Factors influencing the use of potentially inappropriate medication in older patients in Slovakia

Jha

et al. 2017

J Coll Med Sci-Nepal

Background & Objectives:Older individuals often suffer fr om multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The study was conducted with objectives to determine the prevalence of potentially inappropriate medicine (PIM) prescribing in older Nepalese patients in a medicine outpatient department. Materials & Methods: A prospective observational analysis of drugs prescribed in medicine out-patient department (OPD) of a tertiary hospital of central Nepal was conducted during November 2012 to October 2013 among 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM) in elderly patients was analysed using Beer's Criteria updated to 2013. Results: In the 869 patients included, the aver age number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%), amlodipine (23.16%), paracetamol (17.6%), salbutamol (15.72%) and vitamin B complex (13.26%). The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Conclusion: Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with number of medications prescribed. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly. Key words:Beer 's criteria; elderly; potentially inappropriate medicine Citation: Sah AK, J ha RK, Sah P, Basnet S. Potentially inappr opr iate pr escr ibing in elder ly population: A study in medicine out-patient department. JCMS Nepal. 2017;13(1):197-202. 198 of Bharatpur, Chitwan, Nepal. All the patients who have visited medicine OPD for treatment of diseases; who were aged 65 years and above and consented for study were included. All the new cases were included in the study during the period May 2013 to April 2014. Data were recorded in a performa which includes Patient demographic data, medical histories, current diagnoses and prescribed medications. The study protocol was approved by the institutional review committee. The recorded data were analysed for potentially inappropriate use with the help of Beers criteria 2003. 8,9 According to Beers criteria, drugs which are prescribed inappropriately are classified into one of the following categories: Category A: Drugs that generally should be avoided in older adults. Category B: Drugs that exceed maximum recommended daily dose. Category C: Drugs to be avoided in combination with specific co-morbidity RESULTS A total of 869 patients were included into the study. Of these, 574 (66.1%) were males and 295 (33.9%) were females. In total, 4833 drugs were prescribed to the patients ranging from two to 11 drugs per prescription with mean of 5.56 per patient. Atenolol (24.3%) and amlodipine (23.16%) were the most frequently used medicines. Other commonl...

Section: Original Research Articlementioning

confidence: 72%

Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department

Jha

et al. 2017

J Coll Med Sci-Nepal

“…Pharmacotherapy is considered potentially inappropriate when the risks of its use outweigh its benefits (18)(19)(20).Exposure of the elderly population to this type of medication has been shown to be associated with increased morbidity and mortality, increased the frequency of health service use and higher occurrence of ADR (12,13,15,16,21,22).Studies have shown that the prescription of PIM to Brazilian elderly is commonplace in some different settings (23)(24)(25). However, the number of pharmacoepidemiological studies focusing on the Brazilian hospitalized elderly population during their hospital stay is small (26).…”

Section: Introductionmentioning

confidence: 99%

“…Also, in geriatric prescribing, combinations of medicines which cause drug interactions, fixed combinations, dual therapy, and drugs with questionable therapeutic value should all be avoided (9)(10)(11).The quality of drugs prescription for the elderly may, therefore, be assessed by different indicators. In pharmacoepidemiological studies targeting hospitalized elderly, evaluation of parameters such as the use of potentially inappropriate medication (PIM) and polypharmacy is common (8,(12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Potentially Inappropriate Medication Use Among Older Hospitalized Patients in a Brazilian General Hospital

Silva

Pereira

Soares

et al. 2016

Infarma

Potentially inappropriate medication use among elderly patients from a Brazilian general hospital Uso de medicamentos potencialmente inadequados entre idosos em um hospital geral brasileiro ABSTRACTThe aim of this study was to determine the profile of the pharmacotherapy used by hospitalized elderly. A cross-sectional study was conducted at a Brazilian charitable general hospital. Drug prescriptions for hospitalized elderly patients (age≥60 years), dated from May to September 2010, were the source of data for this study and retrospectively analyzed (n=1,783). Polypharmacy (use of 5 or more drugs) and potentially inappropriate medications (PIMs -according to the Beers Criteria) were identified. Associations between sex, age, admission for cardiovascular disease or hospital stay and polypharmacy or PIM prescription were studied using univariate analysis (Pearson's Chi-square test). The association between polypharmacy and PIM prescription was also evaluated. A total of 204 elderly were hospitalized (mean age = 75 years) during the study period. The most commonly prescribed drugs acted on the cardiovascular system (29%) and the alimentary tract and metabolism (26%). Around 90% of the elderly were submitted to polypharmacy and 59% had, at least, one prescription of PIMs. A hospital stay of five days or more was associated with polypharmacy and PIM prescription. This study revealed a worrying drug utilization profile of high PIM use and polypharmacy practice. There is a need to implement strategies to improve geriatric prescribing.

