Potentially Inappropriate Medications Research Articles

Reliability and validity of the Swedish indicator 'Drugs that should be avoided in older people'-an appraisal of a set of potentially inappropriate medications.

To analyse the reliability and validity of the Swedish indicator 'Drugs that should be avoided in older people'. From a previous study that included consecutive primary care patients ≥ 65 years of age, all patients ≥ 75 years of age were analysed. Two physicians independently screened their medication lists and medical records, applying the Swedish indicator which includes potentially inappropriate medications (PIMs): long-acting benzodiazepines, drugs with anticholinergic action, tramadol, propiomazine, codeine, and glibenclamide. The clinical relevance of identified PIMs was independently assessed. Thereafter, the physicians determined in consensus whether some medical action related to the drug treatment was medically justified and prioritised before the next regular visit. If so, the drug treatment was considered inadequate, and if not, adequate. A total of 1,146 drugs were assessed in 149 patients (75‒99 years, 62% female, 0‒20 drugs per patient). In 29 (19%) patients, at least one physician identified ≥ 1 PIM according to the indicator at issue; 24 (16%) patients were concordantly identified with ≥ 1 such PIM (kappa: 0.89). Of 26 PIMs concordantly identified, the physicians concordantly assessed four as clinically relevant and 12 as not clinically relevant (kappa: 0.17). After the consensus discussion, six (4%) patients had ≥ 1 PIM according to the studied indicator that merited action. Using the area under the receiver operating characteristic (ROC) curve, the indicator did not outperform chance in identifying inadequate drug treatment: 0.56 (95% confidence interval: 0.46 to 0.66). The Swedish indicator has strong reliability regarding PIM detection but does not validly reflect the adequacy of drug treatment.

Association between potentially inappropriate medications prescription and health-related quality of life among US older adults.

Potentially inappropriate medications (PIMs) are associated with worse health outcomes among older adults. Our objective was to examine the association between PIM prescription and health-related quality of life (HRQoL) among older adults in the United States using nationally representative data. This was a retrospective study utilizing 2011-2015 Medical Expenditure Panel Survey (MEPS) data. Community dwelling US adults aged 65 years or older were included. A qualified definition operationalized from the 2019 American Geriatrics Society Beers Criteria® was used to define exposure to PIMs during the study period. The Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12) were used to measure HRQoL. Survey-weighted linear regression models were constructed to investigate the association between PIM exposure and participants' PCS and MCS scores. Analyses were stratified across three age cohorts (65-74, 75-85, and ≥85 years). Unadjusted analysis showed poorer scores in the PIM exposed group for both PCS and MCS (all p < 0.001). PIM exposure was associated with poorer PCS scores across all age groups with those aged 65-74 years (adjusted regression coefficient = -1.60 [95% CI = -2.27, -0.93; p < 0.001]), those 75-84 years (adjusted regression coefficient: -1.49 [95% CI = -2.45, -0.53; p = 0.003]), and those 85 years and older (adjusted regression coefficient = -1.65 [95% CI = -3.03, -0.27; p = 0.02]). PIM exposure was also associated with poorer MCS scores in participants aged 65-74 years (adjusted regression coefficient = -0.69 [95% CI = -1.16, -0.22; p = 0.004]) and 85 years and older (adjusted regression coefficient = -2.01 [95% CI = -3.25, -0.78; p = 0.002]). Our results suggest that patients' exposure to PIMs is associated with poorer HRQoL. Further work is needed to assess whether interventions to deprescribe PIMs may help to improve patients' HRQoL.

Assessing the prevalence of Beers medication utilization in the Medicare Part D population in 2020.

