Considerations for the Use of Proton-Pump Inhibitors in Older Adults

Desilets, Alicia R; Asal, Nicole J.; Dunican, Kaelen C

doi:10.4140/tcp.n.2012.114

Cited by 20 publications

(7 citation statements)

References 56 publications

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“…Among the elderly, France is the second largest consumer of benzodiazepines in Europe, and not surprisingly the PIM found in the present study were mainly of this class . The second highest PIM in the present study were proton pump inhibitors, whose toxicity has been recently emphasized . Those two drug classes are undoubtedly consumed in excess in France, particularly among the elderly.…”

Section: Discussionsupporting

confidence: 57%

Impact of acute geriatric care in elderly patients according to the Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria in northern France

Frély

Chazard²,

Pansu³

et al. 2015

Geriatrics Gerontology Int

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Section: Discussionsupporting

confidence: 57%

Impact of acute geriatric care in elderly patients according to the Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria in northern France

Frély

Chazard²,

Pansu³

et al. 2015

Geriatrics Gerontology Int

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“…This profile of use is similar to previous studies which have found proton-pump inhibitors to be the largest cause of PIM exposure for older people [ 24 ]. Proton-pump inhibitor use in older adults has been associated with an increased risk of bone loss and fractures, Clostridium difficile infection, community-acquired pneumonia, and vitamin and mineral deficiencies [ 25 ]. There was also high-exposure to psychotropic PIMs (benzodiazepines and antipsychotics), which are frequently associated with adverse effects in older adults, including falls, hospitalization, cardiovascular complications, adverse mental state changes and mortality in older people in residential care [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Costs of potentially inappropriate medication use in residential aged care facilities

et al. 2018

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BackgroundThe potential harms of some medications may outweigh their potential benefits (inappropriate medication use). Despite recommendations to avoid the use of potentially inappropriate medications (PIMs) in older adults, the prevalence of PIM use is high in different settings including residential aged care. However, it remains unclear what the costs of these medications are in this setting. The main objective of this study was to determine the costs of PIMs in older adults living in residential care. A secondary objective was to examine if there was a difference in costs of PIMs in a home-like model of residential care compared to an Australian standard model of care.MethodsParticipants included 541 participants from the Investigation Services Provided in the Residential Environment for Dementia (INSPIRED) Study. The INSPIRED study is a cross-sectional study of 17 residential aged care facilities in Australia. 12 month medication costs were determined for the participants and PIMs were identified using the 2015 updated Beers Criteria for older adults.ResultsOf all of the medications dispensed in 1 year, 15.9% were PIMs and 81.4% of the participants had been exposed to a PIM. Log-linear models showed exposure to a PIM was associated with higher total medication costs (Adjusted β = 0.307, 95% CI 0.235 to 0.379, p < 0.001). The mean proportion (±SD) of medication costs that were spent on PIMs in 1 year was 17.5% (±17.8) (AUD$410.89 ± 479.45 per participant exposed to a PIM). The largest PIM costs arose from proton-pump inhibitors (34.4%), antipsychotics (21.0%) and benzodiazepines (18.7%). The odds of incurring costs from PIMs were 52% lower for those residing in a home-like model of care compared to a standard model of care.ConclusionsThe use of PIMs for older adults in residential care facilities is high and these medications represent a substantial cost which has the potential to be lowered. Further research should investigate whether medication reviews in this population could lead to potential cost savings and improvement in clinical outcomes. Adopting a home-like model of residential care may be associated with reduced prevalence and costs of PIMs.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0704-8) contains supplementary material, which is available to authorized users.

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“…Recent studies in the USA have found almost half of residents are prescribed a PPI without an evidence-based indication [ 31 , 32 ]. This is a concern because frail older residents may be particularly susceptible to harms associated with the long-term use of PPIs, including fractures, pneumonia and vitamin and mineral deficiencies [ 33 ]. There is a need for regular review of PPIs in LTCFs with a view to cease treatment in residents without an ongoing therapeutic need [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Variability in Medications Contributing to Polypharmacy in Long-Term Care Facilities

Jokanovic

Jamsen

Tan

et al. 2017

Drugs - Real World Outcomes

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BackgroundResearch into which medications contribute to polypharmacy and the variability in these medications across long-term care facilities (LTCFs) has been minimal.ObjectiveOur objective was to investigate which medications were more prevalent among residents with polypharmacy and to determine the variability in prescribing of these medications across LTCFs.MethodsThis was a cross-sectional study of 27 LTCFs in regional and rural Victoria, Australia. An audit of the medication charts and medical records of 754 residents was performed in May 2015. Polypharmacy was defined as nine or more regular medications. Logistic regression was performed to determine the association between medications and resident characteristics with polypharmacy. Analyses were adjusted for age, sex and Charlson’s comorbidity index. Variability in the use of the ten most prevalent medication classes was explored using funnel plots. Characteristics of LTCFs with low (< 30%), moderate (30–49%) and high (≥ 50%) polypharmacy prevalence were compared.ResultsPolypharmacy was observed in 272 (36%) residents. In adjusted analyses, each of the top ten most prevalent medication classes, with the exception of antipsychotics, were associated with polypharmacy. Between 7 and 23% of LTCFs fell outside the 95% control limits for each of the ten most prevalent medications. LTCFs with ≥ 50% polypharmacy prevalence were predominately smaller.ConclusionPolypharmacy was associated with nine of the ten most prevalent medication classes. There was greater than fourfold variability in nine of the ten most prevalent medications across LTCFs. Further studies are needed to investigate the clinical appropriateness of the variability in polypharmacy.

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Considerations for the Use of Proton-Pump Inhibitors in Older Adults

Abstract: Patient-specific characteristics must be taken into consideration when recommending and/or prescribing PPIs to older adults.

Cited by 20 publications

References 56 publications

Impact of acute geriatric care in elderly patients according to the Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria in northern France

Impact of acute geriatric care in elderly patients according to the Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment criteria in northern France

Costs of potentially inappropriate medication use in residential aged care facilities

Prevalence and Variability in Medications Contributing to Polypharmacy in Long-Term Care Facilities

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