Prevalence Of Potentially Inappropriate Medications Research Articles

Variability in the prevalence of inappropriate medication use among older adults: A review highlighting the importance of screening methods and database types.

The global older population is growing rapidly, and the rise in polypharmacy has increased potentially inappropriate medication (PIM) encounters. PIMs pose health risks, but detecting them automatically in large medical databases is complex. This review aimed to uncover PIM prevalence in individuals aged 65 years or older using health databases and emphasized the risk of underestimating PIM prevalence due to underutilization of detection tools. This study conducted a broad search on the Medline database to identify articles about the prevalence of PIMs in older adults using various databases. Articles published between January 2010 and June 2023 were included, and specific criteria were applied for study selection. Two literature reviews conducted before our study period were integrated to obtain a perspective from the 1990s to the present day. The selected papers were analysed for variables including database type, screening method, adaptations and PIM prevalence. The study categorized databases and original screening tools for clarity, examined adaptations and assessed concordance among different screening methods. This study encompassed 48 manuscripts, covering 58 sample evaluations. The mean prevalence of PIMs within the general population aged over 65 years was 27.8%. Relevant heterogeneity emerged in both the utilized databases and the detection methods. Adaptation of original screening tools was observed in 86.2% (50/58) of cases. Half of the original screening tools used for assessing PIMs belonged to the simple category. About a third of the studies employed less than half of the original criteria after adaptation. Only three studies used over 75% of the original criteria and more than 50 criteria. This extensive review highlights PIM prevalence among the older adults, emphasizing method intricacies and the potential for underestimation due to data limitations and algorithm adjustments. The findings call for enhanced methodologies, transparent algorithms and a deeper understanding of intricate rules' impact on public health implications.

Comparison of four criteria for potentially inappropriate medications in older patients with newly diagnosed non-small cell lung cancer

ABSTRACT Background Potentially inappropriate medication (PIM) use is a common problem among older patients. This study aimed to compare the prevalence of PIMs in older patients with newly diagnosed non-small cell lung cancer (NSCLC), and to identify the correlates of PIMs. Research design and methods A secondary analysis of a prospective cohort study was conducted. Patients were enrolled from January 2014 to December 2020 and information were extracted from patients’ electronic medical records (EMRs). We evaluated the PIMs using four different PIM criteria. The concordance among the four PIM criteria was calculated using kappa tests. The possible risk factors associated with PIMs were analyzed by multivariate logistic regression. Results The prevalence of at least one PIM identified by the four criteria ranged from 25.1% to 48.2% among 514 patients. There was moderate consistency between the GO-PIM scale and the AGS/Beers criteria, while poor consistency with the other criteria (the STOPP criteria and the Chinese criteria). Polypharmacy was found to be significantly associated with the occurrence of PIMs in all criteria (p < 0.001). Conclusions Our results showed a high prevalence of PIMs in older patients with NSCLC, which was significantly associated with polypharmacy, and the consistency across the four criteria was poor-to-moderate.

Medication use among the oldest old in the Faroe Islands-A national cross-sectional study.

Aging is often associated with an increasing number of comorbidities that warrant use of multiple drugs which increases the use of potentially inappropriate medications (PIMs), drug-drug interactions (DDIs) and drug-related problems (DRPs). The aim is to assess the prevalence of polypharmacy, PIMs, DDIs and DRPs among Faroese residents aged ≥90 years. In this population-based cross-sectional study, 494 individuals ≥90 years were invited and 298 (60%) participated. A pharmacist-led medication review was performed based on self-information, electronic patient journal and the Faroese Prescription Registry. The prevalence of polypharmacy was 74% with no sex-difference. Approximately 60% of participants used PIMs, primarily benzodiazepines and proton pump inhibitors, the latter being a frequently implicated medication in DRPs. Opioid use was low compared with other Nordic studies. DRPs were observed for 79% with discrepancies in the medication lists as the most common cause, and DDIs were identified for 47% of participants, mostly moderately clinically relevant DDIs. In conclusion, the medication use among the oldest old Faroese resembled that in other Nordic countries with a high prevalence of polypharmacy and use of PIMs, especially PPIs and benzodiazepines. However, no sex-difference was noted in medication use and the use of opioids was low.

