A model for identifying potentially inappropriate medication used in older people with dementia: a machine learning study

Abstract

Background Older adults with dementia often face the risk of potentially inappropriate medication (PIM) use. The quality of PIM evaluation is hindered by researchers' unfamiliarity with evaluation criteria for inappropriate drug use. While traditional machine learning algorithms can enhance evaluation quality, they struggle with the multilabel nature of prescription data. Aim This study aimed to combine six machine learning algorithms and three multilabel classification models to identify correlations in prescription information and develop an optimal model to identify PIMs in older adults with dementia. Method This study was conducted from January 1, 2020, to December 31, 2020. We used cluster sampling to obtain prescription data from patients 65 years and older with dementia. We assessed PIMs using the 2019 Beers criteria, the most authoritative and widely recognized standard for PIM detection. Our modeling process used three problem transformation methods (binary relevance, label powerset, and classifier chain) and six classification algorithms. Results We identified 18,338 older dementia patients and 36 PIMs types. The classifier chain + categorical boosting (CatBoost) model demonstrated superior performance, with the highest accuracy (97.93%), precision (95.39%), recall (94.07%), F1 score (95.69%), and subset accuracy values (97.41%), along with the lowest Hamming loss value (0.0011) and an acceptable duration of the operation (371s). Conclusion This research introduces a pioneering CC + CatBoost warning model for PIMs in older dementia patients, utilizing machine-learning techniques. This model enables a quick and precise identification of PIMs, simplifying the manual evaluation process.