Assessing Medication Appropriateness in the Elderly

Abstract

The disproportionate use of medications, combined with age-related pharmacokinetic and pharmacodynamic changes, places older adults at high risk for medication related problems (MRPs). MRPs demonstrate significant morbidity, mortality and economic impact among healthcare systems. The negative outcomes associated with MRPs emphasise the need for more careful and thorough assessments of drug therapy among older adults. In the 1990s a number of methods and instruments were developed to assist in the assessment of medication appropriateness. These tools may be categorised by criteria as: implicit, explicit or one utilising a combination of implicit and explicit criteria. This article reviews these available tools and outlines the advantages and disadvantages of each. In conclusion, those instruments considered to be comprised of both implicit and explicit criteria offer a more thorough assessment of medication appropriateness.

Evaluation of the appropriateness of prescribing in geriatric patients using Beers criteria and Phadke's criteria and comparison thereof

“…[10] Beers criteria are well established and very frequently used method for evaluating appropriateness of prescribing in elderly. It was developed in 1999 and revised in 2003.…”

Potentially Inappropriate Anticholinergic Medication Use in Community-Dwelling Older Adults: A National Cross-Sectional Study

“…A study by Hilmer et al suggested similar findings; increased exposure to medications with anticholinergic and sedative effects, measured through the Drug Burden Index (DBI), was found to be associated with lower physical function over a 5-year period in community-dwelling older adults [17]. These adverse effects are of significant concern in older adults because of polypharmacy, comorbidities and age-related changes in pharmacokinetic and pharmacodynamic parameters [18]. Drugs with significant anticholinergic side effects are thus generally considered potentially inappropriate and should be avoided in the older population irrespective of the diagnosis [19].…”

Reliability of the medication appropriateness index in Dutch residential home

“…None of the currently available measurement tools cover all aspects of the aforementioned prescribing process. Nonetheless, several methods and instruments have been developed in order to assess prescribing, including whether guidelines are met in combination with the evaluation of the entire drug profile of individual patients [5]. The ideal instrument would be a combination of a structured approach together with a possibility to apply clinical judgment [5].…”