Prevalence of Polypharmacy and Potentially Inappropriate Medications Prescribed among Elderly Inpatients in a Primary Care Setting of Pokhara, Nepal

Introduction: Polypharmacy, referred to as prescription several medications is major concern in the elderly population. Potentially inappropriate medications (PIMs) are those medications that should be avoided due to their adverse clinical effects. This study aimed to estimate the prevalence of polypharmacy and identify PIMs in primary care practice using Beer’s criteria and the Screening Tool of Older People’s Potentially Inappropriate Prescription (STOPP) criteria. Methods: This was an observational cross-sectional study. A total of 102 elderly patients aged ≥ 65 years were enrolled in the study from a primary care centre in Pokhara, Nepal. A questionnaire comprising sociodemographic and prescribed medication information was used for data collection. Potentially inappropriate prescriptions were assessed using Beer’s and STOPP criteria. Results: The majority of the study population were females (53%) age group 65-74 years (74.5%). Comorbidities were common in 69% of the elderly, and major polypharmacy was prevalent in approximately 73% of the elderly. PIM prevalence rates of 36.12% and 6.86% were identified using the Beer’s criteria and STOPP criteria, respectively. Conclusion: This study reports the prevalence of polypharmacy and PIM prescriptions among elderly patients. Appropriate drug therapy can be achieved by using appropriate tools for the detection of PIM use in elderly patients. Further research on interventions related to PIMs is warranted to prevent adverse drug events in the elderly.

Use of potentially inappropriate medication for elderly patients in tertiary care hospital of Riyadh, Saudi Arabia

Background and objectivesThe elderly population is affected by chronic diseases and lifelong medication. The American Geriatrics Society (AGS) Beers Criteria is a comprehensive approach to medication usage in the older population to reduce potentially inappropriate medication (PIM) use. The purpose of this study was to assess the usage of PIMs in elderly patients upon discharge from tertiary care hospital settings in Riyadh, Saudi Arabia, using the AGS Beers Criteria 2019. MethodsThe data was obtained from the medical records of 1237 patients (>65 years) who were discharged from medical or surgical wards at two hospitals affiliated with King Abdulaziz Medical City. The data was analyzed to determine the prevalence of PIM prescription, and the proportional odds of the independent factors influencing outcomes were estimated using ordinal regression analysis for criteria 1 and 2, while Binary regression analysis was conducted for criterion 3. ResultsThere were approximately equal numbers of male and female participants in our study (male: 50.8 % vs. female: 49.2 %). One-third of the patients were above the age of 80 years, with 41 % being between the ages of 70 and 80 years. Moreover, almost 70 % of the samples had chronic illnesses. The overall prevalence of PIMs was 29.2 %, with 11 % of PIMs to be avoided in elderly patients and 17 % to be used with caution in the elderly, while disease-specific PIMs were identified in 1.2 % of the patients. The most common PIM class was proton pump inhibitors (44.41 %), and patients discharged from the surgical unit were more likely to be prescribed PIMs. Proton pump inhibitors (44.41 %) were the most inappropriately prescribed drug class, and patients discharged from the surgical unit were more likely to be prescribed PIMs. ConclusionThe study noticed that male gender, the presence of multiple diseases, and obesity are associated with more than one PIM prescription. There is a need to streamline the surgical department’s prescription procedure to eliminate prescription disparities. Prescription monitoring is recommended to avoid medication errors, particularly in patients who are taking multiple medications.

What is the association of polypharmacy with frailty in heart failure? A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to explore the differences in the number of prescribed medications and polypharmacy risk between patients with heart failure (HF) and frailty vs. those with HF but without frailty. Eligible studies included observational or experimental studies in patients aged ≥50 years. Thirteen studies met the criteria and were included in the final analysis. Patients with frailty and HF exhibited a higher risk of polypharmacy (OR: 1.87, 95% CI 1.72 - 2.04, I2 = 0%, P < 0.01) compared to those without frailty. Results remained significant after adjusting for comorbidity status. Additionally, patients with frailty and HF were prescribed more medications compared to those without (k = 6; MD: 1.43, 95% CI 0.31 - 2.55, I2 = 94%, P = 0.01), with a high degree of heterogeneity. However, results were non-significant after adjustment for comorbidity status. Patients with HF and frailty have a higher need of polypharmacy compared to those without frailty, which may increase the risk of potentially inappropriate medications (PIM). Investigating the real-world prevalence of PIM may support clinicians in their routine assessment as part of a comprehensive management strategy in patients with HF and frailty.