“…Quanto aos fatores de risco relacionados ao uso de MPI, verificou-se que a polifarmácia e a depressão apresentaram significância estatística quanto a essa associação, corroborando com vários outros autores 9,19,34,35 . Como afirmam Bao e colaboradores 35 , não é de surpreender que a polifarmácia foi um fator fortemente associado ao uso de MPI, visto que pacientes com múltiplos medicamentos em uso tem mais chances de receber uma prescrição inadequada e estão mais propensos a ter múltiplas comorbidades, hospitalizações e consultas com médicos de várias especialidades.…”

Section: Discussionunclassified

“…A polimorbidade foi identificada quando o paciente apresentava quatro ou mais doenças 19 , sendo categorizada em: sim, apresenta polimorbidade (≥ 4 doenças) e não apresenta polimorbidade (0 a 3 doenças). As doenças verificadas nos prontuários médicos dos idosos foram agrupadas de acordo com a Classificação Internacional de Doenças, 10ª revisão (CID-10) 20 .…”

Section: O Variáveis Independentesunclassified

Perfil da farmacoterapia utilizada por idosos institucionalizados

Garbín¹,

Lima²,

Editorial³

et al. 2017

Arch Health Invest

ResumoIntrodução: O desenvolvimento de patologias crônicas aumenta com o avançar da idade, bem como a quantidade de medicamentos administrados, desafiando o Sistema Único de Saúde quanto a polifarmácia e a farmacovigilância. Objetivos: Este estudo objetivou verificar o perfil da farmacoterapia utilizada por idosos institucionalizados, através da identificação dos medicamentos mais usados, da detecção da ocorrência da polifarmácia e do uso de medicamentos inapropriados para idosos. Material e Método: Os dados foram obtidos através de consulta aos prontuários médicos dos idosos e entrevistas semi-estruturadas às enfermeiras responsáveis de seis Instituições de Longa Permanência para Idosos de quatro municípios do estado de São Paulo. A polifarmácia foi definida através do uso concomitante de cinco ou mais medicamentos diários, sendo que os medicamentos potencialmente inapropriados para idosos foram identificados através dos critérios de Beers. Também foi verificado os fatores associados ao uso de MPI, por meio de análise multivariada. Resultados: Participaram do estudo 261 idosos com idade ≥ 60 anos, sendo que 73,9% foram acometidos pela polifarmácia. Foram prescritos 1452 medicamentos, sendo a maioria (36%) com ação sobre o Sistema Nervoso Central. 50,6% consumiam pelo menos um MPI diariamente, sendo o diazepam (8,4%) e a fluoxetina (7,7%) os mais utilizados. Conclusão: Desta forma, a polifarmácia se faz presente entre a maioria dos idosos, havendo uma prevalência de antipsicóticos e antidepressivos. Quanto ao uso de medicamentos potencialmente inapropriados verificou-se uma alta prevalência, sendo a polifarmácia e a depressão os fatores associados a sua utilização. Descritores: Uso Indevido de Medicamentos sob Prescrição; Idoso; Prescrição Inadequada. AbstractIntroduction: The development of chronic pathologies increases with age, as well as the quantity of drugs administered, challenging the Brazilian public health system regarding polypharmacy and pharmacovigilance. Objectives: This study aimed to verify the profile of pharmacotherapy used by institutionalized elderly, through the identification of the most used drugs, the detection of the occurrence of polypharmacy and the use of inappropriate drugs for elderly. Material and Method: The datas were obtained by consulting the medical records of elderly and applying semi-structured interviews with the responsible nurses of six long-stay institutions for elderly in four cities of São Paulo State, Brazil. Polypharmacy was defined as the concomitant use of five or more daily medications; while potentially inappropriate medications for elderly were identified using the Beers criteria. The factors associated with the use of potentially inappropriate medications were performed by multivariate analysis. Results: The study included 261 elderly aged ≥ 60 years old, being 73,9% affected by polypharmacy. 1452 medications were prescribed, where most of them (36%) act on the central nervous system. 50,6% of the patients consumed at least one potentially inappropriate medicat...