Screening Tool Of Older People Research Articles

Prevalence and Risk Factors Associated with Potentially Inappropriate Prescribing According to STOPP-2 Criteria among Discharged Older Patients-An Observational Retrospective Study.

Pharmacokinetic and pharmacodynamic changes associated with old age, along with multimorbidity and polypharmacy might lead to inappropriate prescribing and adverse reactions. Explicit criteria such as the Screening tool of older people's prescribing (STOPP) are useful to identify potential inappropriate prescribing's (PIPs). Our retrospective study included discharge papers from patients aged ≥65 years, from an internal medicine department in Romania (January-June 2018). A subset of the STOPP-2 criteria was used to assess the prevalence and characteristics of PIPs. Regression analysis was performed to evaluate the impact of associated risk factors (i.e., age, gender, polypharmacy and specific disease). Out of the 516 discharge papers analyzed, 417 were further assessed for PIPs. Patients' mean age was 75 years, 61.63% were female and 55.16% had at least one PIP, with 81.30% having one or two PIPs. Antithrombotic agents in patients with significant bleeding risk was the most prevalent PIP (23.98%), followed by the use of benzodiazepines (9.11%). Polypharmacy, extreme (>10 drugs) polypharmacy, hypertension and congestive heart failure were found as independent risk factors. PIP was prevalent and increased with (extreme) polypharmacy and specific cardiac disease. Comprehensive criteria like STOPP should be regularly used in clinical practice to identify PIPs to prevent potential harm.

Analysis of Potentially Inappropriate Drug Prescribing in Hospitalized Elderly Patients

Abstract The study was conducted at the Clinical Centre Kragujevac, during the period March-May 2016. The study population consisted of patients older than 65 that were treated at different departments of the Clinic for Internal Medicine. Data were collected from hospital medical records of patients and anonymous semi-structured questionnaires. STOPP (screening tool of older people's prescriptions)/ START (screening tool to alert to right treatment) criteria from 2014 were used to monitor the outcome of interest. Based on the outcome PIM (potentially inappropriate drugs)/PPO (potential prescribing omissions), respondents were divided into groups of cases - patients to whom at least one potentially inappropriate drug determined by STOPP criteria was prescribed and those with at least one potential prescribing omission determined by START criteria. Control groups were patients without these outcomes. Most commonly, PIM was detected in the treatment of cardiovascular system diseases (27.12%), followed by the use of drugs that predispose falls in elderly (20.34%). The most important risk factors for the occurrence of PIM were female gender (OR=3.27; 95% CI 1.01-10.64), polypharmacy (5-8 drugs used simultaneously) (OR=3.10; 95% CI 1.11-12.04) and with whom the patient lives (OR=11.26; 95% CI 1.46-86.68). The use of STOPP/START criteria is proved to be efficient in the detection of PIM/PPO at the secondary level of health care. Full attention should always be paid to patients who are at the highest risk for inappropriate drug prescription. Doctors should make their decisions conscientiously and in line with clinical evidence, not blindly believing the pharmaceutical representatives.

Evaluation of potentially inappropriate medications in older patients admitted to the cardiac intensive care unit according to the 2019 Beers criteria, STOPP criteria version 2 and Chinese criteria.

Potential inappropriate medications (PIMs) can increase the risk of medication-induced harm. However, there are no studies regarding PIMs in older and critically ill patients with cardiovascular diseases in China. Therefore, studies evaluating PIMs in these patients can help in the implementation of more effective interventions to reduce the risk of drug use. Our objective was to analyse the prevalence of PIMs in elderly patients admitted to the cardiac intensive care unit (CICU) comparing the 2019 Beers criteria (Beers criteria), Screening Tool of Older People's Potentially Inappropriate Prescriptions (STOPP) criteria version 2 (STOPP criteria) and criteria of potentially inappropriate medications for older adults in China (Chinese criteria); and analyse the factors influencing the PIMs. This cross-sectional and retrospective study was performed with elderly patients (≥65 years) admitted to the CICU of the Beijing Tongren Hospital in China from January 2019 to June 2020. The PIMs were identified based on the Chinese, STOPP and Beers criteria at admission and discharge. The three criteria were compared using the Kappa statistic. Multiple regression analysis was used to investigate the influencing factors associated with PIMs. A total of 369 patients who met the inclusion/exclusion criteria were included in this study. According to the three criteria used to evaluate the PIMs, the prevalence was 78.3% and 72.6% at admission and discharge, respectively. The prevalence rate of PIMs determined by the Chinese criteria was 62.1% at admission versus 56.6% at discharge (p=0.134); the Beers criteria was 53.9% at admission versus 46.9% at discharge (p=0.056); by the STOPP criteria was 20.6% at admission versus 13.8% at discharge (p=0.015). Moreover, 28.9% (STOPP criteria), 56.8% (Beers criteria) and 73.4% (Chinese criteria) of patients taking PIMs on admission still had the same problem at discharge. The most common PIMs screened by the Beers, STOPP and Chinese criteria were diuretics, benzodiazepines and clopidogrel, respectively. Besides, the three criteria showed poor agreement. Finally, the stronger predictor of PIMs was the increased number of medications (p < 0.05). The prevalence of PIMs in elderly patients admitted to the CICU was high. The Chinese, STOPP and Beers criteria are effective screening tools to detect PIMs, but the consistency between them was poor. The increased number of medications was a significant predictor of PIMs.