Potentially inappropriate medication prescribing based on 2019 Beers criteria and the impact of pharmacist intervention in elderly patients with kidney diseases: A report from Iran.

A potentially inappropriate medication (PIM) is a pharmaceutical agent that poses a greater risk of harm than potential benefit to elderly patients. This study aimed to detect PIMs and their risk factors in hospitalized elderly patients with kidney disease. This cross-sectional study assessed medication orders of elderly patients (≥65 years old) with kidney diseases admitted to the hospital. In the first 6 months, we retrospectively evaluated all medications to identify PIMs according to the 2019 Beers criteria. In the second phase, a clinical pharmacist prospectively evaluated all medications and suggested modifications as needed. Data were analyzed to determine risk factors for prescribing PIMs. Based on our evaluation of 258 patients, we observed that the utilization of PIMswas prevalent among the study population. Of the total patients evaluated, 273 instances of PIM use were identified, with only 23.3% of patients not having any PIMs. Notably, proton pump inhibitors and benzodiazepines were the most frequently prescribed PIMs. The risk of experiencing a PIM was significantly amplified by a higher degree of polypharmacy, with odds approximately 2.68 times higher (p < 0.01). Several factors were found to be associated with an increased likelihood of having a PIM, including being male, undergoing hemodialysis, having chronic kidney disease or other comorbidities, and having an extended hospital stay. The second phase of study, in terms of addressing these issues, physicians adhered to 67.5% of the 120 recommendations made by pharmacists regarding the discontinuation of PIM usage. High prevalence of PIMs was detected in our study population. Preventing medication-associated harms in the elderly can reduce the financial burden imposed on healthcare systems. Therefore, routine evaluation of medications with clinical pharmacists and/or implementation of computerized medication decision support systems is recommended to prevent PIMs use.

Patterns and Outcomes of Polypharmacy and Effect of Potentially Inappropriate Medications in Elderly Patients undergoing Orthopaedic Surgeries: A Retrospective Observational Study

Introduction: Prescription of Potentially Inappropriate Medication (PIM) among elderly patients is becoming a global concern. There has been an increase in the number of elderly patients coming for operative procedures, especially in orthopaedic surgery, due to the association of advanced age with chronic musculoskeletal conditions, such as osteoarthritis, and an increased incidence of fragility fractures. Aim: To determine the prevalence of polypharmacy and PIMs among elderly patients undergoing orthopaedic surgery. Materials and Methods: A retrospective observational study was conducted from February 2022 to April 2022 in the Orthopaedic Department of Anaesthesiology, MOSC Medical College, Kolenchery, Ernakulam, Kerala, India. Hospital records of 130 patients aged 65 years and above, who underwent orthopaedic surgeries from January 2016 to December 2021, were included. The prescriptions during the perioperative period were analysed for polypharmacy, defined as the use of five or more drugs. The American Geriatric Society (AGS) 2019 Beers criteria were used to identify PIMs, drug interactions, and drugsyndrome interactions. Chi-square tests were performed on clinically significant variables to assess their effect on hospital stay, with a p-value of &lt;0.05 considered significant. Results: Polypharmacy was highest on postoperative day 1, with 119 patients (91.5%) experiencing it. The study observed a high prevalence of PIMs, with 106 patients (81.53%) affected. The most commonly used PIMs were Pantoprazole, followed by Piroxicam, Regular human Insulin, and Glimepride. A significant association was observed between hospital stay ≥10 days, postoperative Intensive Care Unit (ICU) stay, and preoperative polypharmacy (p-value=0.002). Conclusion: Polypharmacy and PIMs in patients above 65 years of age admitted for surgeries remain major concerns. Further exploration of current pharmacologic practices in the perioperative period and interventions, such as physician education programs regarding PIMs, are needed.

