Prevalence Of Potentially Inappropriate Medications Research Articles

Prevalence of potentially inappropriate medication use in the older population living in Germany

Abstract Background Potentially inappropriate medications (PIM) are medicines for which the risks for adverse events (AEs) usually outweigh the clinical benefits in older adults. PIM is associated with an increased risk of AEs, hospitalizations, mortality and higher health care costs. This analysis presents the prevalence of PIM use and associated factors in people aged 66+ years living in Germany. Methods Data from the nationally representative Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2021-2023 by the Robert Koch Institute, was analyzed. All medicines used, prescribed and over-the-counter (OTC), in the 7 days before the interview were classified into anatomical therapeutic chemical codes. PIM use was identified based on the PRISCUS 2.0 list. Weighted prevalences and associated factors for PIM use are presented. Results 96% of the sample (N = 1,474) took at least 1 medication in the 7 days before the interview. The prevalence of PIM use was 29% (95% CI: 26%-32%), 23% took 1 PIM and 6% 2+. There were no sex differences but a significant increase with age: 23% in the age group 66-74, 33% in the age group 75-84, and 39% in the age group 85 + (29% 1 PIM and 10% 2+). People with a low educational level had a PIM prevalence of 32% compared to 21% in those with a high educational level. Among those reporting having chronic diseases, the PIM prevalence was 34% compared to 19% among those not reporting them. The prevalence of PIM increased with the number of medicines used: 13% in 1-4 medicines, 31% in 5-9 medicines, and 53% in 10+ medicines. The most frequently used PIM in this sample was ginkgo biloba leaf extract (plant-based antidementia drug) followed by diclofenac (non-steroidal anti-inflammatory drug), and then by tricyclic antidepressant drugs (opipramol and amitriptyline). Conclusions PIM use was higher than suggested by prescription data analysis. It was associated with higher age, chronic diseases, polypharmacy and a low educational level. Key messages • PIM use was common, affecting more people with chronic diseases, older age groups and people with a low educational level. • Strategies to promote and monitor appropriate medication use are needed.

Polypharmacy and associated factors in the older population in Germany: Results Gesundheit 65+ study

Abstract Background Polypharmacy, the use of 5 or more medications simultaneously, favors the risk of adverse drug events, drug interactions, potentially inappropriate medication (PIM), hospitalizations, falls, frailty, and mortality. This analysis presents the prevalence of polypharmacy and associated factors in people aged 66+ years living in Germany. Methods Data from the nationally representative Study on Health of Older People in Germany (Gesundheit 65+) conducted between 2021-2023 by the Robert Koch Institute, was analyzed. All medicines used, prescribed and over-the-counter, in the 7 days before the interview were documented and classified into anatomical therapeutic chemical codes. Weighted prevalences and associated factors for polypharmacy are presented. Results 96% of the sample (N = 1,474) took at least 1 medication in the 7 days before the interview. Of these, 39% took up to 4 medications, 39% 5-9 and 22% 10+. The overall prevalence of polypharmacy was 61% (95%CI 58-65%) and was significantly higher in women (64%) than in men (59%). Polypharmacy increased with age, from 52% in the age group 66-74 (53% in men, 51% in women), 66% in the age group 75-84 (63% in men, 69% in women) to 81% in the age group 85 + (72% in men, 86% in women). People with low educational level had a polypharmacy prevalence of 63% (58% in men, 66% in women) compared to 56% (55% in men, 58% in women) in those with high educational level. Severe difficulties in organizing daily medication intake were reported in 1% of people taking up to 4 medicines, in 4% of people taking between 5-9 medicines and in 16% of people taking 10+. The prevalence of PIM increased with the number of medicines used: 13% in 1-4 medicines, 31% in 5-9 medicines, and 53% in 10+ medicines. Conclusions Polypharmacy was more frequent in women, older age groups and in people with low educational level. It was associated with increased difficulty in organizing medication intake and with PIM use. Key messages • Polypharmacy is very common, affecting more women, older age groups, people with a low educational level and is associated with PIM use. • Strategies to promote appropriate medication use are needed.

