and mortality. The objective of this study was to develop and test the reliability and feasibility of the De-Med tool. Methods This tool was developed using ReactJS for data extraction and manipulation. Users can upload drug lists for analysis, and the software delineates PIMs adhering to the Beers 2019 version, Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) Version 2, and Fit fOR The Aged (FORTA) 2021 criteria. Reliability was assessed by juxtaposing software-generated outputs with manual assessments conducted by independent research pharmacists using retrospective medication records. The System Usability Scale (SUS) and AttrakDiff Mini questionnaires were used to assess feasibility and usability, respectively. Key findings Manual and software-generated PIM identifications agreed completely, demonstrating high reliability (100% concordance). A total of 1496 PIMs were identified from 231 records, with an average of 0.63 encounters per patient. The overall usability score was 83.75, indicating “Excellent.” According to the AttrakDiff ratings, users attributed the software to both pragmatic (mean PQ:1.84) and hedonic (mean HQ:1.50) qualities, with moderate overall attractiveness (mean ATT:2.13). Conclusions This web-based tool successfully identified PIMs with perfect reliability, high usability, and a moderate level of attractiveness. This tool has the potential to improve medication management in older adults by reducing PIMs.

Prescribing patterns in people living with dementia in the community: A cross-sectional study.

To identify the prevalence of and factors associated with medication use in people living with dementia in the community. A cross-sectional study using baseline data from a randomised controlled trial known as the Interdisciplinary Home-bAsed Reablement Program (I-HARP) between 2018 and 2021 in Sydney, Australia. Participants included people with mild-moderate dementia and their carers. Medication use was classified according to the Anatomical Therapeutic Chemical codes, while potentially inappropriate medications (PIMs) were defined using 2019 Beer's Criteria and 2024 Australian list. Logistic regression models were used to identify factors associated with use of medication classes. A total of 130 people with dementia and their carers were included. Of the people with dementia, 35% were using antidementia medication, 48% psychotropics, 76% PIMs and 65% polypharmacy (≥5 medications). Polypharmacy was associated with the use of psychotropics (adjusted OR [aOR]: 5.09, 95% confidence interval [CI]: 1.94-13.39) and PIMs (aOR: 17.38, 95% CI: 5.12-59.02). Higher education level was associated with lower odds of psychotropic use (aOR: .33, 95% CI: .15-.76), and age over 80 years was associated with lower odds of antidementia medication use (aOR: .29; 95% CI: .12-.72). The use of PIMs, psychotropics and polypharmacy were common in this sample of people with dementia living in the community. Associations were seen between participant characteristics and medication use. Future research should focus on reviewing PIMs and polypharmacy in people with dementia living in the community to assess the impact on health outcomes.

Non-steroid anti-inflammatory drugs: recommendations and precautions for safe use in a multidisciplinary surgical department

Aim of the study. Conducting a safety analysis of the use of non-steroidal anti-inflammatory drugs in order to develop informed recommendations and precautions for medical practice.Materials and methods. A retrospective analysis of inpatient medical records of 250 patients in the multidisciplinary surgery department was conducted for the period from December 2023 to February 2024.Results and discussion. Based on the results of the analysis of inpatient medical records, such criteria as the presence of indications for the prescription of non-steroidal anti-inflammatory drugs (according to the diagnosis, clinical pain syndrome and according to pain assessment scales), compliance of the choice of non-steroidal anti-inflammatory drugs with national protocols/international recommendations, compliance with age, the patient's physiological/ pathological condition and allergy history for the prescription of non-steroidal anti-inflammatory drugs were 100%. The indicator for compliance of a single therapeutic dose, route of administration, frequency, duration and an appropriate diluent of non-steroidal anti-inflammatory drugs with instructions for use was 86%, where medication errors were mainly made in the frequency of use of drugs. The percentage of polypharmacy was 20%. The criterion for assessing drug-drug interactions between drugs taken by patients showed that interactions of high clinical significance (major) were 8%, while those of moderate clinical significance (moderate) were 40%.Conclusions. Nonsteroidal anti-inflammatory drugs are convenient and affordable drugs that are widely used in the treatment of diseases of various organs and systems. Therefore, to ensure the rational and safe use of drugs in this group, it is necessary to introduce effective recommendations and precautions:1. Timely completion of pain assessment scales and diary records in the Damumed medical information system;2. Development in the Damumed medical information system of divisions of appointments into planned and pro re nata (as necessary), introduction into the system of accurately recording the time of execution of doctors’ prescriptions by nursing staff for strict compliance with the intervals between doses of non-steroidal anti-inflammatory drugs allowed by the instructions.3. Introduction into the practice of doctors the use of tools to combat polypharmacy in patients ≥65 years old: Beers criteria;4. Conducting educational activities, covering both medical personnel and patients, in order to increase the level of registration of unwanted adverse reactions.

