Beers AGS 2019 criteria in very old hospitalized patients

Abstract

SUMMARY OBJECTIVE To define the rates and types of potentially inappropriate medications (PIMs) for older adults according to the Beers AGS 2019 criteria in oldest-old patients (aged ≥80 years) hospitalized in an Internal Medicine ward. METHODS A retrospective analysis of prescriptions from medical records of oldest-old patients hospitalized in an Internal Medicine Teaching-Hospital ward using the Beers AGS 2019 criteria was performed. Data was also collected for gender, mean age, days of hospitalization, presence of feeding tube, delirium, and polypharmacy (≥5 drugs/day). The drugs listed in Table 2 of the Beers criteria were considered PIMs. RESULTS The series comprised 39 very old patients (22 men, 17 women), with a mean age of 86.3±4.7 years and hospitalization of 22.8±21.3 days. All patients were admitted via the Emergency Room. Feeding tube placement and polypharmacy occurred in 84.6% of cases and delirium in 71.8%. The prescription of a total of 16 drugs considered PIM was detected by the Beers AGS 2019 criteria (mean 1.8 ± 1.0 PIM per patient). Main prescribed PIMs were Metoclopramide “if necessary” [IN] (41.0% of cases), Omeprazole (38.5%), Regular Insulin [IN] (23.1%), Haloperidol [IN] (18.0%), Quetiapine and Amiodarone (10% each). CONCLUSION In the present series of oldest-old hospitalized patients, significant rates of PIM were found, especially for drugs prescribed as “If Necessary”, thereby increasing the risk of side-effects to that of the common polypharmacy in this age group.

Prevalence and factors associated with potentially inappropriate medication and medication complexity for older adults in the emergency department of a secondary teaching hospital in Indonesia

“… 33 Another study conducted in Brazil reported that 41% of elderly patients received metoclopramide. 34 Jeon et al also showed that in 79,552 elderly patients in South Korea, metoclopramide was one of the most frequently used PIMs (22%). 35 On the other hand, omeprazole poses a risk of Clostridium difficile infection especially in long-term use.…”

“…They further reported that 63% of the omeprazole prescriptions were not indicated. 34 Omeprazole, a proton pump inhibitor (PPI) is used for treating gastric acid disorders. 37 Some patient-related factors make older adults more susceptible to receiving PIMs in the ED.…”

Polypharmacy and Mental Health Issues in the Senior Hemodialysis Patient

“…Grina and Briedis showed with a retrospective, observational study including 431,625 patients, that 25.9% had potentially inappropriate medications based on Beers 2015 criteria, of which benzodiazepines were the most common ( 83 ). Another study by Gorzoni and Rosa in 39 patients aged >80 years showed that each patients has 1.8 potentially inappropriate medications prescribed according to Beers criteria, mostly from the “if necessary” group ( 84 ).…”

Prescription Habits Related to Chronic Pathologies of Elderly People in Primary Care in the Western Part of Romania: Current Practices, International Recommendations, and Future Perspectives Regarding the Overuse and Misuse of Medicines

“…In a study performed in Spain in 2019, where the two versions of the Beers criteria (2012 and 2015) and the two versions of the STOPP criteria (v.1, 2008 and v.2, 2015) were applied, benzodiazepines, proton-pump inhibitors, peripheral alpha-1 blockers, and NSAIDs were among the most common potentially inappropriate medications found [ 64 ]. Another study performed in Brazil in very old hospitalized patients emphasized (after applying the 2019 Beers criteria) that polypharmacy occurs in approximately 84.6% of cases and that the most commonly encountered PIMs are metoclopramide, omeprazole, regular insulin, and haloperidol [ 65 ]. A study performed on South Korean geriatrics and published in 2018 showed that chlorpheniramine and amitriptyline were the most frequently prescribed PIMs (after applying the Beers Criteria) [ 66 ].…”