Potentially Inappropriate Medication Use in Older Adults with Chronic Kidney Disease.

This study aimed to identify the prevalence of potentially inappropriate medication use (PIMU) in adults above the age of 65 with chronic kidney disease (CKD) according to the American Geriatric Society Beers Criteria (Beers), Screening Tool of Older People's Potentially Inappropriate Prescriptions Criteria (STOPP) and medication appropriateness index (MAI) 30 criteria and to compare them to justify their use in this specific patient group. This was a retrospective and descriptive study conducted between October 1st, 2019 and March 18th, 2020 at Ibni Sina Hospital, Nephrology Department, Faculty of Medicine, Ankara University. Among 269 patients discharged from the hospital during the study period, 100 of them were eligible for the study. The mean age was 73.3 ± 6.9 years and 51.9% of them were male. The prevalence of 35 PIMU was 91%, 42%, and 70% according to the Beers, STOPP, and MAI criteria, respectively. There was a statistically significant difference in terms of prevalence among 3 criteria (p<0.001). Beer detected more PIMU (11.3% vs. 6.4%) and had higher sensitivity among older adults with CKD (0.97 vs. 0.56) compared to the STOPP criteria. Most patients had at least one drug-drug interaction (DDIs) in their discharge prescription (93%) and DDI was one of the main contributors of PIMU. Proton pump inhibitors were the most common medication associated with PIMU in all 3 criteria. The prevalence of PIMU was high among older adults with CKD at discharge according to these criteria. To improve the prescriptions after hospital discharge, it is considered appropriate to use Beers criteria under guidance of a clinical pharmacist.

Selected Domains within a Comprehensive Geriatric Assessment in Older Patients with Non-Hodgkin Lymphoma are Highly Associated with Frailty

BackgroundThe incidence of Non-Hodgkin Lymphoma (NHL) is increasing, particularly among older patients who tend to have worse outcomes and can be predisposed to increased toxicities and less treatment tolerance. Therefore, a thorough pre-treatment assessment is essential. A comprehensive geriatric assessment (CGA) can be used to evaluate the older patient considering chemotherapy and is the preferred evaluation tool. However, a formal CGA is laborious, complex and time-consuming.ObjectivesTo characterize older adults with NHL and determine the CGA variables with the greatest association to frailty in order to propose a more simplified assessment.MethodsWe performed a cross-sectional study using data collected from CGAs in NHL patients > 65 years admitted to our oncology service, from September 2015 to August 2017. Our evaluation parameters included: polypharmacy, a screening tool of older people's prescriptions (STOPP), the Lawton scale, Barthel index, Katz index, gait speed, a Timed Up and Go (TUG) test, a Mini-Mental state examination (MMSE), the Yesavage and Gijon scales, a Mini-nutritional assessment (MNA), a Geriatric Syndromes assessment, and a Cumulative Illness Rating Scale-Geriatric (CIRS-G). The formal CGA was comprised of nine domains; frailty was defined as an impairment in > 2 domains. Each parameter was individually compared with frailty, and the results were used to build different multivariate models using logistic regression analyses to obtain the variables with the highest frailty association.ResultsA total of 253 patients were included. Their median age was 75.4 years (range 65–92), and 62.1% had > 1 impaired domain, with 39.9% considered frail. Bivariate analysis showed strong associations with age > 85 and all the geriatric parameters except for STOPP. Our final multivariate analysis resulted in 5 domains (the use of > 5 medications, a Lawton < 7, TUG > 20, Yesavage > 5, and the presence of at least one geriatric syndrome) being significantly associated with frailty and performing similarly to a CGA.ConclusionIn our population of older NHL patients, an abbreviated evaluation based of only five domains, polypharmacy, TUG, Lawton scale, Yesavage scale and the presence of at least one geriatric syndrome, had similar performance to a formal CGA in determining frailty.