Prevalence and Predictors of Potentially Inappropriate Prescribing in Older People Receiving Home Health Care in Saudi Arabia According to the American Geriatrics Society Beers Criteria 2019.

Potentially inappropriate prescribing (PIP) is a common health problem in older adults and is associated with negative health outcomes such as the occurrence of adverse drug events. Several studies have been conducted in different countries and settings to assess the prevalence of PIP, including in Home Care Services. However, data on the prevalence of PIP in home-care services in Saudi Arabia are limited. This study aimed to evaluate PIP use among older patients receiving home healthcare services in Saudi Arabia and to identify the predictors and commonly implicated medications.; Methods: A cross-sectional study was conducted over an 8-month period between January and August 2023. Data were collected from the medical records of patients older than 65 years who were currently receiving home health care services at King Faisal Hospital in Taif City, Saudi Arabia. PIPs were identified using the 2019 updated Beers Criteria.; Results: A total of 375 patients were included. Out of these, 285 PIPs were identified, of which 219 patients (58.4%) received at least one PIP. The most common therapeutic class associated with the PIPs was gastrointestinal medications (66.3%). Patient age and number of medications were significant predictors of PIP.; Conclusions: Our study found a high prevalence of PIP among elderly patients receiving home health care in Taif, Saudi Arabia. This study highlights the need for improved patient data automation and implementation of the Beers criteria to prevent PIPs in the future.

Polypharmacy and potentially inappropriate medicine use in older adults with cancer: a multicenter cross-sectional study in Northwest Ethiopia oncologic centers.

Most patients with cancer have comorbid conditions that necessitate advanced medical treatment. Polypharmacy (PP) and potentially inappropriate medicine (PIM) use is common among older adult patients with cancer. Not much research has been conducted on PP and PIM use among older adult patients with cancer in Ethiopian oncology centers. Therefore, this study aimed to evaluate the prevalence and determinants of PP and PIM use among older adults with cancer in Northwest Ethiopia oncology centers using the American Geriatrics Society (AGS) 2019 updated Beers criteria. This multicenter cross-sectional study was conducted among older adult patients with cancer from July 15-December 30, 2023 in Northwest Ethiopian oncology centers. The use of at least one drug included in the 2019 Beers criteria revisions was classified as potentially inappropriate medication use. To identify the factors influencing PP and PIM use, logistic regression analysis was performed. Of the 310 samples aproched, 305(98.4% response rate) participated in the study. The prevalence of PP and PIM use were 70.2% (95% CI 64.9-75.1) and 63.0% (95% CI 57.4-68.8) respectively. Being female AOR:3.6; 95% CI:1.7-7.8; p = 0. 001, advanced age [(70-74 years) AOR:3.9; 95% CI:1.2-6.7; p = 0.046 and ≥75 years AOR:3.8; 95% CI:1.7-8.4; p = 0.0028], abnormal body weight (underweight AOR:5.5; 95% CI:1.5-9.6; p = 0.019, overweight AOR:5.1; 95% CI:1.5-7.3; p = 0.01 and obese AOR:5.6; 95% CI:1.5-9.3; p = 0.021) and comorbidities AOR:3.5; 95% CI:1.7-8.3; p = 0.0032 were statistically significant factors for PP. Advanced age [(70-74 years) AOR:5.5; 95% CI:1.4-9.8; p = 0.015 and ≥75 years AOR:3.3; 95% CI:1.5-7.1; p = 0.002)] and polypharmacy; AOR:7; 95% CI:3.4-9.4; p = 0.001 were statistically significant factors for PIM use. Polypharmacy and potentially inappropriate medicine use were prevalent among older adult patients with cancer. Ensuring safe medicines prescription practices for older patients with cancer requires understanding the issue, stopping unwarranted treatment, and replacing it with less toxic, age-appropriate medicines.