Medication utilization has been increasing in the U.S. year-over-year for several decades. As older adults take more medications, there is a higher risk of them being exposed to drug-drug or drug-disease interactions. The American Geriatrics Society in 2019 updated their Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults. The objective of this study was to assess the prevalence of utilization of medications included in the 2019 Beers Criteria. An analysis was conducted using the Medicare Part D Provider Utilization and Payment Data Public Use File for calendar-year 2020. Medications identified in the 2019 Beers Criteria were applied to the analysis. Two categories of medications were assessed: (1) "Avoid" and (2) "Use With Caution." In 2020, 56 million prescriptions were dispensed to Medicare patients 65 years and older that are recommended to be avoided without exception (4.7% of all prescriptions) totaling $957 million in medication costs. The most utilized medication classes in this category were benzodiazepines (25,949,994 prescriptions), "Z-drugs" (6,204,909 prescriptions), long-acting sulfonylureas (5,306,577 prescriptions), 1st-generation antihistamines (5,049,289 prescriptions), and tricyclic antidepressants (4,190,062 prescriptions). Additionally, 135 million prescriptions were dispensed to Medicare beneficiaries 65 years and older for medications which the Beers Criteria states to use caution (11.3% of all prescriptions) exceeding $2.85 billion in medication costs. The most utilized medications for this category were diuretics (74,599,126 prescriptions), selective serotonin reuptake inhibitors (30,033,121 prescriptions), serotonin and norepinephrine reuptake inhibitors (11,858,968 prescriptions), tramadol (11,450,878 prescriptions), and mirtazapine (5,737,304 prescriptions). Even with the existence of the AGS Beers Criteria for PIM Use in Older Adults and its continued updated versions, 16% of medications dispensed to Medicare Part D were potentially inappropriate. Future studies are needed to assess if this has led to worsened outcomes among older adults who utilized these PIM.

The impact of hospitalization on inappropriate prescribing and polypharmacy in older patients: A descriptive cross-sectional study.

Polypharmacy and the use of potentially inappropriate medications (PIMs) in older individuals are widespread phenomena that are associated with an increase in morbidity and mortality. The Beers Criteria is a tool that helps to identify patients that are prescribed with PIMs, thereby reducing the risk of associated harm. Amongst other populations, the criteria identify drugs that should not be used by the majority of older patients. Determining the proportion of older inpatients who were discharged from hospitalization with polypharmacy (a prescription for more than seven drugs), or with a PIM as defined by the Beers Criteria. A descriptive cross-sectional study based on patients aged 65 and over who were hospitalized in the years 2019-2021 in the internal medicine, orthopedic and surgical wards at a medium-size hospital. Demographic information and details about drug treatment were collected from the electronic patient records system. Patients who died during hospitalization were excluded from the study group. The proportion of inpatients with polypharmacy or a PIM as part of their regular prescription, at the time of admission and at discharge. 49 564 patients were included in the study cohort. At discharge, 19% of the patients were given a prescription for a PIM, with a small but significant decrease compared with the rate admission (22.1%). At discharge, 42.8% of patients had polypharmacy, representing a small but significant increase compared with the rate on admission (40.6%). The study demonstrated high baseline rates of PIM prescription and polypharmacy. Hospitalization was associated with a decrease in PIM prescription and an increase in polypharmacy. This highlights the importance of medication review during admission to reduce the potential risk to older adults from polypharmacy and PIM prescription.

Rationality of Prescribing Diabetes Mellitus Drugs Using Beers Criteria for Geriatric Patients in Outpatient Installations dr. Iskak Hospital

Diabetes mellitus (DM) is se group of metabolic disorders with symptom hyperglycemia Which happen caused because abnormality secretion insulin and insulin action or both . Diabetes mellitus (DM) is a global problem in which 20% of sufferers are geriatrics. Treatment of DM in geriatrics has the potential to occur irrationally due to the complexity of health problems in geriatrics. Irrational prescribing has a negative impact on health care facilities, patients, and society. One method of assessing rational prescribing is the Beers criteria, developed by the American Geriatrics Society Beers Criteria 2 019. The purpose of this study was to determine the rationality of prescribing DM drugs using the Beers criteria for geriatric patients at the outpatient installation at RSUD dr. Iskak Tulungagung. This research is a descriptive observational study with a cross sectional design. Retrospective data collection on 275 medical record documents of geriatric patients with a diagnosis of DM at the outpatient installation of RSUD dr. Iskak – Tulungagung in the 2021 period. Samples were analyzed using the American Geriatrics Society Beers Criteria 2019 guidelines . The results of the study DM drugs in the Sulfonylurea class were most widely used (13.1%) and 41,3 % identified potentially inappropriate medications (PIMs). The use of potentially inappropriate drugs is 7,32 %, the use of drugs that interact with disease is 3,8%, the drugs that must be used with caution, 6,4%, the drugs that have the potential to interact clinically 0,3%, and the use of drugs that must be avoided or reduced dose related to renal function 0,3%.

