Prevalence of Potentially Inappropriate Medication Use in Elderly Hospitalised Patients

Widagdo, Imaina; Nyfort‐Hansen, Karin; Kowalski, Stefan R.

doi:10.1002/j.2055-2335.2011.tb00678.x

Cited by 8 publications

(6 citation statements)

References 20 publications

(40 reference statements)

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“…Several studies have used modified versions of the Beers criteria to identify potentially inappropriate medicine (PIM) prescribing for older Australians (Table ) . The studies used different modifications of the criteria, and different study methods, so the data are not directly comparable.…”

Section: Resultsmentioning

confidence: 99%

“…The Screening Tool of Older Person's Prescriptions (STOPP), published in 2008 as an alternative to the Beers criteria, has not been widely used in Australia . A study in hospitalised older people using these criteria identified that 60% of patients were exposed to one or more PIMs (Table ) . PIMs most frequently identified using the Beers and STOPP criteria included: benzodiazepines, tricyclic antidepressants, anticholinergics, non‐steroidal anti‐inflammatory drugs and amiodarone.…”

Section: Resultsmentioning

confidence: 99%

“…In a study of 602 RACF residents, 42% were exposed to sedative medicines and 36% to anticholinergic medicines . High levels of potentially inappropriate use of proton pump inhibitors have also been highlighted in several studies …”

Section: Resultsmentioning

confidence: 99%

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Problems with medicine use in older Australians: a review of recent literature

Elliott

Booth

2014

J Pharm Pract Res

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Abstract:Older people are at increased risk of medication-related problems and adverse medication events. This paper reviews literature on problems with medicine use in older Australians published between 2006 and 2013. The prevalence of polypharmacy has continued to rise. Polypharmacy, multiple comorbidities and inappropriate prescribing have been linked to drug-drug and drug-disease interactions and medicine-related hospitalisations. Inaccurate medication histories, suboptimal continuity of medication management, complex medication regimens and non-adherence have been reported. Studies describing medication reviews, usually conducted by pharmacists, indicate that older people taking multiple medicines have an average of one to three current medication-related problems, including inappropriate or unnecessary medicines, untreated indications, suboptimal monitoring and adverse drug reactions. These findings indicate that problems with medicine use and adverse medication events remain highly prevalent in older Australians, despite the introduction of a range of quality use of medicines strategies. This may be due to a range of factors such as increasing intensity and complexity of medical therapy, and suboptimal uptake and /or targeting of quality use of medicines strategies. In settings where quality use of medicines strategies have been implemented, there is evidence for improved prescribing and, in some situations, reduced adverse events. Problems with medicine use in older people remain a major challenge to the Australian healthcare system: polypharmacy may be unavoidable in people with multiple comorbidities, so there needs to be a focus on managing and reducing the risks associated with polypharmacy.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Problems with medicine use in older Australians: a review of recent literature

Elliott

Booth

2014

J Pharm Pract Res

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“…This is because medicine availability and use in Australia is largely determined by the Australian Pharmaceutical Benefits Scheme37. Other Australian studies have found that some medicines listed as inappropriate by Beers may be appropriate for certain older people according to Australian practice;105 many medicines listed by Beers are not available in Australia; and that some medicines considered inappropriate in Australia are not listed by Beers 106. Disagreement between Beers and other criteria, such as the improving prescribing in the elderly tool, have been identified 109…”

Section: Discussionmentioning

confidence: 99%

Validation of prescribing appropriateness criteria for older Australians using the RAND/UCLA appropriateness method

2012

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ObjectiveTo further develop and validate previously published national prescribing appropriateness criteria to assist in identifying drug-related problems (DRPs) for commonly occurring medications and medical conditions in older (≥65 years old) Australians.DesignRAND/UCLA appropriateness method.ParticipantsA panel of medication management experts were identified consisting of geriatricians/pharmacologists, clinical pharmacists and disease management advisors to organisations that produce Australian evidence-based therapeutic publications. This resulted in a round-one panel of 15 members, and a round-two panel of 12 members.Main outcome measureAgreement on all criteria.ResultsForty-eight prescribing criteria were rated. In the first rating round via email, there was disagreement regarding 17 of the criteria according to median panel ratings. During a face-to-face second round meeting, discussion resulted in retention of 25 criteria after amendments, agreement for 14 criteria with no changes required and deletion of 9 criteria. Two new criteria were added, resulting in a final validated list of 41 prescribing appropriateness criteria. Agreement after round two was reached for all 41 criteria, measured by median panel ratings and the amount of dispersion of panel ratings, based on the interpercentile range.ConclusionsA set of 41 Australian prescribing appropriateness criteria were validated by an expert panel. Use of these criteria, together with clinical judgement and other medication review processes such as patient interview, is intended to assist in improving patient care by efficiently detecting potential DRPs related to commonly occurring medicines and medical conditions in older Australians. These criteria may also contribute to the medication management education of healthcare professionals.

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“…A recent study has indicated a high prevalence of PP reported to be 76% among Australian older patients admitted to an acute care hospital. 16 In terms of PIMs and DDIs at admission, the prevalence in Australian elderly patients for at least 1 PIM and 1 DDI is 39-60% [38][39][40] and 71% 41 , respectively. Other studies have revealed the prevalence of PIMs among older hospitalized patients with cognitive impairment ranging from 53% to 90%.…”

Section: Introductionmentioning

confidence: 99%

<p>The Changes in Medication Prescribing Among the Older People with Cognitive Impairment in the Acute Care Setting</p>

Ruangritchankul

Peel

Hanjani

et al. 2020

CIA

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Purpose: Most older people with cognitive impairment usually have multiple comorbidities. In the last decade, the guidelines for the management of chronic diseases have been changed, leading to changes in the patterns of medication prescribing and in the prevalence of drugrelated problems (DRPs). The main objectives were to explore the changes in medication use and in the prevalence of polypharmacy (PP), the use of potentially inappropriate medications (PIMs) and drug-drug interactions (DDIs) among older hospitalized adults with cognitive impairment in a 5-year period. Patients and Methods: Older hospitalized patients with cognitive impairment diagnosed by cognitive performance scale (CPS) score of 2 or more at tertiary hospital in Brisbane, Australia in 2009 and 2015 to 2016 were enrolled. Prescribed medication use, and exposures to PP, PIM and/ or DDI were evaluated at two time points. The associated factors with patients exposed to >1 criteria of PP, PIM or DDI were analyzed by using logistic regression analyses. Results: The median number of prescribed medications was not significantly different between the two periods. The number of medications use as dermatological agents and analgesics substantially increased over 5 years. In contrast, there was a decrease in prescription of drugs for acid-related disorders, drugs used in diabetes, and mineral supplements. Most of the participants were exposed to at least one of PP, PIM or DDI. In multivariate regression analysis, the presence of diabetes diagnosis was a risk factor associated with increased exposure to >1 criteria of PP, PIM or DDI. Conclusion: The patterns of many prescribed medications use have altered in a 5-year period. The present study confirms that the majority of older adults with cognitive impairment admitted in an acute care setting are prone to PP, PIM and DDI. Comprehensive medication reviews should be undertaken in clinical care of older patients with cognitive impairment.

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Prevalence of Potentially Inappropriate Medication Use in Elderly Hospitalised Patients

Cited by 8 publications

References 20 publications

Problems with medicine use in older Australians: a review of recent literature

Problems with medicine use in older Australians: a review of recent literature

Validation of prescribing appropriateness criteria for older Australians using the RAND/UCLA appropriateness method

<p>The Changes in Medication Prescribing Among the Older People with Cognitive Impairment in the Acute Care Setting</p>

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