Medications and cognitive risk in Aboriginal primary care: a cross-sectional study.

Aboriginal and Torres Strait Islander people are ageing with high rates of comorbidity, yet little is known about suboptimal prescribing in this population. The prevalence of potentially suboptimal prescribing and associated risk factors were investigated among older patients attending primary care through Aboriginal Community Controlled Health Services (ACCHSs). Medical records of 420 systematically selected patients aged ≥50 years attending urban, rural and remote health services were audited. Polypharmacy (≥ 5 prescribed medications), potentially inappropriate medications (PIMs) as per Beers Criteria and anticholinergic burden (ACB) were estimated and associated risk factors were explored with logistic regression. The prevalence of polypharmacy, PIMs and ACB score ≥3 was 43%, 18% and 12% respectively. In multivariable logistic regression analyses, polypharmacy was less likely in rural (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.24-0.77) compared to urban patients, and more likely in those with heart disease (OR = 2.62, 95% CI = 1.62-4.25), atrial fibrillation (OR = 4.25, 95% CI = 1.08-16.81), hypertension (OR = 2.14, 95% CI = 1.34-3.44), diabetes (OR = 2.72, 95% CI = 1.69-4.39) or depression (OR = 1.91, 95% CI = 1.19-3.06). PIMs were more frequent in females (OR = 1.88, 95% CI = 1.03-3.42) and less frequent in rural (OR = 0.41, 95% CI = 0.19-0.85) and remote (OR = 0.58, 95% CI = 0.29-1.18) patients. Factors associated with PIMs were kidney disease (OR = 2.60, 95% CI = 1.37-4.92), urinary incontinence (OR = 3.00, 95% CI = 1.02-8.83), depression (OR = 2.67, 95% CI = 1.50-4.77), heavy alcohol use (OR = 2.83, 95% CI = 1.39-5.75) and subjective cognitive concerns (OR = 2.69, 95% CI = 1.31-5.52). High ACB was less common in rural (OR = 0.10, 95% CI = 0.03-0.34) and remote (OR = 0.51, 95% CI = 0.25-1.04) patients and more common in those with kidney disease (OR = 3.07, 95% CI = 1.50-6.30) or depression (OR = 3.32, 95% CI = 1.70-6.47). Associations between potentially suboptimal prescribing and depression or cognitive concerns highlight the importance of considering medication review and deprescribing for these patients.

Prevalence of polypharmacy: a cross-sectional study in Singapore public healthcare institutions

Abstract Introduction: Polypharmacy is associated with increased prevalence of potentially inappropriate medications (PIMs), leading to higher risk of adverse drug events and medication errors. This study was the first multicentre cross-sectional study in Singapore that determined the prevalence of polypharmacy, its associated factors and the common drug classes involved, and evaluated prescribing appropriateness of drugs used by older adults. Methods: The prescriptions on two randomly selected days from five acute care hospitals and primary care polyclinics were retrospectively reviewed. Patients’ demographic characteristics, number of prescription line items and details of prescribed drugs were collected. Prescribing appropriateness was evaluated by identifying PIMs using the Beers Criteria. Logistic regression was used to assess the association of demographic characteristics and type of care setting with polypharmacy and PIM use. Results: Prevalence of polypharmacy was significantly higher in hospitals than in polyclinics (66.6% vs. 35.0%, P &lt; 0.001). On the contrary, prevalence of PIMs in older adults with polypharmacy was significantly higher in polyclinics than in hospitals (34.6% vs. 27.1%, P = 0.010). Patients aged ≥65 years and hospitalised patients had higher odds of having polypharmacy than patients aged 21–64 years and polyclinic patients, respectively. Drugs used for chronic conditions commonly contributed to polypharmacy in both care settings. The top PIMs in hospitals and polyclinics were drugs for functional gastrointestinal disorders and systemic antihistamines, respectively. Conclusion: With the ageing population and growing burden of chronic disease in Singapore, increase in prevalence of polypharmacy is expected. More focus should thus be placed on reducing inappropriate polypharmacy.

