Inappropriate Medications in the Elderly

Laroche, Marie‐Laure; Charmes, JP; Bouthier, F.; Merle, Louis

doi:10.1038/clpt.2008.214

Cited by 89 publications

(71 citation statements)

References 22 publications

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“…These strategies include reducing the underuse, overuse, and misuse of drugs, as well as reducing potentially important drug-drug interactions. The overuse of drugs and polypharmacy, leading to increased risk of ADRs and drug-drug interactions, Arrow indicates the influence of the second (interacting) drug on the concentration of the first, object drug a Clinically significant pharmacokinetic drug-drug interactions selected by Hanlon and Schmader [36] b Clinically significant drug-drug interactions selected by Malone et al [35] c Other clinically important drug-drug interactions, not selected by Malone's panel, including an additional four drug-drug interactions we added [35] d Clinically significant pharmacokinetic drug-drug interactions selected by Hanlon and Schmader, including additional two drug-drug interactions we added [36] can be avoided if only drugs with a clear indication, proven efficacy, and favorable risk-to-benefit profile are used [5,18]. The overall number of drugs should be the smallest possible and the duration of treatment the shortest possible.…”

Section: Discussionmentioning

confidence: 97%

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Potentially inappropriate medications in the elderly: a comprehensive protocol

Matanović

Vlahović‐Palčevski

2012

Eur J Clin Pharmacol

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Elderly patients are at increased risk of drug-related morbidity and mortality. Avoiding the use of potentially inappropriate medications (PIMs) is one of the strategies that has been widely adopted to reduce the harmful consequences of drug use. There are several PIM screening tools available. In this review, we provide an overview of existing screening tools to detect PIMs in the elderly, emphasizing the advantages and disadvantages of each. Combining previously published and adopted tools (adjusted Beers list, French consensus panel, McLeod's list, and Lindblad's list of clinically important drug-disease interactions), we develop a new comprehensive tool that also includes the adjusted Hanlon's and Malone's lists of potentially serious drug-drug interactions in the elderly. In addition to listed PIMs and clinically important drug-drug interactions, alternative therapeutic solutions are suggested. The new protocol differentiates: drugs with an unfavorable benefit/risk ratio (to be avoided regardless of the underlying disease/condition), drugs with a questionable efficacy, and drugs to be avoided with certain diseases/conditions, and provides a list of potentially serious drug-drug interactions. A tool consisting of PIMs and potential drug-drug interactions within the same protocol provides more comprehensive quality assessment of drug-prescribing behavior to the elderly, which in turn may lead to better prescribing practices.

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Section: Discussionmentioning

confidence: 97%

“…Misuse encompasses the use of potentially inappropriate medications (PIMs), inappropriate dose, or inappropriate duration of treatment. PIMs are defined as drugs with a potential risk that is higher than their potential benefit to the patient, particularly when safer alternative therapies exist for the same condition [4,5].…”

Section: Introductionmentioning

confidence: 99%

Potentially inappropriate medications in the elderly: a comprehensive protocol

Matanović

Vlahović‐Palčevski

2012

Eur J Clin Pharmacol

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“…An inappropriate medication is any drug in which the risks outweigh the benefits or where these do not align with goals of care. Thus, it encompasses both ineffective or unnecessary treatment and those treatments which are high risk [56]. However, various definitions exist in the literature and so inclusion of this term in our definition may be contentious as there is potential for misinterpretation.…”

Section: Proposed Definitionmentioning

confidence: 99%

A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice.

