An evaluation of medication appropriateness and frailty among residents of aged care homes in Malaysia

Abstract

Aging is significantly associated with the development of comorbid chronic conditions. These conditions indicate the use of multiple medications, and are often warranted by clinical guidelines. The aim of the present study was to evaluate medication appropriateness and frailty among Malaysian aged care home residents with chronic disease. The participants were 202 elderly (≥65 years) individuals, a cross-sectional sample from 17 aged care homes. After ethics approval, each participant was interviewed to collect data on sociodemographics, frailty status (Groningen Frailty Indicator [GFI]), medication appropriateness (Medication Appropriateness Index (MAI), the 2015 Beers’ criteria (Potentially Inappropriate Medication [PIM]), and 2014 STOPP criteria (Potentially Inappropriate Prescribing [PIP]). The findings show that 81% (n = 164) and 42% (n = 85) were taking medications for cardiovascular and central nervous system-related conditions, respectively, and 34% were using medications for diabetes (n = 69). Each participant had a mean of 2.9 ± 1.5 chronic diseases, with an average GFI score of 6.4 ± 3.6. More than three-quarters of the participants (76%) were frail and polypharmacy was a factor in nearly half (48%); 41% and 36% were prescribed at least one PIP and PIM, respectively, whereas the average MAI score was 0.6 (range: 0–6). The number of medications used per participant correlated significantly and positively (0.21, P = .002) with GFI score. These findings reinforce the need for participants of aged care homes to receive periodic medication review aimed at minimizing morbidity associated with inappropriate pharmacotherapy.

Hospital readmissions, mortality and potentially inappropriate prescribing: a retrospective study of older adults discharged from hospital

“…Consistent with previous studies using both versions 1 and 2 of the STOPP criteria, this study identified a significant association between polypharmacy (>5 medications) and prescription of at least one PIM [25,30,32,33,[35][36][37][38][39][40][41][42][43][44][45]. The association between PPO occurrence and polypharmacy identified in this study has been less consistently reported elsewhere [33,36,37,46].…”

“…Published studies which have applied version 2 of the STOPP criteria report PIM prevalence of between 39.1% and 56.1% in older adults in the community and long-term care setting, and 42.1% to 88.5% in the inpatient setting [25][26][27][28][29][30][31][32][33][34]. The higher reported prevalence in the inpatient setting is likely a reflection of greater co-morbidity and prescription medication burden.…”

“…In recognition of changes in evidence-based treatment and recognition of the diminished clinical relevance for some criteria, an updated version (version 2) of the STOPP/START criteria were introduced in 2014 [24]. While the updated STOPP criteria have been used extensively to assess PIMs in older adults [25][26][27][28][29][30][31][32], there is limited data using the updated START criteria to assess prevalence of PPOs [33,34]. Additionally, little is known about the utility of the new criteria to predict clinically meaningful outcomes such as readmission rates and mortality [33].…”

The relationship between frailty and polypharmacy in older people: A systematic review

“…After the screening of the full texts, 62 articles were excluded because they did not meet the inclusion criteria. Therefore, 25 publications were ultimately selected and included in the review (Figure ).…”

“…. The prevalence of frailty ranged between 6.2% and 76% . Regarding study setting, 13 studies included community‐dwelling individuals, five studies included hospitalized patients in acute units and the rest included outpatients, care home residents or mixed populations.…”