Pharmacist-guided deprescribing for frail older adults in nursing homes using STOPPFrail

Abstract Introduction Frail older adults in nursing homes are often prescribed inappropriate medications. Whilst STOPPFrail can aid deprescribing in such persons with limited life expectancy, there has been insufficient research showing pharmacists’ application of this tool.[1,2] Aim To evaluate the impact of pharmacist-led application of STOPPFrail to frail older nursing home residents. Methods Nursing home residents aged ≥65 years with advanced frailty and a poor one-year survival prognosis were eligible to partake.[1] A convenience sample of nursing homes was recruited via nursing home GPs within the research team’s professional network. After recruitment by their general practitioner (GP), a research pharmacist (EH) reviewed participants using STOPPFrail to identify potentially inappropriate medications (PIMs). Deprescribing recommendations for each participant were provided to GPs via email and discussed via videoconference, whereby recommendations were implemented if GPs perceived they were clinically appropriate. Outcome measures were recorded at baseline, post intervention, and at six months. Descriptive and inferential statistics were performed, where p&amp;lt;0.05 represents a statistically significant difference from baseline. Results Ninety-nine patients from six nursing homes were recruited (76% female). The mean age was 86 years (standard deviation [SD]: 6.9), and the mean number of comorbidities was 15 (SD: 5.3). Nearly all patients (94%) were prescribed ≥1 PIM at baseline. From 349 clinically relevant STOPPFrail recommendations to deprescribe 329 PIMs, 58% were accepted (n=203) and 55% were implemented (n=193), resulting in 176/329 PIMs (53%) being deprescribed – with 167/176 (95%) persisting at six months. Recommendations most commonly concerned medications without a clear indication (29.5%), vitamin D (16.9%), antipsychotics (8.9%), memantine (7.2%), and proton pump inhibitors (7.2%). Relating to baseline, post intervention, and at six months: i)the mean ± SD number of prescribed medications was 16.0±6.1, 14.6±5.7 (p&amp;lt;0.01), and 15.4±5.5 (p=0.03); ii)the monthly mean ± SD cost of patients’ medications was €186.8±123.7, €172.7±119.0 (p&amp;lt;0.01), and €186.4±121.2 (p=0.949); iii)the mean ± SD Modified Medication Appropriateness Index (MMAI) was 2.19±0.73, 2.11±0.74 (p&amp;lt;0.01), and 2.08±0.71 (p&amp;lt;0.01); iv)the median [interquartile range] Drug Burden Index (DBI) was 1.03 [0.50-2.00], 0.93 [0.50-1.80] (p&amp;lt;0.01), and 0.93 [0.50-1.80] (p&amp;lt;0.01); v)the mean ± SD Anticholinergic Cognitive Burden (ACB) was 4.27±2.45, 3.86±2.54 (p&amp;lt;0.01), and 3.94±2.70 (p=0.03). The mean ± SD EQ-5D-5L QoL summary score was 0.183±0.286 at baseline and 0.159±0.312 (p=0.18) at six months. The mean ± SD EQ-5D-5L visual analogue score was 60.3±22.8 at baseline and 61.8±19.9 (p=0.45) at six months. Over two-thirds of residents (70/99) were alive at six months. There were 36 falls, one emergency department visit, and eight non-elective hospitalisations six months prior to baseline compared to 31, four, and seven respectively in the six months post intervention. Conclusion To the authors’ knowledge, this is the first study to apply STOPPFrail to residents of long-term care facilities and also the first to have a pharmacist do so. Although this study lacked a control group, the intervention significantly reduced PIMs, medication costs (initially, but not maintained at follow-up), and both the anticholinergic and sedative burden. The intervention maintained QoL and reduced fall frequency. Given these results, policymakers, nursing home facilities, and clinicians should consider the wider implementation of pharmacist-led STOPPFrail-guided reviews to optimise the medications of frail older adults.

Feasibility study of a multidisciplinary DEprescribing review for Frail oldER Adults in Long-term care (DEFERAL) targeting potentially inappropriate antihypertensive medications