Assessment of the Appropriateness of Prescriptions in a Geriatric Outpatient Clinic

Appropriateness of the geriatric outpatients' medications needs special attention due to risks of falls, fractures, depression, hospital admissions and mortality. This study aimed to identify current practice on medication usage by using the 2nd version of "Screening Tool of Older People's Potentially Inappropriate Prescriptions" and "Screening Tool to Alert Doctors to Right Treatment" criteria and affecting factors for the Turkish population. This cross-sectional study was conducted between September 2015 and May 2016 at a university research and training hospital's geriatric outpatient clinic. Patients aged ≥65 years and had ≥5 different prescribed medications (considered as polypharmacy) were recruited. The main outcome measure was the frequency of inappropriate medications identified by clinical pharmacist in the outpatient clinic according to the 2nd version of the criterion sets. A total of 700 patients (440 female) were included in this study. According to the results, 316 patients (45.1%) with at least one potentially inappropriate medication and 668 patients (98.3%) with at least one potential prescription omission were detected. Potentially inappropriate medications were associated with the number of medications used per patient [odds ratio (OR): 1.20 p<0.001], living alone (OR: 4.12 p=0.02), and having congestive heart failure (OR: 2.41 p<0.001). Twenty-two (27.5%) out of 80 criteria and 4 (11.8%) out of 34 criteria did not apply to the study population. Detecting inappropriate medications to maintain treatment effectiveness is necessary to provide the optimum therapy. Despite the awareness of polypharmacy in outpatient clinics it is still one of the important causes of inappropriate prescription followed by vaccination rate. Therefore, with the contribution of clinical pharmacist using these available criteria is important, moreover modification of these criteria according to the local needs to be considered to achieve better outcomes.

Validation of the Integrated Care for Older People Screening Tool: Focus on the Chair Rise Test to Assess Locomotion

The Integrated Care for Older People (ICOPE) is a function- and person-centered healthcare pathway developed by the World Health Organization (WHO). ICOPE's first step (Step 1) consists of screening for impairments in the intrinsic capacity (IC) domains (namely sensorial, cognition, nutrition, psychological, and locomotion). For instance, the ICOPE Step1 tool suggests a cut-point of 14 seconds for five-repetition chair rise time as a marker of impaired locomotion. Given the lack of validation of this tool in the literature, we aimed to validate the ICOPE screening tool concerning incident health outcomes, focusing on the locomotion assessment. First, we analyzed the five-domain screening tool's ability to identify older adults (OA) at higher risk of incident outcomes (frailty, disability, dementia) using longitudinal data from the Multidomain Alzheimer Preventive Trial (MAPT). For the locomotion assessment (chair rise test), we derived and cross-validated age-specific cut points from two population-based cohorts using ROC (receiver operating characteristic) analysis. We further verified those cut points among OA real-life users of the health system and clinical trial participants. In conclusion, the ICOPE Step 1 screening tool was able to identify OA at higher risk of incident frailty, disability, and dementia. New chair-rise-time cut points for age groups 70-79 years old and 80 years and older were valid in populations from different settings. The ICOPE Step 1 tool provides a practical and integrative way of screening older adults for impairments in IC and detecting those at higher risk of functional decline.

Inappropriate drug use rates of geriatric patients attending to a university hospital cardiology policlinic.

The interest in risks related to inappropriate drug use (IDU) and polypharmacy among the elderly has increased in recent years. We aimed to determine the frequency of IDU and multiple drug use in elderly patients in the cardiology outpatient clinic. : In this prospective, cross-sectional study, a total of 513 patients aged 65 years and above who were admitted to the Cardiology Policlinic between December 2017 and January 2018 were included. To determine the prevalence of IDU, we investigated the suitability of the drugs used by the patients (according to the criteria of Beers 2015 and Screening Tool of Older People's Prescriptions [STOPP] version 2), the number of violated criteria in both the guidelines and which criterion was violated by the inappropriate drugs. : The 513 patients (mean age: 73.18 ± 5.99) in this study included females (n = 235; 45.8%) and males (n = 278; 54.2%). A total of 2,910 drugs were used by the 513 patients (mean per patient: 5.67 ± 2.51); 52.8% of the patients were using more than five drugs. The Beers criteria revealed that 304 IDUs were detected among the drugs and showed that 38.6% (n = 198) of the patients had IDU. According to the STOPP criteria, 366 IDUs were identified among the drugs used, and 45.6% (n = 234) of the patients had IDU. IDU frequencies of the elderly patients are similar to the world literature in our study. As the number of chronic illnesses the patients had increases, the frequency of IDU increases according to Beers and STOPP criteria in our study.