Prevalence of potentially inappropriate medications according to STOPP-Frail criteria in nursing home residents, the SHELTER study

ObjectiveThe aim of this study was to determine the prevalence of potentially inappropriate medications (PIMs) in nursing home residents across eight countries and investigate differences between residents with and without cognitive impairment, as well as those with and without life expectancy of six months or less.Methods and deignThe study utilized the second edition of the STOPP-Frail criteria to operationalize PIMs in the baseline assessment of nursing home residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) project. The data were collected between 2009 and 2012. The project was conducted in eight countries: Czech Republic, England, Finland, France, Germany, Italy, the Netherlands, and Israel. Cognitive impairment was measured by the cognitive performance scale (CPS). The presence of end-stage disease with a life expectancy of six months or less was recorded. The study included residents aged 60 years or older who underwent a valid medication assessment.ResultsAmong the 3,832 eligible residents, 87.9% had at least one PIM. Specifically, 24.3%, 23.5%, 18.8%, and 19.3% of residents had one, two, three, and four or more PIMs, respectively. On average, each person was prescribed 2.16 PIMs. Cognitively impaired residents (n = 1999) had an average of 1.96 PIMs (SD 1.49) per person, while residents with a low CPS score (n = 1783) had an average of 2.40 PIMs (SD 1.57) per person, showing a statistically significant difference (P < 0.001). Similarly, NH residents with life expectancy of six months or less had an average of 1.66 PIMs (SD 1.30), whereas those without had an average of 2.17 PIMs (SD 1.55) (p < 0.001). The average number of PIMs varied across countries, ranging from 3.23 in Finland to 2.15 in the UK (P < 0.001). Anti-platelets and aspirin were the most prescribed PIMs, accounting for over 38.0% of prescriptions.ConclusionsThis study highlights the high prevalence of PIMs among nursing home residents. However, PIMs were somewhat lower in residents with cognitive impairment and life expectancy of six months or less. Efforts must continue to improve the rationale behind prescribing practices in nursing homes.

Prevalence of potentially inappropriate medications and prescription dynamics in elderly hospitalized patients in Spain

PurposeIn recent years, the need for a more appropriate prescription of medications in the older population has emerged as a significant public health concern. In this study, we aimed to evaluate the prevalence of potentially inappropriate medications (PIM) in hospitalized adults aged ≥ 75.Patients and methodsThis was a retrospective descriptive observational study of patients at 16 hospitals in Spain. The study population included inpatients aged ≥ 75 admitted during a 7-day period (May 10 to 16, 2021). Data were obtained from the pharmacy databases of the participating hospitals. The list of PIMs was based on the Beers, STOPP-START, EU-PIM and PRISCUS criteria.ResultsA total of 4,183 patients were included. PIMs were detected in 23.5% (N = 1,126) of the cohort. The prevalence rates at the participating hospitals ranged from 10% to 42.5%. The PIM/patient ratio was 1.2. The most common PIMs were midazolam, dexketoprofen, diazepam, and doxazosin, all of which (except for doxazosin) were more common in women. Benzodiazepines accounted for 70% of all PIMs. In 35% of cases, the PIMs were initiated before hospital admission. Of the 818 PIMs initiated during hospitalization, the two most common were benzodiazepines (49%) and anti-inflammatory drugs (25%). At discharge, only 4.9% of the PIMs initiated during the hospital stay were still prescribed.ConclusionIn this population of older hospitalized patients, the overall prevalence of PIMs was moderate. However, the prevalence rate at the participating hospitals was highly variable. In most cases, PIMs prescribed prior to hospitalization for chronic conditions were not withdrawn during the hospital stay. No significant increase in PIMs was observed from pre-admission to post-discharge.These findings underscore the need for multidisciplinary interventions to optimize the pharmaceutical treatment in older adults in the hospital setting to reduce the consequences of PIMs in patients.

The Prevalence of Potentially Inappropriate Medications (PIMs) Among Frail Older Participants of The Irish Longitudinal Study on Ageing (TILDA)

Abstract Background This study aimed to assess PIMsprevalence among frail older participants of The Irish Longitudinal Study on Ageing (TILDA), using a newly developed OPTI-3S criteria (criteria for OPTImising medicines by Stopping, Stepping down, or Switching to safer alternatives). Methods All TILDA participants with polypharmacy (i.e. ≥5 medicines) and frailty based on Clinical Frailty Scale (CFS) ≥4 were included. PIMswere assessed based on the Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail v2) [1], Poudel et al. algorithm [1], the Norwegian General Practice--Nursing Home criteria (NORGEP-NH) [1], and OPTI-3S. The prevalence of PIMsidentified by each tool was assessed across all frailty levels (CFS ≥4). Poisson regression assessed associations between PIM prevalence and covariates (e.g. medications). Results Most of the study cohort (86.5%, n=504) had at least one PIM identified by any of the four tools. OPTI-3S identified at least one PIM in 62.6% of participants, followed by Poudel’s algorithm (53.9%) and NORGEP-NH (40.5%). OPTI-3S could identify at least one PIM in 97.8% of participants with CFS ≥7, followed by STOPPFrail (88.9%). Overall, 34.8% of prescribed medications were considered to be PIMsThe OPTI-3S list detected more PIMsthan any other tool for all frailty levels (e.g. OPTI-3S, 78.4% vs STOPPFrail, 40.2% in CFS ≥7). Deprescribing all OPTI-3S-defined PIMswould reduce polypharmacy by 20.6% compared to NORGEP-NH (13.3%) and Poudel’s algorithm (12.0%). The most prevalent PIMswere aspirin, benzodiazepines and z-drugs, and antihypertensive medications. The number of medications, anticholinergic burden, and being on specific medications (e.g. aspirin, NSAIDs, benzodiazepines, antidepressants) were significantly associated with increased PIMs. Conclusion OPTI-3S is a useful PIM screening tool in community-dwelling frail older adults, pending further testing in the hospital setting. Reference 1. Anlay, D.Z et al. Br J Clin Pharmacol. 2024;90(1):12-106.

