Explicit Criteria for Determining Potentially Inappropriate Medication Use by the Elderly

Abstract

This study updates and expands explicit criteria defining potentially inappropriate medication use by the elderly. Additional goals were to address whether adverse outcomes were likely to be clinically severe and to incorporate clinical information on diagnoses when available. These criteria are meant to serve epidemiological studies, drug utilization review systems, health care providers, and educational efforts. Consensus from a panel of 6 nationally recognized experts on the appropriate use of medication in the elderly was sought. The expert panel agreed on the validity of 28 criteria describing the potentially inappropriate use of medication by general populations of the elderly as well as 35 criteria defining potentially inappropriate medication use in older persons known to have any of 15 common medical conditions. Updated, expanded, and more generally applicable criteria are now available to help identify inappropriate use of medications in elderly populations. These criteria define medications that should generally be avoided in the ambulatory elderly, doses or frequencies of administrations that should generally not be exceeded, and medications that should be avoided in older persons known to have any of several common conditions.

Drug related problems associated with the psychoactive drugs used on geriatric, hospitalized patients

“…The most commonly inappropriately prescribed medication was chlordiazepoxide, diazepam (27.78%) and meprobamate (13.89%). Other study reveal values similar to those identified in relation to the use of potentially inappropriate medication (Beers, 1991;Beers, 1997;Stuch et al, 1994;Pardo et al, 2003;Bandrés et al, 2008), which exposes the elderly to unnecessary risks such as adverse effects of a worsening of the quality of life, increased hospitalizations and increased health spending (Jano et al, 2007).…”

“…In the same way, amitriptyline and chlordiazepoxide, due to their anticholinergic and sedating properties, are not the best choice for elderly patients. Meprobamate produces sedation relatively easily, that is why all the drugs were inadequately used in the patients of the sample (Beers, 1997;Fick et al, 2003;Pardo et al, 2003;Bandrés et al, 2008).…”

Medication appropriateness tool for co‐morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel

“…General prescribing criteria for older adults do not specifically consider the particularities of a progressive, life‐limiting nature of dementia 45, 46, 47, 48, 49. We anticipated that this project would generate a list of appropriate and inappropriate medications for managing co‐morbidities in dementia, similar to other existing explicit prescribing criteria in older people such as the Beers and STOPP/START criteria 60, 61.…”

“…Medication management decisions for people with dementia are often based on data collected in younger adults or peers, which may not be generalisable or relevant to this population. The existing explicit prescribing criteria developed for older people do not account for the additional complexities of dementia or its life‐limiting nature 45, 46, 47, 48, 49. Consensus‐based guidance specifically for people with dementia would assist clinicians with decision‐making in this population 50, 51.…”

Pharmacy Practice, Research, Education, and Advocacy for Older Adults

“…141 Updated versions include recommendations for community-dwelling older adults. 60,143 The criteria were developed based on recommendations from nationally recognized experts in geriatric care, clinical pharmacology, and psychopharmacology, by using a modified Delphi method. 60,[141][142][143] Investigators compiled a list of drugs that are potentially inappropriate in any patient older than 65 years and a list of drugs that should be used cautiously based on certain diseases or conditions.…”