Abstract Introduction Frail older adults who reside in long-term care facilities (LTCFs) are at a higher risk of adverse drug events due to potentially inappropriate medications (PIMs). Deprescribing is a safe and effective method of reducing PIMs. Despite the benefits, there is evidence that deprescribing is not being conducted. The DEFERAL strategy was designed to support healthcare professionals (HCPs) to deprescribe PIMs for frail older adults in LTCFs. DEFERAL consists of a three-monthly multi-disciplinary team (MDT) deprescribing review, incorporating evidence-based deprescribing tools. It is conducted in person at the LTCF, targeting one pre-determined class of PIMs, organised by a nurse champion on site.[1] Aim To test the DEFERAL strategy, focusing on implementation outcomes of acceptability, feasibility, appropriateness and fidelity while collecting intervention data on deprescribing decision-making. Methods A feasibility study was conducted, recruiting a convenience sample of two LTCFs in the South-West of Ireland. The LTCFs required a general practitioner, pharmacist and nurse to be eligible. To be included in the deprescribing review, patients were required to be ≥65 years, frail, prescribed ≥1 antihypertensive and to have no deprescribing contraindications. The study followed a hybrid type three design,[2] focusing on implementation outcomes whilst collecting intervention data. HCP feedback was collected using a post-meeting survey, which was emailed to HCPs or available in paper format via the on-site nurse champion. Data were analysed quantitatively. Open-ended comment boxes were analysed using content analysis. Data on intervention outcomes were collected using a summary sheet documenting meeting attendance, recruitment and decision-making, and were analysed quantitatively. Results The survey was completed by ten HCPs (83.3%). Of completed surveys, 100% (n=10) agreed that the DEFERAL strategy was acceptable and appropriate to support deprescribing and 90% (n=9) agreed that it was feasible to undertake. The majority (90%) of HCPs indicated that they completed their designated roles exactly as described; however, qualitative feedback described site-specific modifications. In Site 1, the wider MDT were not engaged as intended and the site did not facilitate the education and screening phase as described. Site 2 introduced an additional resource to facilitate documentation of clinical measurements to support deprescribing decision-making. From a total of 90 residents, 56 (62.2%) were prescribed ≥1 antihypertensive medication. Of those resident at the time of the review, 16 (29.6%) patients were eligible and deprescribing occurred for six patients (37.5%) through dose reduction of antihypertensive medications. Documented reasons for not deprescribing included fear of negative consequences and inappropriate blood pressure measurements. Conclusion The DEFERAL strategy led to successful deprescribing of antihypertensive medications in LTCFs, supported with positive feedback on implementation outcomes. A strength of the strategy is its universal nature. DEFERAL could be adjusted to support deprescribing for different PIMs, patient cohorts or organisational structures in LTC. The strategy provides a blueprint to support medication reviews in LTC, integrating the pharmacist into routine practice. Future research is required to test the strategy for effectiveness, considering the site-specific modifications. A study limitation was the lack of completion of the follow-up survey, limiting the completeness of the feedback on the strategy.

Reducing potentially inappropriate medication use and patient harm in a dedicated geriatric oncology clinic: a cross-sectional study

Abstract Introduction International guidance on conducting medication reviews in older adults with cancer was published in June 2022,[1] and current clinical practices have been outlined by pharmacists working in this field.[2] This process includes assessing for drug-drug interactions (DDIs), potentially inappropriate medications (PIMs), and assessing anticholinergic burden (ACB), all of which have been associated with poorer outcomes in older adults with cancer.[2] Since July 2022, the Geriatric Oncology Assessment and Liaison (GOAL) Clinic in our tertiary cancer centre has offered a comprehensive geriatric assessment (CGA) to patients ≥70 years, which includes a comprehensive geriatric pharmacological assessment (CGPA), performed by the primary author. Aim Identify pharmacist interventions that resulted in a reduction of medication use in older adults attending a geriatric oncology clinic. Methods Data were collected between July 2022 and September 2023 inclusive. Patients who attended the GOAL clinic consented and underwent a CGPA. The CGPA database was analysed to assess for recommendations that reduced medication usage via two metrics: (i) reduced doses of medications; (ii) deprescribing of medications. Descriptive statistics were used to analyse the data (Table 1). Results One hundred and seventy four patients (98%) consented to a CGPA. Interventions to reduce medication use occurred in 120 patients (69%). There were 199 total number of interventions, with some patients having more than one intervention. The nature of the interventions are described in Table 1. Conclusion A structured medication review in the form of a CGPA, alongside a multidisciplinary CGA is effective at identifying potential areas to reduce medication usage in older adults with cancer, through appropriate dose reductions and deprescribing strategies. This service is unique as the GOAL clinic is Ireland’s only dedicated geriatric oncology clinic. The utilisation of a clinical pharmacist in a geriatric oncology outpatient clinic can effectively identify opportunities to reduce inappropriate medication, with almost 70% of patients being identified as being prescribed potentially inappropriate medications. This study was limited to the outpatient setting only. Future research should consider the impact of pharmacist review of medications for older adults with cancer at transitions of care.

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.

