Inappropriate prescribing in the hospitalized elderly patient: Defining the problem, evaluation tools, and possible solutions

Page, Robert L.; Linnebur, Sunny A.; Bryant, Lucinda L.; Ruscin, J. Mark

doi:10.2147/cia.s9564

Cited by 190 publications

(166 citation statements)

References 51 publications

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“…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%

“…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%

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

Silva

Pereira

Soares

et al. 2016

Infarma

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Silva

Pereira

Soares

et al. 2016

Infarma

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“…This last one initiates with the admission's pharmacological background, continues with the conciliation of the patient's intra-hospital regimen and with the checking of the resulting lists again when there is a transition in the treating service. There will be a definitive list of the medications that will be received by the patient after discharge, including an education intervention given to the patient and/or caregiver, and the communication of said information to the general ambulatory physician and specialists [10,12,13].…”

Section: Pharmacotherapeutic Conciliationmentioning

confidence: 99%

“…In several studies it has been quantified that the adverse effects caused by mistakes account for 19~56% of the total detected [12][13][14][15][16][17][18][19][20][21][22] Likewise, he concludes that the accidents with medication are public health concern whose magnitude cannot be foreseen yet [23].…”

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confidence: 99%

Safety of the Patient from the Medication

Casallas¹

2017

JPP

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Currently, more than 7% of admissions to acute care hospitals are related with AEMs (adverse events to medications). AEMs are the sixth cause of death, causing a cost of over $5.6 million dollars (USD) per hospital per year. There is an estimate that between 19% and 23% of hospitalized patients will have an adverse effect within the first 30 days after being discharged, 14.3% will be re-admitted and 70% of these events will be related to a medication prescription. Fortunately, at least 58% of these AEMs are preventable, since they result from a lack of information on the medication, prescription and dosage errors and from the abuse and underuse of the same. Polymedicated patients, especially the elderly with multiple pathologies and/or chronic patients that need to be admitted into the hospital more frequently, usually to internal medicine, neurology, psychiatry, rehabilitation and intensive care, are precisely the most liable to suffer from medication errors. It must be the objective to aim for the increase in the patient safety standards when it comes to medications.

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“…It is also important to separate out the general factors responsible for the high incidence of drug-related problems in older people [11][12][13][14][15][16][17], versus other factors that further modulate the rate of ADRs in the hospital setting. In regard to the former, it is common for older people to have many diseases at the same time that may be treated with a variety of different drugs, which obviously increases the complexity of the drug therapy for patients as well as the risk for adverse drug events, including undesirable drug-drug interactions.…”

Section: Introductionmentioning

confidence: 99%

Geriatric Pharmacotherapy: Optimisation Through Integrated Approach in the Hospital Setting

Petrovic

Somers

Onder

2016

Developing Drug Products in an Aging Society

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Since older patients are more vulnerable to adverse drug-related events, there is a need to ensure appropriate prescribing in these patients in order to prevent misuse, overuse and underuse of drugs. Different tools and strategies have been developed to reduce inappropriate prescribing; the available measures can be divided into medication assessment tools, and specific interventions to reduce inappropriate prescribing. Implicit criteria of inappropriate prescribing focus on appropriate dosing, search for drug-drug interactions, and increase adherence. Explicit criteria are consensus-based standards focusing on drugs and diseases and include lists of drugs to avoid in general or lists combining drugs with clinical data. These criteria take into consideration differences between patients, and stand for a medication review, by using a systematic approach. Different types of interventions exist in order to reduce inappropriate prescribing in older patients, such as: educational interventions, computerized decision support systems, pharmacist-based interventions, and geriatric assessment. The effects of these interventions have been studied, sometimes in a multifaceted approach combining different techniques, and all types seem to have positive effects on appropriateness of prescribing. Interdisciplinary teamwork within the integrative pharmaceutical care is important for improving of outcomes and safety of drug therapy. The pharmaceutical care process consists of four steps, which are cyclic for an individual patient. These steps are pharmaceutical anamnesis, medication review, design and follow-up of a pharmaceutical care plan. A standardized approach is necessary for the adequate detection and evaluation of drug-related problems. Furthermore, it is clear that drug therapy should be reviewed in-depth, by having full access to medical records, laboratory values and nursing notes. Although clinical pharmacists perform the pharmaceutical care process to manage the patient's drug therapy in every day clinical practice, the physician takes the ultimate responsibility for the care of the patient in close collaboration with nurses.

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Inappropriate prescribing in the hospitalized elderly patient: Defining the problem, evaluation tools, and possible solutions

Cited by 190 publications

References 51 publications

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

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

Safety of the Patient from the Medication

Geriatric Pharmacotherapy: Optimisation Through Integrated Approach in the Hospital Setting

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