Under‐prescription of medications in older adults according to START criteria: A cross‐sectional study in Lebanon

Abstract

Background and Aims Under‐prescription is defined as the exclusion of medications indicated for the treatment of certain conditions without any rationale for not prescribing them. The under‐prescription of medications is highly prevalent among older adults (≥65 years) receiving polypharmacy. This study aimed to assess the prevalence of the under‐prescription of medications using the Screening Tool to Alert to Right Treatment (START) criteria version 2 and to identify the predictors of having potential prescribing omissions (PPOs). Methods This cross‐sectional, face‐to‐face interview study was carried out between September 2021 and February 2022. The study comprised community‐dwelling older adults taking at least one medication on a regular basis. The study questionnaire included the patients' demographics, clinical data, and comorbidities. PPOs were identified using the START criteria. The χ 2 test was used to assess the association between under‐prescription of medication and the demographic/clinical variables. Multivariable logistic regression was performed to explore factors associated with under‐prescription of medications as the dependent variable and taking all variables that showed a p < 0.05 in the bivariate analysis as independent. Results A total of 444 older adults agreed to participate in this study. The mean age of participants was 71 ± 8.6; the majority of them, 305 (68.7%), were men. Polypharmacy was present in 261 patients (58.8%) and underprescribing of medications in 260 patients (58.6%). The highest percentage of under‐prescribing of medications was reported with statins in 115 patients (44.2%) followed by aspirin in 93 (35.7%), and angiotensin‐converting enzyme inhibitors in 61 (23.4%). The results of the multivariable analysis showed that patients with underprescribed medications had higher odds of polypharmacy (odds ratio [OR]: 2.015, confidence interval [CI] 95% 1.362–2.980, p < 0.001) and higher Charlson Comorbidity Index (OR 2.807, CI 95% 1.463–5.85, p = 0.02). Conclusion The present findings highlight that PPOs are highly prevalent among community‐dwelling older adults in Lebanon. Multimorbidity and polypharmacy were the identified predictors for under‐prescription of medications in this population.

Self-efficacy and Optimism in frail elderly men without functional disability attending geriatric outpatient clinic in Mansoura university: a case-control study.

“…Administration of Statin (45.7%in frails) (71.4% in controls), ACEI (34.3%in frails) (62.9% in controls) and Aspocid (34.3%in frails) (60% in controls) were signi cantly less frequent in frail group. Our study agreed withÖZTÜRK et al, 2023, Yoshimura et al, 2022, Hanna et al, 2022, that frail elderly take fewer protective medications. This could be due to nancial burden, drugs adverse effect, care giver issues, advanced age, negative believes about usefulness of such medication in advanced age and its role in decreasing mortality/ morbidity.…”

Prevalence and Associated Predictors of Inappropriate and Omitted Medications Prescribing in Older Patients with Advanced Cancer: A Cross-Sectional Study

“…This study results were in agreement with earlier studies which showed that omissions of cardiovascular medications represent the most common omissions among geriatric patients with and without cancer. 21 , 32 , 33 …”

“…This study results were in agreement with earlier studies which showed that omissions of cardiovascular medications represent the most common omissions among geriatric patients with and without cancer. 21,32,33 The limitations of this study include the retrospective nature of the medical record evaluations, even though researchers evaluated the medical charts carefully to ensure a high level of accuracy for patient data extraction. Second, some factors such as performance status of the patients and over the counter and self-medications taking which could contribute to PIMs and POMs occurrence were not evaluated in this study.…”

Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study

“…At the same time, the explicit method is direct, based on criteria that are usually elaborated upon through expert consensus based on the literature review. 9 Criteria from different countries are used to classify and describe the risks of PIM use, 10 , 11 so part of these criteria are based on the Beers criterion and local differences regarding the drugs approved for use.…”