Potentially Inappropriate Prescribing among Elderly Outpatients: Evaluation of Temporal Trends 2012–2018 in Piedmont, Italy

Abstract

Pharmacological intervention is one of the cornerstones in the treatment and prevention of disease in modern healthcare. However, a large number of drugs are often prescribed and used inappropriately, especially in elderly patients. We aimed at investigating the annual prevalence of potentially inappropriate prescriptions (PIPs) among older outpatients using administrative healthcare databases of the Piedmont Region (Italy) over a seven-year period (2012–2018). We included all Piedmont outpatients aged 65 years or older with at least one drug prescription per year. Polypharmacy and the prevalence of PIPs according to the ERD list explicit tool were measured on an annual basis. A range between 976,398 (in 2012) and 1,066,389 (in 2018) elderly were evaluated. Among them, the number of subjects with at least one PIP decreased from 418,537 in 2012 to 339,764 in 2018; the prevalence significantly reduced by ~25% over the study period. The stratified analyses by age groups and sex also confirmed the downward trend and identified several differences in the most prevalent inappropriately prescribed drugs. Overall, despite a reduction in PIP prevalence, one out of three older outpatients was still exposed to inappropriateness, highlighting the extensive need for intervention to improve prescribing.

Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide

“…Following exclusion of 213 duplicate studies, 1258 studies were excluded by the titles and abstracts. Ninety-four studies with 371 224 692 older outpatients were included for analysis (Figure 1; eAppendix 2 in Supplement 1).…”

“…Forty-one studies were conducted in Asia, followed by 22 studies in Europe, 14 studies in North America, 8 studies in South America, 7 studies in Africa, and 2 studies in Oceania. Between 1999 and 2021, a total of 51 studies were performed in high-income countries, 23 studies in upper- to middle-income countries, 17 studies in lower- to middle-income countries, and 3 studies in low-income countries. Sixty-three studies of the PIM prevalence estimates were based on the Beers criteria, 26 studies…”

“…Between 1999 and 2021, a total of 51 studies were performed in high-income countries, 23 studies in upper- to middle-income countries, 17 studies in lower- to middle-income countries, and 3 studies in low-income countries. Sixty-three studies of the PIM prevalence estimates were based on the Beers criteria, 26 studies were based on the STOPP/START criteria, 13 studies on localization criteria that were developed based on the characteristics of medication for older patients in their own country, and 13 studies on other criteria. Eighty-five studies…”

“…Sixty-three studies of the PIM prevalence estimates were based on the Beers criteria, 26 studies were based on the STOPP/START criteria, 13 studies on localization criteria that were developed based on the characteristics of medication for older patients in their own country, and 13 studies on other criteria. Eighty-five studies were cross-sectional in design, and 11 studies were conducted in a national population survey. The mean age of the participants in most studies (65 studies…”

“…Eighty-five studies were cross-sectional in design, and 11 studies were conducted in a national population survey. The mean age of the participants in most studies (65 studies) was younger than 80 years and older than 65 years, and 31 studies had a mean number of drugs greater than 5. Thirty-four studies had a male ratio of more than 50%, and 34 studies included older outpatients with certain diseases.…”