Potentially inappropriate medication discontinued or changed based on pharmacists' recommendations in older end-stage cancer patients receiving palliative care: a cross-sectional study.

Avoiding potentially inappropriate medications (PIMs) can reduce adverse events in older cancer patients receiving palliative care. However, studies have not examined the extent to which pharmacists' recommendations reduce the prescription of PIMs. Therefore, we designed a cross-sectional study to determine the extent to which their recommendations play a role in reducing the prescription of PIMs for older cancer patients receiving palliative care. Patients brought their medications with them upon admission to the hospital. These medications were examined by pharmacists and deemed inappropriate based on the Screening Tool of Older People's Prescriptions version 2 (STOPP2). In this study, these 220 patients were surveyed, and the percentage of medications that were discontinued or changed based on pharmacists' recommendations was compared with previously published results of similar studies on older non-cancer inpatients, using univariate analysis. A total of 218 PIMs were detected in 1261 medications administered to 220 patients. Of these, 61 medications were discontinued or changed based on the recommendation of pharmacists (rate of discontinuation/change of medications: 28.0%). The univariate analysis results showed that this rate of discontinuation or change of medications was significantly lower than that of a previous report intended for non-cancer patients (40.6%). The rate of discontinuation/change of medications for benzodiazepines was extremely low, but for other drugs it was almost the same as in the previous report. In the case of older end-stage cancer patients receiving palliative care, compared with older patients hospitalized for other diseases, it was more difficult, on pharmacists' recommendations, to discontinue or change PIMs detected by STOPP2. The low significance of discontinuing or changing benzodiazepines in subjects was a major reason it was difficult to reduce the prescription and, eventually, administer PIMs based on pharmacists' recommendations.

Risk Assessment Of Adverse Drug Reactions In Elderly Patients With Chronic Diseases

Introduction: The adverse drug reaction (ADR) is 4-7 times more common in elderly patients. That was also related to changes in pharmacokinetics and pharmacodynamics that triggered the emergence of Drug-Related Problems. Objective: The purpose of this study was to assess ADR in elderly patients with chronic diseases using the GerontoNET Score and the Screening Tool of Older People's Prescriptions (STOPP) criteria. Methods: The research design used a cross-sectional study which was analyzed descriptively. The sample consisted of 72 patients, aged more than 60 years, accompanied by chronic diseases, and hospitalized at Waluyo Jati Kraksaan Hospital. The exclusion criteria were patients referred to the Intensive Care Unit. Assessment to see the risk of ADR in elderly patients with chronic diseases using the GerontoNet Score while the wrong type of drug is given to elderly patients using the STOPP criteria. The variables contained in the GerontoNET Score are comorbid conditions ³4 (score= 1), heart failure (score= 1), liver disease (score = 1), the number of drugs such as: £5 (score= 0); 6-7 (score=1); ³8 (score=4), history of ADR (score=2), kidney failure (score=1). Results: The variable with the most ADR risk factors was the number of drugs ³8 drugs as many as 47 patients (65.3%) with GerontoNET score ³4 as much as 70.8%. The types of drugs included in the STOPP criteria are clopidogrel, Arixtra (fondaparinux), beta-blockers, NSAIDs, and furosemide. Conclusion: The risk factor for ADR was the number of drugs ³8 drugs.

Potentially inappropriate prescriptions and therapeutic complexity in older HIV patients with comorbidities.

