Health outcomes associated with potentially inappropriate medication use in older adults

Abstract

The purpose of this study was to examine the prevalence of potentially inappropriate medication use (PIMs) among community-dwelling older adults and the association between PIMs and health care outcomes. Participants were 17,971 individuals age 65 years and older. PIM use was defined by the Beers criteria. Drug-related problems (DRPs) were defined using ICD-9 codes. Forty percent of the 17,971 individuals filled at least 1 PIM prescription, and 13% filled 2 or more PIM prescriptions. Overall DRP prevalence among those with at least 1 PIM prescription was 14.3% compared to 4.7% in the non-PIM group (p < .001). In conclusion, preventing PIM use may be important for decreasing medication-related problems, which are increasingly being recognized as requiring an integrated interdisciplinary approach. Keywordsmedications; healthcare costs; geriatrics; adverse drug events Drug-related problems (DRPs) are prevalent in the older adult population and pose a major patient safety concern. DRPs arise because of the increasing number of medications required by this age group, fragmented systems of care, pre-existing health conditions, and the pharmacokinetic and pharmacodynamic changes that occur with aging (Bigos, Bies, & Pollock, 2006;Cusack, 2004;Gurwitz, 2004;Hajjar et al., 2003;Turnheim, 2004Turnheim, , 2005. Avoiding use of high-risk drugs is an important strategy in reducing DRPs. The purpose of this study was to examine both the prevalence of potentially inappropriate medication (PIMs) use among community-dwelling older adults and the association between PIMs and health care outcomes.One method promoted to identify high-risk medications is the use of an explicit list of PIMs. PIMs were first devised and publicized by Beers et al. for nursing home residents and subsequently expanded to include older adults in all settings (Beers, 1997). PIMs are medications identified through expert panel review as having risks that outweigh benefits (Beers et al., 1991). Since the early 1990s, the prevalence of PIMs has been examined in a (Lau, Kasper, Potter, & Lyles, 2004), outpatient (Aparasu & Sitzman, 1999Curtis et al., 2004), acute care (Onder et al., 2005), and community settings (Zhan et al., 2001). For research purposes, use of explicit criteria is generally preferred over the use of implicit criteria applied by expert reviewers.The clinical validity of using a list of medications based on expert panel review and explicit criteria has been questioned as being overly simplistic and not including all the common drugs causing problems in older adults (Crownover & Unwin, 2005;Shorr, 2004). Moreover, despite the numerous reports of the prevalence of PIMs, only a few investigators (Fu, Liu, & Christensen, 2004;Thapa, Gideon, Cost, Milam, & Ray, 1998) have examined whether PIMs are associated with adverse clinical outcomes. Therefore, we investigated the outcomes associated with PIM use in a population of community-dwelling older adults.The Beers criteria have been revised recently; hence, the current prevalence of PIMs in...

Potentially inappropriate medications among elderly Brazilian outpatients

“…53 Among the positive aspects of using the Beers list are the facts that it can be adapted to computer systems, it enables pharmacoepidemiological studies on large populations, it incorporates information from the specialized literature and from specialists' consensuses, and it can easily be used for educational purposes. 2,49 To obtain the results from this study, a spreadsheet generated through a database was used. The advantages of using a computerized database for investigating prescribed medications include the accuracy of registering what was prescribed and the fact that it does not depend on information supplied by patients.…”

“…1 The presence of many comorbidities, high consumption of medicines, fragmented care, physiological changes and socioeconomic factors, among other factors, make it common for problems relating to medicines to arise among this population. 2 This concern regarding the impact of prescriptions among an aging population has led to the creation of several strategies for dealing with this phenomenon. Among these is the detection of potentially inappropriate medicines (PIMs).…”

“…3,4 Avoidance of the use of high-risk medicines is an important strategy for reducing occurrences of adverse effects from medicines, especially adverse reactions. 2 Planning of interventions for promoting rational use of medicines requires knowledge of the prescriptions made for the elderly population.…”

Safety Assessment of Potentially Inappropriate Medications Use in Older People and the Factors Associated with Hospital Admission

“…Potentially inappropriate medication (PIM) are those medications or classes of medications that should be avoided in patients aged ≥ 65 years, since they have no clear evidence-based indication, are not cost-effective [5] , pose unnecessarily high risk for older persons [6] , once the risks of using overcome the benefits [7] , and safer alternatives are available [6,8] . The exposure of older people to PIM is associated with the increased use of health care services [9] , ADR [4,10] and higher medical costs [11] . However, PIM prescriptions are common among these patients [12] , since studies have shown that 24.5% to 66.0% [8,[11][12][13][14][15][16] of older people take these drugs.…”

Innovative Collaborative Practice to Optimize Pharmacotherapy for Frail Older Patients

“…[1][2][3] At the same time, adverse drug events are common in this population, resulting in functional impairment and increasing morbidity, mortality, and health care costs. [4][5][6][7] Reported rates of adverse drug events in older populations range from 10% to 30% for ambulatory and inpatients alike. [8][9][10][11][12] Inappropriate prescribing, as indicated by explicit criterion-based or implicit judgment-based measures, increases the occurrence of adverse drug events.…”