Polypharmacy in an Older Female: Thoughtful Deprescribing

Abstract The magnitude of polypharmacy is on the rise as the global population faces a demographic shift with a larger proportion of older people, along with a marked increase in the prevalence of multimorbidity. An 85-year-old woman with diabetes mellitus, systemic hypertension, rheumatoid arthritis, chronic depression, parkinsonism, and dementia presented with inappropriate polypharmacy, taking 32 medications. Comprehensive medication reconciliation was performed using the Discuss, Review, Use tools, Geriatric medicine approach, and Stop medication guide, assessing appropriateness based on Beers Criteria. Goals of care were established through shared decision-making, focusing on reducing her pill burden and relaxing treatment targets for blood pressure and glycated hemoglobin. The patient was ultimately prescribed 13 medications. This case highlights the importance of tailored, patient-centered approaches in managing polypharmacy and chronic conditions in older adults to improve overall health outcomes.

Should a physician use the Beers criteria when prescribing direct oral anticoagulants to elderly patients?

The Beers Criteria are a tool for optimizing pharmacotherapy in elderly patients, containing information on potentially inappropriate drugs, which is only advisory in nature and is not mandatory for use in Russian Federation. In the updated version of the Beers Criteria from 2023, the expert opinion on rivaroxaban has changed — instead of "use with caution", as stated in the previous document from 2019, the experts now believe that "long-term treatment with rivaroxaban in non-valvular atrial fibrillation (AF) and venous thromboembolic complications (VTE) should be avoided in favor of safer alternative anticoagulants". This statement is based on moderate-quality evidence obtained from observational studies and network meta-analyses, which are significantly inferior to randomized controlled trials and have numerous limitations. The available evidence base for the use of rivaroxaban in elderly patients with AF and VTE and critical comments on the Beers criteria methodology, indicate the recommendations of the American Geriatrics Society experts regarding direct oral anticoagulants (DOAC) should be treated thoughtfully and carefully. When choosing a DOAC in elderly patients with AF or VTE, one should primarily focus on current clinical guidelines mandatory for use in Russian Federation, and on the data of studies that studied the efficacy and safety of specific DOACs in this category of patients. Rivaroxaban is a well-studied anticoagulant in elderly patients with AF and VTE, since its efficacy and safety have been established in RCTs and specially designed multicenter prospective observational studies with a fairly high quality of evidence. Based on this, rivaroxaban is a justified treatment option for elderly and senile patients with AF or VTE.

Effect of polypharmacy and potentially inappropriate medications on physical functional decline among older adults with advanced cancer receiving systemic treatment.

Polypharmacy and potentially inappropriate medications (PIM) are common among older adults with advanced cancer, but their association with physical functional outcomes is understudied. This study aimed to estimate the risk of physical functional decline associated with medication measures in older adults with advanced cancer starting a new line of systemic treatment. This secondary analysis of GAP 70+ Trial (PI: Mohile) enrolled patients aged 70+ with advanced cancer, had ≥ 1 geriatric assessment domain impairment and planned to start a new antineoplastic regimen with a high risk of toxicity. Polypharmacy (concurrent use of ≥ 8 medications (meds)) was assessed before initiation of treatment. PIM were categorized using Screening Tool of Older Person's Prescriptions (STOPP) criteria and 2019 Beers criteria. Physical functional outcomes were assessed within 3months of treatment initiation: (1) Activity of Daily Living (ADL) decline: 1-point decrease in ADL score between baseline and 3months; (2) Instrumental ADL (IADL) decline: 1-point decrease in IADL score between baseline and 3months; (3) Short physical performance battery (SPPB) decline, defined as 1-point decrease on SPPB; (4) ≥ 1 falls within 3months of treatment. Separate multivariable, cluster-weighted Generalized Estimating Equations models adjusted for relevant covariates (e.g., age, baseline function/comorbidities). Among 616 participants, mean number of meds was 6 (range 0-24); 28% received ≥ 8 meds. Polypharmacy was associated with increased risk of ADL decline (adjusted risk ratio [aRR], 1.31; 95% CI, 1.00-1.71). Taking ≥ 1 PIM per STOPP was associated with increased risk of IADL decline (aRR, 1.21; 95% CI, 1.04-1.40) and falls (aRR, 1.93; 95% CI, 1.49-2.51). In a large cohort of vulnerable older adults with advanced cancer receiving systemic treatment, polypharmacy and PIM were independently associated with an increased risk of physical functional decline. This emphasizes the need to develop interventions to optimize medication use, intending to improve outcomes in these patients. ClinicalTrials.gov Identifier: NCT02054741. Registered 01-31-2014.

