Prevalence of potentially inappropriate prescribing and prescribing omissions in older Irish adults: findings from The Irish LongituDinal Study on Ageing study (TILDA)

Abstract

PurposeWe sought to estimate the prevalence of potentially inappropriate prescriptions (PIP) and potential prescribing omissions (PPOs) using a subset of the STOPP/START criteria in a population based sample of Irish adults aged ≥65 years using data from The Irish LongituDinal Study on Ageing (TILDA).MethodsA subset of 26 PIP indicators and 10 PPO indicators from the STOPP/START criteria were applied to the TILDA dataset. PIP/PPO prevalence according to individual STOPP/START criteria and the overall prevalence of PIP/PPO were estimated. The relationship between PIP and PPOs and polypharmacy, age, gender and multimorbidity was examined using logistic regression.ResultsThe overall prevalence of PIP in the study population (n = 3,454) was 14.6 %. The most common examples of PIP identified were NSAID with moderate-severe hypertension (200 participants; 5.8 %) and aspirin with no history of coronary, cerebral, or peripheral vascular symptoms or occlusive event (112 participants; 3.2 %). The overall prevalence of PPOs was 30 % (n = 1,035). The most frequent PPO was antihypertensive therapy where systolic blood pressure consistently >160 mmHg (n = 341, 9.9 %), There was a significant association between PIP and PPO and polypharmacy when adjusting for age, sex and multimorbidity (adjusted OR 2.62, 95 % CI 2.05–3.33 for PIP and adjusted OR 1.46, 95 % CI 1.23–1.75 for prescribing omissions).ConclusionOur findings indicate prescribing omissions are twice as prevalent as PIP in the elderly using a subset of the STOPP/START criteria as an explicit process measure of potentially inappropriate prescribing and prescribing omissions. Polypharmacy was independently associated with both PPO and PIP. Application of such screening tools to prescribing decisions may reduce unnecessary medication, related adverse events, healthcare utilisation and cost.Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-014-1651-8) contains supplementary material, which is available to authorized users.

Geriatric prescription analysis with respect to “STOPP” and “START” criteria: a descriptive study in the Indian scenario

“…Study conducted in Ireland showed proportion of patients receiving PIM to be 14%, while a study from Australia showed a prevalence of 37.5%. 15,16 It was as high as 51% in a study conducted by Delleur. 17 A study conducted by Gallenger reports the proportion on PIMs to be between 12-40% and the results of the present study falls between the same range.…”

“…Study published in European Journal of pharmacology shows prescription of NSAIDs in patients of hypertension as a common PIM while studies analyzing prescriptions as per Beers criteria show common PIMs related to prescription of antihistaminic, muscle relaxants and long acting benzodiazepines . [16][17][18][19] Thus, criteria adopted for identification of PIMs play a very important role in explaining the discrepancies between studies in this regard. Other explanations for differences in the type of PIPs reported from studies conducted in different geographical areas may be related to the epidemiology of diseases treated in a particular area, local availability of drugs, cost and treatments guidelines followed in a particular setup.…”

What to give the patient who has everything? A qualitative study of prescribing for multimorbidity in primary care

“…6 Multimorbid patients are also more likely to experience polypharmacy and potentially inappropriate prescribing than patients with single diseases. 7,8 However, prescribing 'appropriately' in multimorbidity is not always straightforward. 9,10 Guidelines exist for most common chronic diseases and offer benefits associated with the best available evidence, but adhering to guidelines in the management of a patient with multimorbidity almost invariably leads to multiple medications, resulting in increased risk of drug interactions, adverse effects, and poor adherence.…”

Aspirin Increases the Risk of Nondiagnostic Yield of Fine-Needle Aspiration and Biopsy of Thyroid Nodules

“…Given the proven benefits of aspirin in secondary prevention of cardiovascular diseases, and data suggesting no differences in serious complications, including hematoma formation [6], it is unlikely that our study results would necessitate a change in FNAB preparation practice in patients in whom the risk of a cardiovascular event may outweigh the benefit of obtaining a diagnostic sample [15, 16]. However, aspirin is the second most commonly prescribed medication without a known indication, after nonsteroidal anti-inflammatory drugs as per The Irish Longitudinal Study on Ageing (TILDA) [17]. Given this knowledge, and our results of a 3-fold higher risk of a nondiagnostic yield in patients on aspirin, FNAB (or a repeat FNAB procedure after a first nondiagnostic result) of thyroid nodules may offer a chance to revisit the rationale for its use in patients with a low cardiovascular risk, thereby potentially reducing drug-related adverse effects and increasing the likelihood of yielding a diagnostic sample.…”