A Study of Polypharmacy and its Consequences in Geriatric Patients

The term polypharmacy is the concurrent use of five or more drug by a patient. In older persons, the cutoff threshold of five medicines is linked to the unfavourable outcomes such falls, disability, and mortality one of the crucial components. The main components of polypharmacy therapy in the clinical setting are reviewed in this study. Potential Drug-Drug Interactions (pDDIs) and Potentially Inappropriate Medications (PIMs) are threatening and contribute to increased rate of morbidity and mortality rate. The present study was performed on the prevalence of pDDIs and PIMs among the geriatric patients at a tertiary care hospital. Methodology: The study was Prospective, Cross-sectional study carried out for a period of six months in General Medical Ward at Akash hospital, Bangalore PIMs were analyzed using Beer’s criteria and pDDIs were analyzed using online data base system (Micromedex 2.2) Results: In this study, a total of 110 patients were enrolled, out of which 69 (62.72%) were males and 41 (37.28%) were females. Out of which 21 (19.10%) prescription showed PIMs and 66 (56%) prescription showed pDDIs. A total of 180 pDDIs were observed, 3 interactions (1.7%) come under the classification of contraindication, 87 (48.3%) fall under major severity, 85 (47.29%) were of moderate severity and 5 (2.8%) were of minor severity. Among 180 pDDIs, 13 (7.2%) were of rapid, 21 (11.6%) were delayed and 146 (81.6%) were not specified. 97 (57.30%) were of synergism, 49 (27.40%) were antagonism and 34 (18.80%) were unknown. 13 (7.2%) were of excellent, 29 (16.20%) were good and 138 (76.60%) were fair. Conclusion: This study concluded that awareness on the most prevalent pDDIs can help the practitioners to prescribe drugs with a low risk for pDDIs and prevent the concomitant use of various drug combinations.

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.

Potentially Inappropriate Use of Medication and Its Determinants Among Ambulatory Older Adults in Six Community Chain Pharmacies in Asmara, Eritrea: A Cross-Sectional Study Using the 2023 American Geriatric Society Beers Criteria®.

Potentially inappropriate medication (PIM) use is one of the main drug-related problems encountered in older adults. It is associated with adverse drug events, morbidity, mortality, increased economic costs, and negative effects on the quality of life that requires strict monitoring of prescriptions in older adults. Thus, the study aimed to assess potentially inappropriate medication use and its determinants among older adults. A cross-sectional study was conducted among all outpatient prescriptions dispensed to older adults (aged 65 years and above) in six community chain pharmacies in Asmara, Eritrea. Data were collected retrospectively, between June 16 and July 16, 2023. PIMs were detected using the 2023 American Geriatric Society (AGS) Beers Criteria®. Descriptive statistics and logistic regression analysis were performed using IBM SPSS® (Version-26.0). A total of 2680 outpatient prescriptions dispensed to older adults were included in this study. The prevalence of PIM among prescriptions was 18.1% (95% CI: 16.7, 19.6). Moreover, a total of 470 medications were found to be avoided in older adults. The most commonly prescribed PIMs were sulfonylureas (27.2%) and substituted alkylamines (16.2%). The prevalence of prescriptions containing medications to be used with caution in older adults was 13.2% (95% CI: 12.0, 14.5). Age (Adjusted Odds Ratio (AOR))=0.98, 95% CI: 0.97, 0.99), polypharmacy (AOR=2.77, 95% CI: 1.49, 5.15), and general practitioner prescriber (AOR=1.38, 95% CI: 1.11, 1.70) were significantly associated with PIMs. A considerable number of ambulatory older adults were exposed to PIMs which require a close attention by policymakers, program managers, and healthcare professionals.