The management of polypharmacy in people living with HIV.

Antiretroviral therapy (ART) has modified the prognosis of HIV which has evolved into a chronic condition. People living with HIV (PLWH) are living longer presenting an increased number of comorbidities leading to polypharmacy. Literature on the prevalence, associated factors, drug-drug interactions (DDIs), effects on ART-outcomes, geriatric conditions, and nutritional status together with health-interventions aimed to reduce it is presented in this review. A literature search was conducted on the MEDLINE database for all relevant English- and Spanish-language studies since 2006. Studies providing data of interest were identified and ordered in groups: (i) prevalence and associated factors (n = 37), (ii) DDIs (n = 19), (iii) Effects on ART-outcomes (n = 12), (iv) Effects on health conditions (n = 13), and (V) Health-interventions to assess and/or reduce it (n = 9). Polypharmacy occurs in 9-91% of PLWH (2.6-19.5% affected by severe polypharmacy). Main factors associated with polypharmacy are older age, a higher number of comorbidities, frailty, deteriorated renal function, and previous hospitalizations. DDIs were present in 19.15-84% of cases (1.3-12.2% for the most severe types). Mainly involved non-ART drugs were antihypertensives, statins, antithrombotic agents, corticosteroids, divalent cations, and antiacids. Polypharmacy can affect ART selection, adherence, and outcomes and has been related to some geriatric conditions such as falls, frailty, and poor nutritional status. Potentially prescribing issues are present in up to 87.9% of cases according to the STOPP-START and Beers criteria and some pharmacist-led interventions have been shown to reduce it. Considering these findings, polypharmacy should be considered a clinical concern in this population and treatment-optimization programs are needed to reduce its burden.

Analysis of Beer's Criteria 2019 and Patient Characteristics of Potentially Inappropriate Medication in Elderly Patients with Diabetes Mellitus

Background: Elderly patients with type 2 diabetes mellitus with polypharmacy and various comorbidities often have problems with Potentially Inappropriate Medications (PIMs). One of the methods commonly used to detect this event is Beer's Criteria 2019.Objectives: This study aims to: (1) identify the characteristics of elderly hospitalized patients with type 2 DM; (2) analyze the incidence of PIM in patients; and (3) analyze the relationship between characteristics (age, gender, comorbidities, length of stay, and number of drugs given) with the incidence of PIMs.Methods: The research was conducted at two type C hospitals in the city of Bengkulu, with a total of 105 patients using the purposive sampling method. This research is a cross-sectional study with data collection techniques in the form of medical record data from patients for the period January – December 2022 who received drug therapy. Data analysis consists of comparing data with Beer'’s Criteria, quantitative descriptive and Fisher'’s test.Results: The research results showed that: (1) the largest age group in Hospitals ) had comorbidities, the highest number of drugs given was more than 10 types of drugs, and the majority of patients were hospitalized for less than five days; (2) There was an incidence of PIMs of 98.65% (73 patients) in Hospital (3) Statistical tests show that there is no relationship between age, gender, comorbidities, number of medications and length of stay with the incidence of PIMs.Conclusion: There is still inappropriate use of drugs given to elderly DM patients. It is hoped that further researchers will be able to find out the reasons for giving these drugs to elderly patients.

Potentially Inappropriate Medication Use in Older Adults With Multimorbidity in Taiwan.