The prolonged current survival of human immunodeficiency virus (HIV) patients exposes them to new problems arising from the comorbidities they face. To describe the situation of comorbidities, polypharmacy, therapeutic complexity and adherence in people living with HIV over 65years of age and to assess the presence of potentially inappropriate prescriptions (PIP) by applying deprescription criteria. Observational study including HIV people (> 65years) from a university tertiary level hospital. Demographic, clinical and pharmacotherapeutic characteristics of the patients and their treatments were studied. The prevalence of polypharmacy (> 5 medications) and the pharmacotherapy complexity, quantified by the Medication Regimen Complexity Index (MRCI), were calculated. Therapeutic adherence was assessed by the Simplified Medication Adherence Questionnaire (SMAQ) and the medication possession ratio, according to prescription dispensing records. The Screening Tool of Older People's Prescriptions (STOPP) and List of Evidence-baSed depreScribing for CHRONic patients (LESS-CHRON) criteria were applied to identify PIP. PIP in elderly people living with HIV. Thirty patients were included, 73% of whom were men, with a median age of 71years (IQR 67 - 76) and a median duration of infection of 17years (IQR, 9 - 21). Seventy percent of the patients suffered from dyslipemia, 66.7% from hypertension, 43.3% from diabetes and 26.7% from mental health disorders. Seventy percent of the patients took more than 5 medications and 30% more than 10. The MRCI of concomitant medications was higher (18.3 points) than the MRCI of antiretroviral therapy (5.1 points), 66.7% of the studied population was classified as adherent. Finally, 70% of the patients present some PIP according to the STOPP or LESS-CHRON criteria. The polypharmacy was significantly associated (p = 0.008) with meeting deprescription criteria. The elderly people living with HIV present numerous comorbidities and met the criteria for polypharmacy. Their pharmacotherapy complexity is mainly determined by the concomitant treatments. There is a high prevalence of meeting deprescription criteria in people living with HIV over the age of 65 and a clear relationship between polypharmacy and deprescription. The optimization of pharmacotherapy is necessary in this population.

Improving the Care of Older Patients by Decreasing Potentially Inappropriate Medications, Potential Medication Omissions, and Serious Drug Events Using Pharmacogenomic Data about Variability in Metabolizing Many Medications by Seniors.

Polypharmacy, potentially inappropriate medications (PIMs) identified by the American Geriatrics Society and Screening Tool of Older People’s Prescriptions (STOPP), potential prescribing omissions (PPOs) identified by Screening Tool to Alert to Right Treatment (START) and serious drug events (SDEs), are major problems for seniors. They correlate with increased risks of rehospitalization and death within six months of hospital discharge. About 75% of commonly prescribed medications are metabolized by P450 cytochrome enzymes. Electronic medical records (EMRs) providing integrated comprehensive pharmacogenomic advice are available only in very large health organizations. The study design of this article is a cross-sectional analysis of the American Geriatrics Society (AGS) and STOPP PIM and START PPO databases integrated with three P450 cytochrome enzyme databases (Flockhart Tables, DrugBank, and Rx Files) and the data are reported using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. To enable optimally prudent prescribing this article presents for primary care physicians and physicians in remote or rural areas without access to such services a comprehensive integration of the data on PIM and PPO medications with the data on the P450 cytochrome isoforms that metabolize these medications. Additionally presented are the medications metabolized by multiple isoforms and medications that inhibit or induce individual or multiple isoforms. The most extensive metabolic activities involve the central nervous system, anxiolytic, antidepressive, antipsychotic, musculoskeletal, and cardiovascular drugs. The P450 cytochrome isoforms that metabolize the most medications are 3A457, 2C9, 2D6, and 2C19 and nearly all central nervous systems medications compete to be metabolized by 3A457. Medications with the largest inducer or inhibitor activity are highlighted and also a list of commonly prescribed medications that are neither PIMs nor PPOs but compete for metabolism by the same isoforms.

Polypharmacy among older advanced lung cancer patients taking EGFR tyrosine kinase inhibitors

ObjectivePolypharmacy (PP) is a common problem among the older adults and has a potential effect on health-related problems. However, the significance of PP in older advanced non–small cell lung cancer (NSCLC) patients and those on oral molecular-targeted anticancer agents is unclear. Materials and methodsThis retrospective, nonrandomized study reviewed the records of 334 advanced NSCLC patients who underwent epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) treatment. PP was defined as ≥ 5 concomitant medications. Potentially inappropriate medication (PIM) use was measured using the updated screening tool of older people's prescriptions (STOPP) ver. 2 criteria. We also estimated survival distributions using the Kaplan–Meier method, compared between–group differences using the log-rank test, explored potential predictors of survival using Cox regression, and performed cluster analysis to identify factors affecting multiple-medication use. ResultsThe PP and PIM use prevalence was 38.4% and 31.9%, respectively. The median overall survival (OS) for PP(+) and PP(−) patients was 19.4 and 27.3 months, respectively. Multivariate analysis revealed a significant correlation between PP and OS. The frequency of unexpected hospitalization during EGFR-TKI treatment was higher in PP(+) patients compared to PP(−) patients (49.4% vs. 29.4%; odds ratio = 2.34). ConclusionPP is an independent prognostic factor in older advanced NSCLC patients taking EGFR-TKIs. PP can be used as a simple indicator of such patients' comorbidities and symptoms or as a predictive marker of unexpected hospitalization during treatment.