Potentially Inappropriate Medication Dispensing in Outpatients: Comparison of Different Measurement Approaches.

This paper aims at comparing different approaches to measure potentially inappropriate medication (PIM) with routinely collected data on prescriptions, patient age institutionalization status (ie in nursing home or in the community). A secondary objective is to measure the rate and prevalence of PIM dispensing and to identify problematic practices in Switzerland. The studied population includes about 90,000 insured over 17 years old from a Swiss health maintenance organization in 2019 and 2020. We computed and compared the number of PIM per patient for Beers criteria, Priscus list, Laroche, NORGEP and Prescrire approaches. We also created a composite indicator that accounts for the specificities of the Swiss context (adaptation to the Swiss drugs' market, recommendations in force related to sleeping pills, anxiolytics and NSAIDs). We also stratified the analysis per physician, including initiation and cessation of PIM prescription. Our comparison revealed similarities between the approaches, but also that each of them had specific gaps that provides further motivation for the development of a composite approach. PIM rate was particularly high for sleeping pills, anxiolytics, NSAIDs, even when analyses were limited to chronic use. Drugs with anticholinergic effect were also frequently prescribed. Based on our composite indicator, 27% of insured over 64 years old received at least one PIM in 2020, and 8% received more than one. Our analyses also reveal that for sleeping pills and anxiolytics, half of the volume (or prevalence?) occurs in the <65 population. We observed strong variations between physicians and a significant proportion of new users among patients with PIM. Our results show that PIMs prescribing is very frequent in Switzerland and is driven mostly by a few drug categories. There is important physician variation in PIM prescribing that warrants the development of intervention targeted at high PIM-prescribers.

Prevalence of potentially inappropriate medications among elderly patients with diabetes – study based on STOPP/START criteria

Objective: The prevalence of drug-related problems in elderly patients is a concerning issue that can lead to elevated morbidity, mortality, and health care resource utilisation. This study focuses on the significance of addressing diabetes in the context of an ageing population, where elderly individuals face higher risks of comorbidities and mortality. The main objective of this study was to assess potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among patients with diabetes in Bulgaria, using the explicit STOPP/START criteria, version 2. By evaluating the appropriateness of drug prescriptions in this specific patient population, this study aims to shed light on areas that require optimisation to enhance patient safety and treatment outcomes. Materials and methods: A national prospective questionnaire study was conducted in Bulgaria among patients aged over 65 years. The research was conducted in 25 randomly selected pharmacies. The study supports the use of the STOPP/START criteria based on the clinical information provided. A total of 133 patients with T1DM or T2DM participated in the study. The evaluation of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) was performed in 131 patients. sStatistical differences in demographics and medication numbers between patients with and without PIMs or PPOs were assessed using a Chi-square test, with a p-value of ≤ 0.05 considered statistically significant. Results: The pharmacotherapy of 131 patients with diabetes was assessed, and it was found that 57% of them had polypharmacy. Among the study population, 90 PIMs were identified, indicating that 66% of the patients had inappropriate prescribing. Notably, inappropriate prescribing concerning diabetes was associated with the use of long-acting sulfonylureas (n=10) and beta-blockers (n=13). Applying the START criteria revealed 67 PPOs among 67 patients, representing a prevalence of 50% in the study population. However, no PPOs were detected in the context of diabetes pharmacotherapy. Furthermore, a significant relationship was observed between the number of medications and PIMs, as evidenced by the chi-square test result with a p-value close to zero, indicating statistical significance. Conclusion: The study revealed a high prevalence of PIMs in elderly patients with diabetes in Bulgaria. Endocrine disorders contribute to 26% of PIMs. As Bulgaria’s ageing population faces increasing diabetes challenges, effective management strategies are crucial. These findings underscore the significance of addressing prescribing practises to enhance disease control and prevent complications.

