Prescribing patterns of proton pump inhibitors in older hospitalized patients in a Scottish health board

Abstract

Inappropriate PPI prescribing is common in frail older hospitalized patients, and might increase the risk of drug-drug interactions. Polypharmacy and comorbidity were independently associated with inappropriate PPI prescribing in this group.

Proton pump inhibitors: Are we still prescribing them without valid indications?

“…4 In our study, out of 80 PPI discharge prescriptions, 64 were pre-admission prescriptions that patients were taking for various reasons, such as previous history of upper GI symptoms (which had occurred from several years up to two decades earlier), peptic ulcer disease, GIP of low-dose aspirin, and non-specified reasons.…”

“…However, all recent studies have reported a very high prevalence of inappropriate PPI prescribing and our result findings are consistent with these studies. 2,3,4,[18][19][20] Finally, as the guidelines recommend periodic assessment for the continued use of PPI, it may be challenging to assess symptoms among the very elderly, frail, and debilitated elderly with dementia and communication issues. This may have posed difficulties for the prescribing physicians in determining the need for a prescription.…”

“…2 In the hospital setting, the prevalence of PPI overprescribing has been reported to be between 61 to 86 per cent in recent Western studies. 3,4 Non-judicious PPI use is a matter of great concern in the elderly who often have multiple comorbidities, are taking multiple medications, and hence are at an increased risk of long-term PPI-related adverse outcomes. The most significant of the documented adverse effects of PPIs include: Clostridium difficile-associated diarrhea, 5 pneumonia, 6 hip fractures, 7 malabsorption of iron, nutrients and vitamins, 8 and acute interstitial nephritis.…”

Proton‐Pump Inhibitors and Long‐Term Risk of Community‐Acquired Pneumonia in Older Adults

“…Approximately 40% of elderly adults receive PPIs, and appropriate clinical indications may be lacking for up to 85% of PPIs prescribed. 22,23 Pneumonia is a major cause of death, 24,25 costing in excess of $17 billion per year in the United States alone. 26 It is therefore important to clarify associations between PPIs and pneumonia for short-and long-term exposure, especially in older adults, who may be most at risk from lack of barriers to respiratory infection.…”

Proton Pump Inhibitors and Hypomagnesemia in Polymorbid Elderly Adults

“…Long‐term PPI users had serum magnesium levels (1.95 mg/dL) similar to those of PPI nonusers (2.00 mg/dL; P = .20). A large percentage of elderly adults have been prescribed PPIs . Because PPIs, even though generally considered to be safe, have some adverse effects, their prescription must always be motivated by and based on scientific evidence.…”