Medication-related problem is a concerning issue in older adults with multimorbidity due to complexity of disease conditions and polypharmacy, and may lead to increase in risk for adverse health outcomes. This study aims to investigate the prevalence and associated factors of potentially inappropriate medication use among the growing population of older adults with multimorbidity in Taiwan. The study population was composed of patients who were aged 65 years or older with multimorbidity (two or more chronic diseases) and had at least one outpatient clinic visit with drug prescription in 2018 identified from the Taiwan National Health Insurance Research Database. Potentially inappropriate medication use was defined using the 2019 Beers criteria for drugs to be avoided for older adults. Multiple logistic regression model was conducted to examine patient-related and prescriber-related factors associated with PIM use. A total of 2 432 416 patients (69.7% of the entire older adult population) had multimorbidity and received at least one drug prescription at the outpatient clinic in Taiwan in 2018. The prevalence of having at least one PIM in this population was found to be 85.6%. Patient-related factors (age, sex, specific chronic diseases, frequency of outpatient visits) and prescriber-related factors (physician characteristics, healthcare setting, total number of medications, prior PIM use) were found to be associated with use of PIM. High prevalence of PIM use was found in older patients with multimorbidity in Taiwan. Both patient-related and prescriber-related factors had been found to be predictors of PIM use, and should be addressed when trying to improve the medication quality in this population.

Inappropriate prescribing and association with readmission or mortality in hospitalised older adults with frailty: a systematic review and meta-analysis

BackgroundInappropriate prescribing (IP) is common in hospitalised older adults with frailty. However, it is not known whether the presence of frailty confers an increased risk of mortality and readmissions from IP nor whether rectifying IP reduces this risk. This review was conducted to determine whether IP increases the risk of adverse outcomes in hospitalised middle-aged and older adults with frailty.MethodsA systematic review was conducted on IP in hospitalised middle-aged (45–64 years) and older adults (≥ 65 years) with frailty. This review considered multiple types of IP including potentially inappropriate medicines, prescribing omissions and drug interactions. Both observational and interventional studies were included. The outcomes were mortality and hospital readmissions. The databases searched included MEDLINE, CINAHL, EMBASE, World of Science, SCOPUS and the Cochrane Library. The search was updated to 12 July 2024. Meta-analysis was performed to pool risk estimates using the random effects model.ResultsA total of 569 studies were identified and seven met the inclusion criteria, all focused on the older population. One of the five observational studies found an association between IP and emergency department visits and readmissions at specific time points. Three of the observational studies were amenable to meta-analysis which showed no significant association between IP and hospital readmissions (OR 1.08, 95% CI 0.90–1.31). Meta-analysis of the subgroup assessing Beers criteria medicines demonstrated that there was a 27% increase in the risk of hospital readmissions (OR 1.27, 95% CI 1.03–1.57) with this type of IP. In meta-analysis of the two interventional studies, there was a 37% reduced risk of mortality (OR 0.63, 95% CI 0.40-1.00) with interventions that reduced IP compared to usual care but no difference in hospital readmissions (OR 0.83, 95% CI 0.19–3.67).ConclusionsInterventions to reduce IP were associated with reduced risk of mortality, but not readmissions, compared to usual care in older adults with frailty. The use of Beers criteria medicines was associated with hospital readmissions in this group. However, there was limited evidence of an association between IP more broadly and mortality or hospital readmissions. Further high-quality studies are needed to confirm these findings.

Experience of using Beers criteria in clinical practice (according to Russian literature)

Objective: analysis of domestic scientific literature to identify ways of applying the Beers criteria, frequency of prescriptions and the structure of potentially inappropriate medications (PIMs) in elderly patients.Material and methods. The search for publications was carried out in Google Scholar abstract database, as wel as in eLibrary and CyberLeninka information-bearing networks for the period from 2013 to 2023. In total, 34 articles were found, among which 18 sources used Beers criteria as a tool for identifying PIMs.Results. In inpatient therapeutic departments, the maximum frequency of PIMs prescriptions according to the Beers criteria was 66.6% of cases, in surgical departments – 70%, in psychiatric departments – 90.4%, and in outpatient treatment settings – 28%. Non-steroidal anti-inflammatory drugs at different diseases were the most prescribed group of PIMs in both inpatients and outpatients. Surgical hospitals took the leading position in prescribing these drugs; specifically, more than 2/3 of elderly patients (75%) received them. According to two studies describing clinical cases of drug-induced falls in patients, the Beers criteria were effective in identifying drugs that can provoke this condition. One of papers presented application of Beers criteria to assess the economic affordability of replacing PIMs with safer new generation drugs.Conclusion. An analysis of domestic literature data has shown various ways of applying the Beers criteria, the frequency of prescriptions, and the most common PIMs. This information will help healthcare workers to be more wary of such drugs and think over applying the Beers criteria in routine practice of geriatric patients, which will further prevent or reduce the number of adverse drug reactions.