Comparing prevalence and types of potentially inappropriate medications among patient groups in a post-acute and secondary care hospital

Reducing potentially inappropriate medications (PIMs) is a challenge in post-acute care hospitals. Some PIMs may be associated with patient characteristics and it may be useful to focus on frequent PIMs. This study aimed to identify characteristic features of PIMs by grouping patients as in everyday clinical practice. A retrospective review of medical records was conducted for 541 patients aged 75 years or older in a Japanese post-acute and secondary care hospital. PIMs on admission were identified using the Screening Tool for Older Person’s Appropriate Prescriptions for Japanese. The patients were divided into four groups based on their primary disease and reason for hospitalization: post-acute orthopedics, post-acute neurological disorders, post-acute others, and subacute. Approximately 60.8% of the patients were taking PIMs, with no significant difference among the four patient groups in terms of prevalence of PIMs (p = 0.08). However, characteristic features of PIM types were observed in each patient group. Hypnotics and nonsteroidal anti-inflammatory drugs were common in the post-acute orthopedics group, multiple antithrombotic agents in the post-acute neurological disorders group, diuretics in the post-acute others group, and hypnotics and diuretics in the subacute group. Grouping patients in clinical practice revealed characteristic features of PIM types in each group.

Potentially inappropriate medication uses and associated factors among elderly primary health care clinics attendees: A call to action.

Polypharmacy is a significant risk factor for using potentially inappropriate medication (PIM), which is using drugs with more risks than benefits, especially for elders. This study aimed to estimate the prevalence of PIM using Beers Criteria, polypharmacy, and their related risk factors. A descriptive cross-sectional study was conducted in West Bank primary health care clinics (PHC)from December 2021 to March 2022. Data were collected from PHC clinic attendees aged 65 and above via an interviewer-administered questionnaire and a review of their medical records. We used the Beers Criteria 2019 update to identify PIM and performed a multivariable analysis to determine its associated factors. The study included 421 older people (197 men and 224 women) with an average age of 73.6 years. The prevalence of polypharmacy was 75.1% (95%CI: 70.6%-79.1%), with an average of six medications dispensed per patient. On the other hand, PIM was identified among 36.8% of the study participants (CI:95%CI: 32.2%- 41.6%). Sulfonylureas were the most common (24.2%) reported PIM, followed by peripheral alpha-blockers (4.3%), non-steroidal anti-inflammatory drugs (3.1%), proton pump inhibitors (2.9%), and central nervous system medications (2.1%). Hyperpolypharmacy (> 10 drugs) [aOR = 4.1, 95%CI: 1.6-10.7], polypharmacy [aOR = 2.8, 95%CI: 1.4-5.4], and Diabetes [aOR = 3.5, 95%CI: 2.0-6.0] are the main associated factors of PIM. This study found that over one-third of the older people attending PHC clinics have PIM, with polypharmacy and Diabetes being the main predicting variables. Improving physicians' awareness of clear and specific PIM lists can reduce the number of PIM prescribed and decrease their impact.

Medication optimization in older adults with advanced cancer and a limited life expectancy: A prospective observational study

IntroductionPolypharmacy is common in older adults with cancer and is associated with drug related problems (DRPs) and potentially inappropriate medication (PIM). We introduced a medication optimization care pathway for older adults with advanced cancer and a limited life expectancy and studied the prevalence of DRPs and PIMs as well as the adherence to medication-related recommendations and the patient satisfaction. Materials and MethodsA medication review was performed in patients aged ≥65 years with polypharmacy and a life expectancy of <24 months. Recommendations on adjustments of medication were discussed in a multidisciplinary team including a pharmacist, an oncologist, and a geriatrician. Implementation of the recommendations was left to the discretion of the oncologist. Four weeks after the implementation, the patient filled a questionnaire to assess satisfaction. ResultsOne hundred twenty patients were included. The mean age was 75 years and 39% were female. A mean of 12 medications was used. The median number of DRP was 6.0 per patient and median number of PIMs was 3.0 per patient. Overtreatment accounted for 26% of DRP and the most frequently involved drug classes were antihypertensive medication (22%), non-opioid analgesics (22%), and antilipemics (12%). The multidisciplinary team accepted 78% of the recommendations of the pharmacist and the oncologist implemented 54% of the recommendations. Overall, patients were satisfied or very satisfied with the intervention. DiscussionDRPs and PIMs are highly prevalent in this population and can be reduced by a multidisciplinary medication optimization intervention. Patients appreciate the medication optimization intervention and are satisfied with the intervention.