Evidence-based application of explicit criteria to assess the appropriateness of geriatric prescriptions at admission and hospital stay.

BackgroundInappropriate prescribing in the elderly is a critical issue in primary care, causing a higher risk of Adverse Drug Reactions (ADRs) and resulting in major patient safety concerns. At international level, many tools have been developed to identify Potentially Inappropriate Medications (PIMs).ObjectiveThe aim of this study was the application of Beers, Screening Tool of Older People's Prescriptions (STOPP)/Screening Tool to Alert to Right Treatment (START) and Improving Prescribing in the Elderly Tool (IPET) criteria as key tool to improve the quality of prescribing.MethodsA retrospective study was conducted using the aforementioned criteria. Two different cohorts of elderly patients were enrolled between January 2015 and December 2016, 1800 at admission and 1466 at hospital stay. The index of each criterion divided by politherapy were correlated with comorbidities (Pearson correlation). A comparison was made between admission and hospital stay through a Student's t test of the average of the index.ResultsThe Proton Pump Inhibitors (PPIs) were the most prescribed PIMs according Beers criteria in both patient cohorts (56%). The most detected drug-drug and drug-disease interactions at admission and at hospital stay were 3 or more drugs active on the Central Nervous System (CNS) as they can predispose to fall-risk. The most detected PIMs with STOPP criteria at admission were PPIs administered for more than 8 weeks. Inhaled β2-agonists or antimuscarinics were the most prescribed Potential Prescription Omissions (PPOs) according to START criteria. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) in patients with high blood pressure were the most detected PIMs according to IPET criteria during hospital stay. A significant correlation between the comorbidities and the all index at hospital stay, while at admission there was no significant correlation for Beers and IPET index.ConclusionThe prescriptive criteria were a useful tool for assessing the quality of prescriptions in the geriatric population and identifying their critical issues.

Polypharmacy as a prognostic factor in older patients with advanced non-small-cell lung cancer treated with anti-PD-1/PD-L1 antibody-based immunotherapy.

Polypharmacy is a common problem among older adults. However, its prevalence and impact on the clinical outcomes of anticancer treatment, such as survival and adverse events, in older patients with advanced cancer have not been well investigated. We retrospectively reviewed data from Japanese patients treated with an immune checkpoint inhibitor (ICI) for advanced or recurrent non-small-cell lung cancer (NSCLC) between 2016 and 2019. Among 157 older (aged ≥ 65years) patients, the prevalence of polypharmacy, defined as ≥ 5 medications, was 59.9% (94/157). The prevalence of potentially inappropriate medication use, according to the screening tool of older people's prescription (STOPP) criteria version 2, was 38.2% (60/157). The median progression-free survival (PFS) in patients with and without polypharmacy was 3.7 and 5.5months, respectively (P = 0.0017). The median overall survival (OS) in patients with and without polypharmacy was 9.5 and 28.1months, respectively (P < 0.001). Multivariate analysis revealed marked associations between polypharmacy and OS, but no significant associations between polypharmacy and PFS. Polypharmacy was not associated with immune-related adverse events but was associated with higher rate of unexpected hospitalizations during ICI treatment (59.6% vs. 31.7%, P < 0.001). Polypharmacy is an independent prognostic factor in older patients with advanced NSCLC treated with ICI. Also, polypharmacy could be utilized as a simple indicator of patients' comorbidities and symptoms or as a predictive marker of unexpected hospitalizations during ICI treatment.

Adaptation and Validation of the Screening Tool of Older People's Prescriptions Instrument for the Indonesian Population.