Risk of falls or fall-related injuries associated with potentially inappropriate medication use among older adults with dementia.

Potentially inappropriate medications (PIMs) are prevalent in older adults with dementia and subsequent falls or fall-related injuries. The present study determined the risk of falls or fall-related injuries associated with PIM use in older adults with dementia. The National Health Insurance Service-Elderly Cohort Database 2.0 (NHIS-ECDB2.0) was used for this self-controlled case series (SCCS) study. This study included 1430 participants who went through exposure and non-exposure periods of PIM application among patients with dementia and experienced outcome events of falls or fall-related injuries between January 2016 and December 2019. The incidence of falls or fall-related injuries during the exposure and post-exposure periods was compared with that during the non-exposure period. Beers Criteria were used to define PIMs in patients with dementia. Negative binomial regression was conducted. The incidence rate ratio (IRR) was used to determine the risk of falls or fall-related injuries. During the exposure periods in which falls or fall-related injuries occurred, the mean number of PIMs among patients with dementia was 3.76 (SD = 2.99), and the most commonly used PIMs among patients with dementia were first-generation antihistamines (n = 283; 59.1%). Compared to the non-exposure period, the adjusted IRR during the exposure period was 1.57 (95% CI = 1.39-1.76). The risk of falls or fall-related injuries was increased when PIM use in patients with dementia was initiated (1-14days: IRR = 2.76, 95% CI = 2.31-3.28; 15-28days: IRR = 1.95, 95% CI = 1.48-2.56; ≥ 29days: IRR = 1.17, 95% CI = 1.01-1.35). Especially, an increased risk of falls or fall-related injuries was associated with greater PIM use among patients with dementia. Among older adults with dementia, PIMs significantly increase the risk of falls and fall-related injuries. Therefore, strategies should be developed to manage PIM prescriptions in patients with dementia to prevent falls.

The frequency of potentially inappropriate medication usage in community-dwelling oldest-old people.

It is critically important to protect the health of the oldest-old people, as their hospitalization and death rates are high. The objective of this study was to analyze the prevalence of potentially inappropriate medication use among the community-dwelling oldest-old people and its association with their demographic characteristics. Data were collected from real-world settings using the observational method for this descriptive study. An older adult aged ≥ 85 years old was defined as the oldest-old. The participants were visited in their homes. The generic names of the medications used, and the age, sex, and province of residence were recorded. The medications were analyzed according to the 2019 Beers criteria, and their prevalence of use among the oldest-old people was determined. Data were collected from 549 of the oldest-old people. The median age of the participants was 88.0 years (88.8 ± 3.5; min = 85.0, max = 102), and 61.3% (n = 336) of them were female. The study findings showed that 65.0% of the community-dwelling oldest-old people used potentially inappropriate medications, with a median number of 1 (min = 0, max = 6). The prevalence of potentially inappropriate medication use increased linearly with the number of drugs used (p = 0.001). The median number of medications was significantly higher in the potentially inappropriate medication user group (5 vs. 2, p = 0.001). Diuretics, proton pump inhibitors, and nonsteroidal antiinflammatory drugs were the most frequently used potentially inappropriate medications. The prevalence of potentially inappropriate medication use was high among the oldest-old people in Turkiye. There were no differences in frequency of use according to age, sex, or geographical region. It is important to prevent the use of potentially inappropriate medications that should be avoided and to monitor the oldest-old group that uses potentially inappropriate medications that should be used with caution.

Polypharmacy and potentially inappropriate medications in older adults who use long-term care services: a cross-sectional study