Potentially Inappropriate Medications in Older Adults-Prevalence, Trends and Associated Factors: A Cross-Sectional Study in Saudi Arabia.

(1) Background: Potentially inappropriate medications (PIMs) in older adults are associated with drug-related problems, adverse health consequences, repeated hospital admissions and a higher risk of mortality. In Saudi Arabia and some Arab countries, studies of PIMs among large cohorts of older adults are limited. This study aimed to determine the prevalence of PIMs, trends and associated factors among outpatient older adults in Saudi Arabia. (2) Methods: A cross-sectional study was carried out. Over three years (2017-2019), data on 23,417 people (≥65 years) were retrieved from outpatient clinics in a tertiary hospital in Riyadh, Saudi Arabia. PIMs were assessed using the 2019 Beers Criteria. Covariates included sex, age, nationality, number of dispensed medications, and number of diagnoses. A generalized estimating equation model was used to assess trends and factors associated with PIMs. (3) Results: The prevalence of PIMs was high and varied between 57.2% and 63.6% over the study years. Compared with 2017, the prevalence of PIMs increased significantly, with adjusted odds ratios (OR) (95% confidence interval (95% CI)) of 1.23 (1.18-1.29) and 1.15 (1.10-1.21) for 2018 and 2019, respectively. Factors associated with being prescribed PIMs included ≥5 dispensed medications (OR_adjusted = 23.91, 95% CI = 21.47-26.64) and ≥5 diagnoses (OR_adjusted = 3.20, 95% CI = 2.88-3.56). Compared with females, males had a lower risk of being prescribed PIMs (OR_adjusted = 0.90, 95% CI = 0.85-0.94); (4) Conclusions: PIMs were common with an increasing trend among older adults in Saudi Arabia. A higher number of dispensed medications, increased number of diagnoses and female sex were associated with being prescribed PIMs. Recommendations on how to optimize prescriptions and implement de-prescribing strategies are urgently needed.

Potentially Inappropriate Medications In Geriatric Hemodialysis Patients

Concerns about inappropriate drug use are increasing in geriatric patients. Potentially inappropriate medication (PIM) lists are being updated accordingly. The aim of this study is to determine the prevalence of PIM in elderly Turkish hemodialysis patients and to assess the association of patient’s characteristic as risk factors for PIMs in this population. Patients aged 65 years and over who were treated at two different hemodialysis centers were included in the study. Medical and sociodemographic information of the patients was obtained from patient’s files and medical records. Patients’ files and SGK-Online Medulla System were used to identify medications used by patients. PIMs were defined by using the modified Beers’ criteria independent of diagnosis and Beers’ Kidney-List. A total of 110 patients (mean age 73.31±6.4 years) were included in the study. 69 of the patients were male (62.7%) and 41 female (37.3%). Only 47.3% of the patients were independent in daily functioning. The average number of medications received by the patients was 7.3. When the charts in the patient files were examined, it was determined that 54.5% of all patients used PIM. However, when all prescribed drugs were scanned online from the Medulla-SGK system, it was found that inappropriate drugs were prescribed in 70.9% of the patients. A statistically significant relationship was found between the use of PIM and the total number of drugs used and the number of hospital admissions. The prevalence rate of PIM in elderly Turkish hemodialysis patients was higher. It is necessary to raise awareness of this in terms of reducing unwanted drug interactions and contributing economically.

Inappropriate Medications Use and Polypharmacy among Older Adults with Anxiety Disorder.

