Prescription of Potentially Inappropriate Medication in Older Inpatients of an Internal Medicine Ward: Concordance and Overlap Among the EU(7)-PIM List and Beers and STOPP Criteria

Abstract

Background: Age-related comorbidities prone older adults to polypharmacy and to an increased risk of potentially inappropriate medication (PIM) use. This work aims to analyze the concordance and overlap among the EU(7)-PIM list, 2019 Beers criteria, and Screening Tool of Older Person’s Prescriptions (STOPP) version 2 criteria and also to analyze the prevalence of PIM.Methods: A retrospective cohort study was conducted on older inpatients of an internal medicine ward. Demographic, clinical, and pharmacological data were collected, during March 2020. After PIM identification by the EU(7)-PIM list, Beers criteria, and STOPP v2 criteria, the concordance and overlap between criteria were analyzed. A descriptive analysis was performed, and all the results with a p-value lower than 0.05 were considered statistically significant.Results: A total of 616 older patients were included in the study whose median age was 85 (Q1–Q3) (78–89) years. Most of the older patients were male (51.6%), and the median (Q1–Q3) number of days of hospitalization was 17 (13–22) days. According to the EU(7)-PIM list, Beers criteria, and STOPP criteria, 79.7, 92.0, and 76.5% of older adults, respectively, used at least one PIM. A poor concordance (<63.4%) among criteria was observed. An association between PIM and the number of prescribed medicines was found in all applied criteria. Moreover, an association between the number of PIMs and diagnoses of endocrine, nutritional, and metabolic diseases, mental, behavioral, and neurodevelopmental disorders, and circulatory system diseases and days of hospitalization was observed according to Beers criteria, and that with diseases of the circulatory system and musculoskeletal system and connective tissue was observed according to STOPP criteria.Conclusion: Despite the poor concordance between the EU(7)-PIM list, 2019 Beers, and STOPP v2 criteria, this work highlights the need for more studies in inpatients to develop strategies to facilitate the identification of PIM to decrease the high prevalence of PIM in hospitalized patients. The poor concordance among criteria also highlights the need to develop new tools adapting the existing criteria to medical ward inpatients.

Prescription of Potentially Inappropriate Medication Use in Older Cancer Outpatients With Multimorbidity: Concordance Among the Chinese, AGS/Beers, and STOPP Criteria

“…The AGS/Beers criteria judge each medicine as a PIM based not only on the medication profile of a patient but also on the pathologies of the patients, as well as the laboratory results ( O'Mahony et al, 2015 ). In order to apply the STOPP criteria, it is imperative to know the entire medication history, clinical information of the patient, and laboratory ( O'Mahony et al, 2015 ; O'Mahony, 2020 ; Perpétuo et al, 2021 ). Based on the 2019 AGS/Beers criteria, our study found that the prevalence of PIM use among older Chinese cancer patients was 32.65%, which was lower than the prevalence of 80.4% reported by a study on Korean cancer patients according to the 2019 AGS/Beers criteria ( Suh et al, 2021 ).…”

Effectiveness of Interventions to Reduce Potentially Inappropriate Medication in Older Patients: A Systematic Review

“…The search strategy was limited to the three main health research databases and articles written in English, Portuguese, and Spanish. The included studies were heterogeneous in practice settings, population, size of the samples, and PIM definition that can be variable depending on the screening tool used, which can influence PIM number detected ( Thomas and Thomas, 2019 ; Perpétuo et al, 2021 ).…”

Recent Updates on Risk and Management Plans Associated with Polypharmacy in Older Population

“…It is a five-step, patient-centered systematic approach ( Figure 2 ) used for evaluating and discontinuing medications in patients where potential harms exceed potential benefits in relation to individual existing functioning capability, care goals, preferences, values and life expectancy. Hence, this process suspends medication, changes medication, and decreases medication dosages for obtaining the best clinical outcomes [ 34 ]. This is because deprescribing approaches are patient-specific and focused and follow interventions with appreciable variability in medications used and patient characteristics [ 35 ].…”