Trends in Number and Appropriateness of Prescription Medication Utilization among Community-Dwelling Older Adults in the US: 2011-2020.

Contemporary data on the quantity and quality of medication use among older adults are lacking. This study examined recent trends in number and appropriateness of prescription medication use among older adults in the US. Data from the National Health and Nutrition Examination Survey (NHANES) between 2011 and March 2020 were used and 6336 adult participants aged 65 and older were included. We examined the number of prescription medication, prevalence of polypharmacy (≥5 prescription drugs), use of potentially inappropriate medication (PIM), and use of recommended medications (ACEI/ARBs plus beta-blockers among patients with heart failure and ACEI/ARBs among patients with albuminuria). There has been a slight increase in the prevalence of polypharmacy (39.3% in 2011-2012 to 43.8% in 2017-2020, p for trend= 0.32). Antihypertensive, antihyperlipidemic, antidiabetic medications, and antidepressants are the most commonly used medications. There was no substantial change in the use of PIM (17.0% to 14.7%). Less than 50% of older adults with heart failure received ACEI/ARBs plus beta-blockers (44.3% in 2017-2020) and approximately 50% patients with albuminuria received ACEI/ARBs (54.0 in 2017-2020), with no improvement over the study period. Polypharmacy, older age, female, and lower socioeconomic status generally were associated with greater use of PIM but lower use of recommended medications. The medication burden remained high among older adults in the US and the appropriate utilization of medications did not improve in the recent decade. Our results underscore the need for greater attentions and interventions to the quality of medication use among older adults.

Clinical impact of an individualised clinical pharmacy programme into the memory care pathway of older people: an observational study.

In older patients, medication exposure [i.e. polypharmacy, potentially inappropriate medications (PIMs), medications with anticholinergic and/or sedative properties] is a modifiable risk factor associated with cognitive iatrogenic risk and dementia. To assess the potential clinical impact of the implementation of an individualised clinical pharmacy programme at the initiation of the Memory care pathway in older patients with a cognitive complaint. This prospective observational study included older patients with high-risk of adverse drug event (HR) admitted in a French geriatric university hospital to explore the cognitive complaint or the cognitive disorder between January and November 2021. Drug-related problems (DRPs) were identified during a medication review performed in HR patients, and pharmaceutical interventions (PIs) notified in the patient's hospitalisation report were collected. The clinical impact of PIs was assessed by an expert panel (geriatricians and clinical pharmacists) using the Clinical, Economic, and Organisational (CLEO) tool. Overall, 326 patients were eligible and 207 (63.5%) were considered as HR patients. Among HR patients, 88.9% (n = 184) were treated using at least 5 medications (polypharmacy), and 36.7% (n = 76) received at least one PIM with cognitive iatrogenic risk. During the medication review, 490 PIs were provided and their clinical impact was rated as minor for 57.3% (n = 281), moderate for 26.7% (n = 131), and major for 2.5% (n = 12). The integration of clinical pharmacist secured the Memory care pathway of older patients with a cognitive complaint by identifying an important number of DRPs and PIMs with potential cognitive iatrogenic risk.

Comparison of polypharmacy and potentially inappropriate medication use in older adults with and without dementia receiving residential medication management reviews.

Among residents who had a residential medication management review (RMMR), there is a lack of studies assessing exposure to polypharmacy and potentially inappropriate medications (PIMs) in people with dementia. This study compared the exposure to polypharmacy and PIMs in residents with dementia and without dementia receiving RMMR. A retrospective analysis was performed using data of 16,261 residents living in 343 Australian residential aged care facilities who had an RMMR in 2019. Medication use was assessed as polypharmacy (defined as ≥9 medications) and use of ≥1 PIMs using the 2019 updated Beers criteria. Dementia diagnosis was determined with ICD-10 coding from medical records. Descriptive analyses reported resident demographics and patterns of medication use. Pearson's χ2 tests and logistic regression analysis were conducted to compare medication exposure between residents with and without dementia. Among 16,261 residents, 6781 (42%) had dementia. Residents with dementia were significantly more likely to be exposed to polypharmacy and PIMs, compared to those without dementia (74% vs. 70% and 83% vs. 73%, p < .001 respectively). Residents with dementia had 1.31 times the odds of exposure to polypharmacy (adjusted OR: 1.31, 95% CI: 1.22-1.41, p < .001) and 1.88 times the odds of being prescribed ≥1 PIMs than people without dementia (adjusted OR: 1.88, 95% CI: 1.73-2.04, p < .001). In a study of residents receiving RMMR, polypharmacy and PIMs were highly common, and those with dementia were more likely to be exposed to inappropriate polypharmacy. There is a need for targeted deprescribing strategies to immediately address inappropriate prescribing in residents, particularly those living with dementia.