BackgroundOlder adults requiring care often have multiple morbidities that lead to polypharmacy, including the use of potentially inappropriate medications (PIMs), leading to increased medical costs and adverse drug effects. We conducted a cross-sectional study to clarify the actual state of drug prescriptions and the background of polypharmacy and PIMs.MethodsUsing long-term care (LTC) and medical insurance claims data in the Ibaraki Prefecture from April 2018 to March 2019, we included individuals aged ≥ 65 who used LTC services. The number of drugs prescribed for ≥ 14 days and the number of PIMs were counted. A generalized linear model was used to analyze the association between the backgrounds of individuals and the number of drugs; logistic regression analysis was used for the presence of PIMs. PIMs were defined by STOPP-J and Beers Criteria.ResultsHerein, 67,531 older adults who received LTC services were included. The median number of total prescribed medications and PIMs was 7(IQR 5–9) and 1(IQR 0–1), respectively. The main PIMs were loop diuretics/aldosterone antagonists (STOPP-J), long-term use of proton pump inhibitors (Beers Criteria), benzodiazepines/similar hypnotics (STOPP-J and Beers Criteria), and nonsteroidal anti-inflammatory drugs (STOPP-J and Beers Criteria). Multivariate analysis revealed that the number of medications and presence of PIMs were significantly higher in patients with comorbidities and in those visiting multiple medical institutions. However, patients requiring care level ≥1, nursing home residents, users of short-stay service, and senior daycare were negatively associated with polypharmacy and PIMs.ConclusionsPolypharmacy and PIMs are frequently observed in older adults who require LTC. This was prominent among individuals with comorbidities and at multiple consulting institutions. Utilization of nursing care facilities may contribute to reducing polypharmacy and PIMs.Graphical

Impact of Hospitalizations on Problematic Medication Use Among Community-Dwelling Persons With Dementia.

Hospitalizations are frequently disruptive for persons with dementia (PWD) in part due to the use of potentially problematic medications for complications such as delirium, pain, and insomnia. We sought to determine the impact of hospitalizations on problematic medication prescribing in the months following hospitalization. We included community-dwelling PWD in the Health and Retirement Study aged ≥66 with a hospitalization from 2008 to 2018. We characterized problematic medications as medications that negatively affect cognition (strongly anticholinergics/sedative-hypnotics), medications from the 2019 Beers criteria, and medications from STOPP-V2. To capture durable changes, we compared problematic medications 4 weeks prehospitalization (baseline) to 4 months posthospitalization period. We used a generalized linear mixed model with Poisson distribution adjusting for age, sex, comorbidity count, prehospital chronic medications, and timepoint. Among 1 475 PWD, 504 had a qualifying hospitalization (median age 84 (IQR = 79-90), 66% female, 17% Black). There was a small increase in problematic medications from the baseline to posthospitalization timepoint that did not reach statistical significance (adjusted mean 1.28 vs 1.40, difference 0.12 (95% CI -0.03, 0.26), p = .12). Results were consistent across medication domains and certain subgroups. In one prespecified subgroup, individuals on <5 prehospital chronic medications showed a greater increase in posthospital problematic medications compared with those on ≥5 medications (p = .04 for interaction, mean increase from baseline to posthospitalization of 0.25 for those with <5 medications (95% CI 0.05, 0.44) vs. 0.06 (95% CI -0.12, 0.25) for those with ≥5 medications). Hospitalizations had a small, nonstatistically significant effect on longer-term problematic medication use among PWD.

Potentially inappropriate anticholinergic drug use among older adults in primary healthcare: prevalence and determinants

ABSTRACT Background Considering the vulnerability of older adults to adverse drug reactions, medications with strong anticholinergic properties are considered potentially inappropriate for this population. This study aims to characterize older adults’ profile of anticholinergics use and to identify the factors associated with their potentially inappropriate use. Research design and methods A retrospective study was conducted on 1200 older adults in primary health care centers of Portugal between April 2021 and August 2022. Potentially inappropriate use was assessed according to the 2023 Beers criteria. Logistic regression analyses were performed to determine associations between independent variables and potentially inappropriate use. Results A 8.9% (95% CI 0.074–0.107) of the older adults were exposed to one or more potentially inappropriate anticholinergics, and amitriptyline was the most used (2.0%). Multivariate analysis revealed that use was associated with a higher mean number of medications (OR 1.173, 95% CI 1.115–1.234), diagnoses of depression (OR 2.889, 95% CI 1.785–4.674) and psychiatric disorders (OR 1.654, 95% CI 1.003–2.729). Conclusions This study underscores the importance of vigilance in prescribing anticholinergic medications to older adults, particularly those with higher medication burdens and mental health diagnoses. By identifying factors associated with potentially inappropriate use, healthcare providers can better tailor medication regimens to mitigate risks and optimize the well-being of older adults.