Elderly with mental health conditions usually use multiple medications, which predisposes them to inappropriate use of medications, which is defined as medications that should be avoided due to their risk; this outweighs their benefit given that safer alternatives are available. This study aimed to examine potentially inappropriate medication use among older patients with anxiety disorder. This study used a cross-sectional retrospective study design using twelve months of data extracted from the Electronic Health Record (EHR) database for older adults diagnosed with anxiety disorder and treated in the ambulatory care setting. Potentially inappropriate medications (PIMs) use was evaluated using the 2019 Beers criteria. Descriptive statistics were used to describe the sample. Pearson's chi-square tests (for categorical variables) and t-tests (for continuous variables) were utilized to measure the differences in independent variables between patients with and without PIMs. Binary logistic regression was used to examine the associations between PIMs use and identify potential factors for PIMs use among older adults with anxiety disorder. Analyses were performed using the Statistical Analysis Software version 9.4 (SAS® 9.4). The study sample includes 371 older adults (age ≥ 65 years) with anxiety disorder; their average age was (72.1 ± 5.8) years. PIMs use was highly prevalent among older adults with anxiety (66.6%). About 35.6% of the study sample used one PIM, 22.6% used two PIMs, and 8.4% used three PIMs. The most frequently prescribed PIMs were NSAIDs and gastrointestinal agents. The adjusted regression analysis found that PIMs use was less likely among men than women. In addition, PIMs use was more likely among women with diabetes, cancer, and polypharmacy. Future studies on strategies and interventions rationing PIMs use in older adults with anxiety disorder are necessary given the high prevalence of PIMs and polypharmacy within this population.

Impact of the publication of the Finnish Meds75+ database on the use of potentially inappropriate medications in older persons.

To evaluate the impact of the updated nationwide Meds75+ database and its linkage to the Finnish health portal on the use of potentially inappropriate medications (PIMs) among older persons. We also aimed to evaluate whether there is regional variation in trend changes of PIM use. Meds75+ was implemented at the population level in 2015, so randomization is unfeasible. We used a quasi-experimental interrupted time series analysis to evaluate the changes in levels and trends of PIM use. The data included all Finnish community-dwelling persons aged ≥75 years (N = 920 163) who had medication purchases in the Prescription Register during 2009-2020. Data were linked with the Care Registers for Health and Social Care and the cause of death register. The prevalence of PIMs decreased from 20.2% in 2009 to 11.7% in 2020. The change of level of the monthly PIM users was negative (β -0.036, 95% confidence interval [CI] -0.202 to 0.131), but not statistically significant (P = .673) after the publication of the database. We found a small decrease (β -0.018, 95% CI -0.083 to 0.047, P = .593) in the slope of PIM users, but it was not statistically significant. The regional results were similar to the main findings. Publication of the updated Meds75+ database did not decrease the level or trend of PIM users. In addition, this study did not show any significant regional variation in PIM use trends. Further research should focus on determining barriers and facilitators to the utilization of PIM criteria in clinical practice.

Regional variation of potentially inappropriate medication use and associated factors among older adults: A nationwide register study

BackgroundCertain medications should be used with caution in older persons, which challenges rational prescribing. Potentially inappropriate medications (PIMs) are defined as medicines whose potential risk of harm typically outweighs the clinical benefits in geriatric population. Earlier studies have found regional differences in PIM use, but the factors underlying this phenomenon are unclear. ObjectiveTo compare prescription PIM prevalence among Finnish hospital districts and determine which population characteristics and factors related to social and health care are associated with regional variation. MethodsThis nationwide register study was based on the Prescription Centre data on all people aged ≥75 years in 2017–2019. Hospital district (n = 20) characteristics were drawn from the Finnish Institute for Health and Welfare's, Finnish Medical Association's, and Finnish Medicines Agency's publicly open data. PIMs were defined according to the Finnish Meds75+ database. A linear mixed-effect model was used to analyze potential associations of regional characteristics with PIM prevalence. ResultsPrevalence of PIMs varied between 16.4% and 24.8% across regions. The highest prevalence was observed in the southern regions, while the lowest prevalence was on the west coast. Hospital district characteristics associated with higher PIM prevalence were higher share of population living alone, with excessive polypharmacy, or assessed using the Resident Assessment Instrument, shortage of general practitioners in municipal health centers, and low share of home care personnel. Waiting time in health care or share of population with morbidities were not associated with PIM use. Of the total variance in PIM prevalence, 86% was explained by group-level factors related to hospital districts. The regional variables explained 75% of this hospital-district-level variation. ConclusionsPIM prevalence varied significantly across hospital districts. Findings suggest that higher PIM prevalence may be related to challenges in the continuity of care rather than differences in health care accessibility or share of the population with morbidities.