The Impact of Pharmacist Medication Reviews on Geriatric Patients: A Scoping Review.

Medication review is an intervention with the potential to reduce drug-related problems (DRPs) in the elderly. This study aimed to determine the effect of pharmacists' medication reviews on geriatric patients. This study accessed two online databases, MEDLINE Complete and Scopus, and examined all studies published in English between 2019 and 2023, except for reviews. The studies included (1) participants over 65 years of age and (2) medication reviews conducted by pharmacists. The titles, abstracts, and full texts were reviewed for data extraction to determine whether the studies satisfied the inclusion and exclusion criteria. Forty-four of the initial 709 articles were included in this study. The articles included discussions on the incidence rates of DRPs and potentially inappropriate medications (PIMs) (n=21), hospitalization (n=14), medication adherence (n=9), quality of life (QoL) (n=8), and falls (n=7). Pharmacist medication reviews were associated with a reduced incidence of DRPs and PIMs, and improved adherence to medications. Patients' overall QoL is also increasing. However, pharmacist medication reviews were not strongly associated with decreased hospitalization or falls. A pharmacist's medication review may be a feasible intervention for reducing the incidence rates of DRPs and PIMs, regardless of whether it is performed as a sole intervention or supplemented with other interventions. The intervention was also effective in increasing medication adherence and QoL.

Influence of chronic medical conditions on older patients’ willingness to deprescribe medications: a cross-sectional study

BackgroundAging correlates with a heightened prevalence of chronic diseases, resulting in multimorbidity affecting 60% of those aged 65 or older. Multimorbidity often leads to polypharmacy, elevating the risk of potentially inappropriate medication (PIM) use and adverse health outcomes. To address these issues, deprescribing has emerged as a patient-centered approach that considers patients’ beliefs and attitudes toward medication and reduces inappropriate polypharmacy in older adults. Our study aims to investigate whether certain chronic medical conditions are associated with older patients’ willingness to deprescribe medications.MethodsA cross-sectional study enrolled 192 community-dwelling individuals aged 65 or older taking at least one regular medication. Data included demographics, clinical characteristics, and responses to the Portuguese revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire. Descriptive statistics characterized participants, while multiple binary logistic regression identified associations between chronic medical conditions and willingness to deprescribe.ResultsAmong the participants (median age: 72 years, 65.6% female), 91.6% had multimorbidity. The analysis revealed that willingness to deprescribe significantly increased with the presence of gastric disease (adjusted odds ratio [aOR] = 4.123; 95% CI 1.221, 13.915) and age (aOR = 1.121; 95% CI 1.009, 1.246). Conversely, prostatic pathology (aOR = 0.266; 95% CI 0.077, 0.916), higher scores in the rPATD appropriateness factor (aOR = 0.384; 95% CI 0.190, 0.773), and rPATD concerns about stopping factor (aOR = 0.450; 95% CI 0.229, 0.883) diminished patients’ willingness to deprescribe.ConclusionsThis study highlights the intricate relationship between older patients’ attitudes toward deprescribing and chronic medical conditions. We found that gastric disease was associated with an increased willingness to deprescribe medications, while prostate disease was associated with the opposite effect. Future research should explore how patients with specific diseases or groups of diseases perceive deprescribing of medications general and for specific medications, aiding in the development of targeted interventions.

Effects of medication management in geriatric patients who have fallen: results of the EMMA mixed-methods study.

comprehensive medication management (CMM) can reduce medication-related risks of falling. However, knowledge about inter-individual treatment effects and patient-related barriers remains scarce. to gain in-depth insights into how geriatric patients who have fallen view their medication-related risks of falling and to identify effects and barriers of a CMM in preventing falls. complementary mixed-methods pre-post study, based on an embedded quasi-experimental model. geriatric fracture centre. qualitative, semi-structured interviews framed the CMM intervention, including a follow-up period of 12weeks. Interviews explored themes of falling, medication-related risks, post-discharge acceptability and sustainability of interventions using qualitative content analysis. Optimisation of pharmacotherapy was assessed via changes in the weighted and summated Medication Appropriateness Index (MAI) score, number of fall-risk-increasing drugs (FRID) and potentially inappropriate medications (PIM) according to the Fit fOR The Aged and PRISCUS lists using parametric testing. thirty community-dwelling patients aged ≥65years, taking ≥5 drugs and admitted after an injurious fall were recruited. The MAI was significantly reduced, but number of FRID and PIM remained largely unchanged. Many patients were open to medication reduction/discontinuation, but expressed fear when it came to their personal medication. Psychosocial issues and pain increased the number of indications. Safe alternatives for FRID were frequently not available. Psychosocial burden of living alone, fear, lack of supportive care and insomnia increased after discharge. as patients' individual attitudes towards trauma and medication were not predictable, an individual and longitudinal CMM is required. A standardised approach is not helpful in this population.