Potentially Inappropriate Medication Use in Primary Care in Switzerland

Potentially inappropriate medication (PIM) exposes patients to an increased risk of adverse outcomes. Many lists of explicit criteria provide guidance on identifying PIM and recommend alternative prescribing, but the complexity of available lists limits their applicability and the amount of data available on PIM prescribing. To determine PIM prevalence and the most frequently prescribed PIMs according to 6 well-known PIM lists and to develop a best practice synthesis for clinicians. This cross-sectional study used anonymized electronic health record data of Swiss primary care patients aged 65 years or older with drug prescriptions from January 1, 2020, to December 31, 2021, extracted from a large primary care database in Switzerland, the FIRE project. Data analyses took place from October 2022 to September 2023. PIM prescription according to PIM criteria operationalized for use with FIRE data. The primary outcomes were PIM prevalence (percentage of patients with 1 or more PIMs) and PIM frequency (percentage of prescriptions identified as PIMs) according to the individual PIM lists and a combination of all 6 lists. The PIM lists used were the American 2019 Updated Beers criteria, the French list by Laroche et al, the Norwegian General Practice Norwegian (NORGEP) criteria, the German PRISCUS list, the Austrian list by Mann et al, and the EU(7) consensus list of 7 European countries. This study included 115 867 patients 65 years or older (mean [SD] age, 76.0 [7.9] years; 55.8% female) with 1 211 227 prescriptions. Among all patients, 86 715 (74.8%) were aged 70 years or older, and 60 670 (52.4%) were aged 75 years or older. PIM prevalence among patients 65 years or older was 31.5% (according to Beers 2019), 15.4% (Laroche), 16.1% (NORGEP), 12.7% (PRISCUS), 31.2% (Mann), 37.1% (EU[7]), and 52.3% (combined list). PIM prevalence increased with age according to every PIM list (eg, according to Beers 2019, from 31.5% at age 65 years or older to 37.4% for those 75 years or older, and when the lists were combined, PIM prevalence increased from 52.3% to 56.7% in those 2 age groups, respectively). PIM frequency was 10.3% (Beers 2019), 3.9% (Laroche), 4.3% (NORGEP), 2.4% (PRISCUS), 6.7% (Mann), 9.7% (EU[7]), and 19.3% (combined list). According to the combined list, the 5 most frequently prescribed PIMs were pantoprazole (9.3% of all PIMs prescribed), ibuprofen (6.9%), diclofenac (6.3%), zolpidem (4.5%), and lorazepam (3.7%). Almost two-thirds (63.5%) of all PIM prescriptions belonged to 5 drug classes: analgesics (26.9% of all PIMs prescribed), proton pump inhibitors (12.1%), benzodiazepines and benzodiazepine-like drugs (11.2%), antidepressants (7.0%), and neuroleptics (6.3%). In this cross-sectional study of adults aged 65 or older, PIM prevalence was high, varied considerably depending on the criteria applied, and increased consistently with age. However, only few drug classes accounted for the majority of all prescriptions that were PIM according to any of the 6 PIM lists, and by considering this manageable number of drug classes, clinicians could essentially comply with all 6 PIM lists. These results raise awareness of the most common PIMs and emphasize the need for careful consideration of their risks and benefits and targeted deprescribing.

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.

Use of Potentially Inappropriate Medications among Older Adults with Dementia or Cognitive Impairment Attending Memory Clinics: A Protocol for a Systematic Review and Meta-Analysis

Introduction: Older adults with dementia who are on multiple medications are more vulnerable to the use of potentially inappropriate medications (PIMs), which can significantly increase the risk of adverse events and drug-related problems. PIMs use is prevalent and varies among older adults with dementia or cognitive impairment (CI) attending memory clinics. However, the prevalence of PIMs, polypharmacy, and hyper-polypharmacy among older adults with dementia or CI who are attending memory clinics is not well understood. We will conduct a systematic review and meta-analyses to examine the overall estimate of the prevalence of the PIMs, polypharmacy, and hyper-polypharmacy use among older adults attending memory clinics, with dementia or CI. The secondary objective of this study will be to compile a list of commonly implicated PIMs and to investigate factors that may be associated with using PIMs in this population. Methods: Ovid MEDLINE, Ovid Embase, Scopus, Cochrane library, EBSCOhost CINAHL, and Ovid International Pharmaceutical s (IPA) will be systematically searched by a researcher (R.S.) with the help of a librarian (C.C.). All databases will be searched from inception to May 05, 2023. Cross-sectional, cohort, randomized clinical trials, quasi-experimental, and case-control studies will be included if they assess PIM’s use among older adults with dementia and/or CI. A step-by-step guide by Pai et al. [Natl Med J India. 2004;17(2):86–95] will be followed when conducting this systematic review (S.R.). The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist will be followed for reporting this SR. Conclusion: The findings from this SR/MA will identify the pooled prevalence of PIMs, providing a more precise estimate of the true prevalence of the PIMs, polypharmacy, hyper-polypharmacy in older adults with dementia or CI who are attending memory clinics at primary, secondary, or tertiary healthcare settings by considering the results of multiple studies.

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.