Objective:In this study, we aimed to prepare and validate an Indonesian version for the Screening Tool of Older People's Prescriptions (STOPP), which is an instrument to identify inappropriate medications for elderly patients.Methods:The Indonesian version of STOPP (STOPP_INA) was developed using modified transcultural adaptation guidelines from the American Academy of Orthopedic Surgeons. Our method consisted of translating original STOPP into Indonesian (forwardly translation), synthesis of forward translation, translation into English and synthesis of back translation, a review by the copyright holder of STOPP, a review by the expert team, pretest, revision of STOPP_INA, field test, and psychometric analysis of the final version of the questionnaire. The study design for this part was quasi-experimental with purposive sampling for members of the translator's team, expert's team, and respondents in the pretest, but they were different from field testing that used purposive and postsurvey sampling for respondents. Content validity and face validity were used to construct the validity of STOPP_INA by assessing item-level content validity and correlation between items and total values. Internal consistency was measured with Cronbach's alpha coefficient.Findings:The expert panel agreed on a list of 81 criteria. Five (62.50%) of expert team members agreed and could be continued to the field test without revision of STOPP_INA and 3 (37.50%) agreed with a revision. The research subjects in the psychometric test had 230 respondents, 5 (2.17%) resigned, with an average of item-level content validity index of 0.99. The construct validity analysis showed that 5-item criteria are “not valid,” namely in A1, A3, B7, B10, and C3. Reliability analysis showed the Cronbach's Alpha and Cronbach's Alpha Based on Standardized Items were 0.978 and 0.979.Conclusion:The expert team was be agreed on 81 criteria (100%) of adaptation of STOPP version 2 criteria. There were 5 criteria that not valid statistically, they could not be removed from the instrument because they can influence content and construct of the instrument. The STOPP_INA has been developed for the Indonesian population, currently being tested in clinical practice against elderly patients undergoing hospitalization.

Association of Potentially Inappropriate Medications With All-Cause Mortality in the Elderly Acute Decompensated Heart Failure Patients: Importance of Nonsteroidal Anti-Inflammatory Drug Prescription.

BackgroundAcute decompensated heart failure (ADHF) is the most common cause of readmissions in the hospital. ADHF patients are associated with polypharmacy. It is a common problem among elderly patients due to frequently occurring multiple morbidities and is associated with the use of potentially inappropriate medications (PIMs). The aim of this study was to examine the association between PIMs and all-cause mortality in elderly ADHF patients.MethodsThis retrospective study included ADHF patients who were admitted to the Showa University Fujigaoka Hospital between January 2015 and August 2016. We investigated the proportion of patients taking at least one PIM at admission and the characteristics of patients at admission. PIMs were defined based on the Screening Tool of Older People’s potentially inappropriate Prescriptions (STOPP). Multiple Cox regression analysis was performed to examine the association between PIM use and all-cause mortality.ResultsA total of 193 elderly patients (median age 81 years, interquartile range (IQR) 65 - 99 years) were included in the study. All-cause death occurred in 30 patients. The median number of medications at admission was 7 (IQR 0 - 18). The number of medications (greater than or equal to six) at admission was associated with mortality. Multivariate Cox regression analysis revealed that systolic blood pressure (SBP) < 100 mm Hg at admission, chronic obstructive pulmonary disease (COPD), and use of non-steroidal anti-inflammatory drugs (NSAIDs) at admission were independent predictors for all-cause mortality.ConclusionsThe medical staff should attempt to stop unnecessary medications that are prone to be inappropriate prescribing. In particular, prescription of NSAIDs should be carefully assessed and monitored.

515P - Polypharmacy as a prognostic factor in elderly patients with advanced non-small cell lung cancer treated with immune checkpoint inhibitors

BackgroundPolypharmacy (PP) is a common problem in elderly patient population. However, the prevalence and impact of PP on treatment-related morbidities in elderly patients with advanced cancer have not been well investigated. MethodsWe retrospectively analyzed data from 157 elderly (aged ≥65 years) patients treated with immune checkpoint inhibitor (ICI) for advanced or recurrent non-small cell lung cancer (NSCLC). Statistical analysis was performed using the Kaplan–Meier method and Cox regression adjusted for risk factors. ResultsThe prevalence of PP, defined as ≥ 5 medications, was 40.1% (63/157). The prevalence of potentially inappropriate medication (PIM), according to the screening tool of older people’s prescription (STOPP) criteria version 2, was 38.2% (60/157). The median progression-free survival (PFS) times in patients with and without PP were 3.7 [95% confidence interval (CI), 1.8–5.4] and 5.5 (95% CI, 3.4–9.0) months, respectively (P = 0.0017). The median overall survival (OS) times in patients with and without PP were 9.5 (95% CI, 6.0–14) and 28.1 (95% CI, 13.3–not reached) months, respectively (P < 0.001). Multivariate analysis revealed marked associations between PP and OS, but no significant associations between PP and PFS. PP was not associated with immune-related adverse events (irAE) but was associated with increased unexpected hospitalizations during ICI treatment. ConclusionsPP is an independent prognostic factor in elderly patients with advanced or recurrent NSCLC treated with ICI. Although PP may not affect the efficacy or toxicity of ICI, it is useful as a simple surrogate indicator of comorbidities or as a predictive marker of negative events during ICI treatment. Editorial acknowledgementThe authors thank Enago for the English language review. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureY. Hosomi: Speaker Bureau / Expert testimony: AstraZeneca; Speaker Bureau / Expert testimony: Chugai Pharmaceutical; Speaker Bureau / Expert testimony: Eli Lilly Japan; Speaker Bureau / Expert testimony: Ono Pharmaceutical; Speaker Bureau / Expert testimony: Taiho Pharmaceutical. All other authors have declared no conflicts of interest.