Emergency department resource utilization among nursing home residents, a National Cross-Sectional Study

ObjectivesPersons 65 years and older (older persons), particularly residents of nursing homes (NHs), disproportionately access the emergency department (ED) and utilize more medical resources. The goal of this study is to provide a contemporary description of healthcare utilization patterns and disposition decisions for United States (US) NH residents presenting to EDs. MethodsOlder persons presenting to EDs in the US were identified in the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2017, 2018 and 2019 datasets. We examined demographic, clinical, and resource use characteristics and outcomes. After survey weighting, we compared the frequency of different imaging, medications, clinical interventions, and outcomes in the ED between NH residents and those residing outside NHs. ResultsFrom 2017 to 2019, older persons made 24,441,285 annual visits to the ED, comprising 17.5% of all visits. Among these, 1,579,916 visits (6.5%) were by NH residents. Compared with non-NH residents, NH residents were older (mean age: 81.2 [95%CI 81.5–82.9] vs 76.1 [95%CI 75.8–76.4]), underwent more imaging (82.8% [95%CI 79.5–86.1] vs 71.6% [95%CI 69.9–73.3]), were administered fewer potentially inappropriate medications (PIMs) in the ED or upon discharge (9.5% [95%CI 6.2–2.7] vs 17.1% [95%CI 15.8–18.4]), and had a higher proportion of visits resulting in hospital admission (44.1% [95% CI 38.2–49.9] vs 26.0% [95%CI 23.3, 28.7]). ConclusionsOlder NH residents presenting to the ED use more resources and are more likely to be hospitalized compared to older persons residing outside NHs. The resource-intensive nature of these visits highlights the importance of targeted, multi-disciplinary interventions that optimize ED care for this population.

Medication Deprescribing in Patients Receiving Hemodialysis: A Prospective Controlled Quality Improvement Study

Patients treated with dialysis are commonly prescribed multiple medications (polypharmacy), including some potentially inappropriate medications (PIMs). PIMs are associated with an increased risk of medication harm (eg, falls, fractures, hospitalization). Deprescribing is a solution that proposes to stop, reduce, or switch medications to a safer alternative. Although deprescribing pairs well with routine medication reviews, it can be complex and time-consuming. Whether clinical decision support improves the process and increases deprescribing for patients treated with dialysis is unknown. This study aimed to test the efficacy of the clinical decision support software MedSafer at increasing deprescribing for patients treated with dialysis. Prospective controlled quality improvement study with a contemporaneous control. Patients prescribed≥5 medications in 2 outpatient dialysis units in Montréal, Canada. Patient health data from the electronic medical record were input into the MedSafer web-based portal to generate reports listing candidate PIMs for deprescribing. At the time of a planned biannual medication review (usual care), treating nephrologists in the intervention unit additionally received deprescribing reports, and patients received EMPOWER brochures containing safety information on PIMs they were prescribed. In the control unit, patients received usual care alone. The proportion of patients with≥1 PIMs deprescribed was compared between the intervention and control units following a planned medication review to determine the effect of using MedSafer. The absolute risk difference with 95% CI and number needed to treat were calculated. The primary outcome was the proportion of patients with one or more PIMs deprescribed. Secondary outcomes include the reduction in the mean number of prescribed drugs and PIMs from baseline. In total, 195 patients were included (127, control unit; 68, intervention unit); the mean age was 64.8±15.9 (SD), and 36.9% were women. The proportion of patients with≥1 PIMs deprescribed in the control unit was 3.1% (4/127) vs 39.7% (27/68) in the intervention unit (absolute risk difference, 36.6%; 95% CI, 24.5%-48.6%; P<0.0001; number needed to treat=3). This was a single-center nonrandomized study with a type 1 error risk. Deprescribing durability was not assessed, and the study was not powered to reduce adverse drug events. Deprescribing clinical decision support and patient EMPOWER brochures provided during medication reviews could be an effective and scalable intervention to address PIMs in the dialysis population. A confirmatory randomized controlled trial is needed.