Reeve

Gnjidic

Long

et al. 2015

Brit J Clinical Pharma

500

415

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Aims The aim of this study was to identify what definitions have been published for the term ‘deprescribing’, and determine whether a unifying definition could be reached. A secondary aim was to uncover patterns between the published definitions which could explain any variation. Methods Systematic literature searches were performed (earliest records to February 2014) in MEDLINE, Embase, CINAHL, Informit, Scopus and Google Scholar. The terms deprescrib* or de‐prescrib* were employed as a keyword search in all fields. Conventional content analysis and word frequencies were used to identify characteristics of the definitions. Network analysis was conducted to visualize characteristic distribution across authors and articles. Results Following removal of duplicates, 231 articles were retrieved, 37 of which included a definition. Eight characteristics of the definitions were identified: use of the term stop/withdraw/cease/discontinue (35 articles), aspect of prescribing included e.g. long term therapy/inappropriate medications (n = 18), use of the term ‘process’ or ‘structured’ (n = 13), withdrawal is planned/supervised/judicious (n = 11), involving multiple steps (n = 7), includes dose reduction/substitution (n = 7), desired goals/outcomes described (n = 5) and involves tapering (n = 4). Network analysis did not reveal patterns responsible for variations in previously used definitions. Conclusions These findings show that there is lack of consensus on the definition of deprescribing. This article proposes the following definition: ‘Deprescribing is the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes’. This definition has not yet been externally validated and further work is required to develop an internationally accepted and appropriate definition.

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“…Other tools including The Improving Prescribing in the Elderly Tool [2], The Medication Appropriate Index [3], Beers' criteria [4], and Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) [5] have also been developed to identify PIMs and PPOs in older people. A recent review by Laroche et al examining the strengths and weakness of inappropriate prescribing (IP) screening tools endorses the use of STOPP and START and highlights important deficiencies of Beers' criteria in the European context [6]. Beers' criteria are the most widely cited older person IP criteria in the literature and are designed to quantify potential IP in older people in primary care, secondary care and nursing homes.…”

Section: Introductionmentioning

confidence: 99%

Potentially inappropriate prescribing in an Irish elderly population in primary care

Ryan¹,

O’Mahony

Kennedy³

et al. 2009

Brit J Clinical Pharma

252

256

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Potentially inappropriate prescribing in older people is a well‐documented problem and has been associated with adverse drug reactions and hospitalization.• Beers' criteria, Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions.• The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria. WHAT THIS STUDY ADDS • Potential errors of prescribing and of omission of medicines are prevalent among medically stable older people in primary care.• Screening tools should be incorporated into the everyday practice of primary care doctors and community pharmacists as a means of preventing potential errors of prescribing commission and prescribing omission in older people.AIMS Screening tools have been formulated to identify potentially inappropriate prescribing (IP) in older people. Beers' criteria are the most widely used but have disadvantages when used in Europe. New IP screening tools called Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) have been developed to identify potential IP and potential prescribing omissions (PPOs). The aim was to measure the prevalence rates of potential IP and PPOs in primary care using Beers' criteria, STOPP and START.METHODS Case records of 1329 patients ≥65 years old from three general practices in one region of southern Ireland were studied. The mean age ± SD of the patients was 74.9 ± 6.4 years, 60.9% were female. Patients' current diagnoses and prescription medicines were reviewed and the Beers' criteria, STOPP and START tools applied.RESULTS The total number of medicines prescribed was 6684; median number of medicines per patient was five (range 1–19). Overall, Beers' criteria identified 286 potentially inappropriate prescriptions in 18.3% (243) of patients, whilst the corresponding IP rate identified by STOPP was 21.4% (284), in respect of 346 potentially inappropriate prescriptions. A total of 333 PPOs were identified in 22.7% (302) of patients using the START tool.CONCLUSION Potentially inappropriate drug prescribing and errors of drug omission are highly prevalent among older people living in the community. Prevention strategies should involve primary care doctors and community pharmacists.

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Inappropriate Medications in the Elderly

Cited by 89 publications

References 22 publications

Potentially inappropriate medications in the elderly: a comprehensive protocol

Potentially inappropriate medications in the elderly: a comprehensive protocol

A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice.

Potentially inappropriate prescribing in an Irish elderly population in primary care

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