Potential Statin Overuse in Older Patients: A Retrospective Cross-Sectional Study Using French Health Insurance Databases.

Although compelling evidence exists supporting statins (HMG-CoA reductase inhibitors) for secondary prevention in older patients with clinical atherosclerotic diseases, the same cannot be said for primary prevention. The objectives of this study were to estimate the frequency of potential statin overuse in older patients, the potential drug cost savings if corrected, and the associated factors. A retrospective cross-sectional study was conducted in Alsace and Lorraine (France) from 1 January to 30 April 2017. All statin users aged 80years or over living in the community (including nursing homes) and identified from the French health insurance database were analyzed. Potential statin overuse was defined according to the STOPP/START (Screening Tool of Older People's Prescriptions/Screening Tool to Alert to Right Treatment) criteria. Among the 38,268 aged insured, 23,228 (60.7%) had potential statin overuse. Of those living in the community, 22,132 (60.0%) patients had potential statin overuse: 12,352 (55.8%) for primary and 9780 (44.2%) for secondary prevention. Among nursing home residents, 1096 (79.0%) had potential statin overuse: 394 (35.9%) for primary and 702 (64.1%) for secondary prevention. The potential drug cost savings associated with the adjustment of potential statin overuse were €924,100 for the study period. Living in nursing home [adjusted odds ratio (ORadjusted) 3.91, 95% confidence interval (CI) 2.82-5.41] and being a female (ORadjusted 2.84, 95% CI 2.54-3.17) were the main risk factors associated with potential statin overuse. The frequency of potential statin overuse is very high among older people aged 80years or over, highlighting the need to re-evaluate statin therapy and consider deprescribing, particularly for primary prevention and in nursing homes.

Prevalence and predictors of inappropriate prescribing according to the Screening Tool of Older People's Prescriptions and Screening Tool to Alert to Right Treatment version 2 criteria in older patients discharged from geriatric and internal medicine wards: A prospective observational multicenter study.

To evaluate the prevalence and predictors of potentially inappropriate medications (PIM) and potential prescribing omissions (PPO) in hospital-discharged older patients, according to the recently updated Screening Tool of Older People's Prescriptions and Screening Tool to Alert to Right Treatment version 2 criteria. This was a multicenter prospective observational study of patients aged ≥65 years consecutively discharged from geriatric and internal medicine wards. Each patient underwent a comprehensive geriatric assessment, and PIM and PPO at discharge were determined according to the Screening Tool of Older People's Prescriptions and Screening Tool to Alert to Right Treatment version 2 criteria. A multivariate logistic regression was carried out to identify variables independently associated with PIM and PPO. Among 726 participants (mean age 81.5 years, 47.8% women), the prevalence of PIM and PPO were 54.4% and 44.5%, respectively. Benzodiazepines and proton-pump inhibitors were the drugs most frequently involved with PIM, whereas PPO were often related to 5-alpha reductase inhibitors, angiotensin-converting enzyme inhibitors, statins and drugs for osteoporosis. The number of medications (OR 1.22, 95% CI 1.15-1.28) and discharge from geriatric units (OR 0.55, 95% CI 0.40-0.75) were associated with PIM, whereas PPO were independently associated with discharge from geriatric wards (OR 0.44, 95% CI 0.31-0.62), age (OR 1.04, 95% CI 1.02-1.07), comorbidities (OR 1.17, 95% CI 1.04-1.30) and the number of drugs (OR 1.12, 95% CI 1.05-1.18). Inappropriate prescribing is highly prevalent among hospital-discharged older patients, and is associated with polypharmacy and discharge from internal medicine departments. Geriatr Gerontol Int 2019; 19: 5-11.