Brain-Hazardous Medications and Potential Subadequate Antidepressant Dosing in Older Surgical Patients Receiving Home Antidepressants: An Observational Study of a Large US Health System.

Older surgical patients with depression often experience poor postoperative outcomes. Poor outcomes may stem from brain-hazardous medications and subadequate antidepressant dosing. This was a retrospective, observational cohort study covering the period between January 1, 2021 and December 31, 2021. Patients ≥60 years of age who underwent inpatient surgery and had an overnight stay at an integrated academic health care system comprising 14 hospitals were eligible. We analyzed the prevalence of home central nervous system (CNS)-active potentially inappropriate medication (PIM) and potential subadequate antidepressant dosing in older surgical patients receiving home antidepressants. Univariable and multivariable regression models were used to identify factors associated with home CNS-active PIM prescribing and potential subadequate antidepressant dosing. Additionally, outcomes were compared among patients receiving and not receiving CNS-active PIMs and patients receiving and not receiving subadequate antidepressant dosing. A total of 8031 patients were included in this study (47% female, mean age = 70 years) of whom 2087 (26%) were prescribed antidepressants. Roughly one-half (49%, 95% confidence interval [CI], 46.5-50.1) of patients receiving home antidepressants were also receiving ≥1 CNS-active PIM and 29% (95% CI, 27.0-29.3) were receiving a potential subadequate dose. Factors associated with an increased likelihood of receiving a home CNS-active PIM included female sex (adjusted odds ratio [aOR], 1.46), anxiety (aOR, 2.43), asthma or chronic obstructive pulmonary disease (aOR, 1.39), and serotonin-norepinephrine reuptake inhibitor use (aOR, 1.54). Patients aged ≥75 years (aOR, 1.57), black race (aOR, 1.48) and those with congestive heart failure (aOR, 1.33) were more likely to be prescribed a potential subadequate antidepressant dose. Patients receiving potential subadequate antidepressant doses were discharged home less often (64% vs 73%), had a longer hospital length of stay (9 days vs 7 days), and a higher mortality rate (18% vs 10%) compared to patients receiving adequate home antidepressant doses (P-value for all <0.01). No differences in these outcomes were found among patients receiving home antidepressants with or without CNS-active PIMs. Older surgical patients receiving antidepressants are frequently prescribed brain-hazardous medications and potentially subadequate antidepressant doses. Those receiving subadequate antidepressant doses may be at risk for worse postoperative outcomes compared to patients receiving adequate doses. The role of preoperative medication optimization to improve outcomes for older surgical patients should be evaluated.

Frequency of Potentially Inappropriate Medications in Iranian Elderly Hospitalized Patients

Background: Potentially inappropriate medications (PIMs) should not be prescribed to the elderly due to low effectiveness and adverse drug reactions. This study was conducted to determine the frequency of PIMs in the elderly admitted to educational hospitals in Kerman, in 2023. Methods: This cross-sectional study was conducted on 1500 elderly patients hospitalized in educational hospitals. The data collection forms were completed according to the health information system (HIS) of the hospital, which includes the patient’s age and gender, drug information, and the name of the hospital and ward. PIMs prescriptions were assessed according to Zhan’s criteria. Statistical analyses were performed using SPSS version 20.0. The results were presented as mean±standard deviation (SD) and frequencies (percents). Results: Nearly 17.8% (n=267) of patients were treated with at least one PIMs included in the Zhan criteria. Among 331 PIMs used for patients, 43.5% (n=144), 23.3% (n=77), and 33.2% (n=110) of drugs were classified as always avoid, rarely appropriate, and some indication, respectively. Sedative-hypnotics, opioids, and antihistamines were the most prevalent PIMs with 29.5% (n=98), 25.4% (n=84), and 23.3% (n=77) frequency. Approximately 71.4% (n=10) of patients who were admitted to the Oncology ward, and 38.9% (n=33) of patients who were admitted to the Critical Care Unit were treated with at least one PIMs. Conclusion: Today PIMs are a problem for elderly patients. Paying attention to PIMS in oncology, and critical care unit wards is important. More attention should be paid to sedative-hypnotics, opioids, and antihistamines as the most frequently prescribed PIMs.