Potentially Inappropriate Prescribing among Elderly Patients at a Primary Care Clinic in Oman

Al-Busaidi, Said; Al-Kharusi, Ayman; Al-Hinai, Mustafa; Al‐Zakwani, Ibrahim; Al-Ghafri, Fahad; Rizvi, Syed; Balushi, Khalid A. Al

doi:10.1007/s10823-019-09393-5

Cited by 11 publications

(10 citation statements)

References 21 publications

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“…The insulin sliding scale is an agent approved for use in diabetic patients; however, in older patients, it may have a higher risk of hypoglycemia without an improvement in hyperglycemia management, and it is now recommended to avoid using it in older adults as per the 2019 AGS Beers criteria. In addition, a study from Oman using the 2015 Beers criteria identified amitriptyline (11%) among the top PIMs in the older patients [ 48 ], and a systematic review of Guaraldo et al found that six out of seven studies (85.7%) mentioned amitriptyline among the most used PIMs in the older population [ 49 ]. The inappropriate medication use in Ethiopia could be due to low awareness of physicians about the risk of PIMs in older patients (disregarding the level of multimorbidity and polypharmacy) and lack of applicability of explicit criteria in their prescribing practice.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

et al. 2021

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Few studies have been conducted on multimorbidity (two or more chronic diseases) and rational geriatric prescribing in Africa. This study examined the prevalence and determinants of multimorbidity, polypharmacy (five or more long-term medications), and potentially inappropriate medication (PIM) use according to the 2019 Beers criteria among the older adults attending chronic care clinics from a single institution in Ethiopia. A hospital-based cross-sectional study was conducted among 320 randomly selected older adults from 12 March 2020 to 30 August 2020. A multivariable logistic regression analysis was performed to identify the predictor variables. The prevalence of multimorbidity, polypharmacy, and PIM exposure was 59.1%, 24.1%, and 47.2%, respectively. Diuretics (10%), insulin sliding scale (8.8%), amitriptyline (7.8%), and aspirin (6.9%) were among the most frequently prescribed PIMs. Older patients experiencing pain flare-ups were more likely to have multimorbidity (adjusted odds ratio (AOR): 1.64, 95% confidence intervals: 1.13–2.39). Persistent anger (AOR: 3.33; 1.71–6.47) and use of mobility aids (AOR: 2.41, 1.35–4.28) were associated with polypharmacy. Moreover, cognitive impairment (AOR: 1.65, 1.15–2.34) and health deterioration (AOR: 1.61, 1.11–2.32) increased the likelihood of PIM exposure. High prevalence of multimorbidity and PIM use was observed in Ethiopia. Several important determinants that can be modified by applying PIM criteria in routine practice were also identified.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

et al. 2021

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“…This study is similar to other studies. 12,17,[27][28][29] It was suggested that females might live longer and complain more about their diseases, which makes them more susceptible to PIMs. 30 Moreover, they visit the physician more than men.…”

Section: Discussionmentioning

confidence: 99%

“…Although these studies can't be generalised to all older patients in these countries, at least they give us an idea about PIMs use in some hospitals of these countries. In Oman, 12.7% PIMs were prescribed to older patients of primary care clinic at Sultan Qaboos University Hospital using beers criteria (2015) 12 . In Qatar, two different studies conducted in different conditions found the prevalence of PIMs according to Beers criteria 38.2% among home health care services department of Hamad hospital and 62.6% among outpatients older adults.…”

Section: Discussionmentioning

confidence: 99%

Potentially inappropriate medications in older adults according to Beers criteria 2019: Prevalence and risk factors

et al. 2021

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Older patients are a sensitive population that should be treated carefully with the most appropriate medication. The definition of a potentially inappropriate medication (PIM) is "a drug in which the risk of an adverse event outweighs its clinical benefit, particularly when there is a safer or more effective alternative therapy for the same disease". 1 Inappropriate prescribing terminology consists of three definitions that must be clarified. Misprescribing, overprescribing and under-prescribing are the main domains of inappropriate prescribing. 2 Misprescribing means prescribing medication that increases the chance of adverse events. Overprescribing means prescribing medication in which no indication for that. Underprescribing means there is an indication for a certain unprescribed drug. 2 It should be noted that there are many factors that make older patients more prone to PIMs. Older patients become more prone to adverse drug reactions from altered pharmacokinetics and

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“…International studies have shown prevalence rates of 43% in Canada [ 15 ], 42,7% in New Zealand [ 11 ], and 46.1% in Portugal [ 41 ]. In Asian countries, the prevalence was 12.7% in Oman [ 42 ], 34.0% in India [ 43 ], 39.4% in Indonesia [ 44 ], 53,1% in Kuwait [ 14 ], and 59.3% in Thailand [ 45 ]…”

Section: Discussionmentioning

confidence: 99%

Potentially inappropriate medications for the elderly: Incidence and impact on mortality in a cohort ten-year follow-up

et al. 2020

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Introduction Pharmacological therapy plays an important role in disease control in the elderly; unfortunately, this comes with a high prevalence in the use of medications classified as potentially inappropriate. Objective To analyze the incidence, risk factors, and survival of elderly people using potentially inappropriate medications (PIM). Method A ten-year follow-up assessment of elderly participants residing in a capital of Central Brazil was conducted. The initial assessment (baseline) included 418 elderly people. Data were collected through home interviews guided by a questionnaire covering socioeconomic, demographic, living conditions, and health variables. The medication information obtained comprised active ingredient, dosage, route, and regimen for the medications. The PIMs were classified according to 2019 Beers Criteria. The analyses were performed using STATA 15.0. For survival analysis, a Cox Regression was performed with the respective Kaplan Meier curve. Results The incidence of PIM was 44.1 cases (95% CI: 35.2–54.7) per 1,000 people a year. The most used PIMs were nifedipine, glibenclamide, and sodium diclofenac. The risk factors were polypharmacy (aRR: 3.00; 95% CI: 1.31–6.88) and diabetes mellitus (aRR: 1.57; 95% CI: 1.03–2.39). We identified no statistically significant association between survival and the use of PIM. Conclusion The study highlights the high consumption of PIM among the elderly causing polypharmacy risks. Health professionals working in drug treatment need to be alert to polypharmacy risks to ensure the rational use of medications to prevent adverse reactions and other health problems.

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Potentially Inappropriate Prescribing among Elderly Patients at a Primary Care Clinic in Oman

Cited by 11 publications

References 21 publications

Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

Potentially inappropriate medications in older adults according to Beers criteria 2019: Prevalence and risk factors

Potentially inappropriate medications for the elderly: Incidence and impact on mortality in a cohort ten-year follow-up

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