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Current Drug Safety


ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

Research Article

Prevalence and Predictors of Potentially Inappropriate Medication Use Among Elderly Patients Using Updated Beers Criteria 2019: A Single Centered Retrospective Analysis

Author(s): Syam Sundar Chinthalapudi, Srilakshmi Cheeti , Aditi Bajpai , S. Deepika, Girish Thunga , Muhammed Rashid , Raviraja V. Acharya and Sreedharan Nair *

Volume 17, Issue 1, 2022

Published on: 23 April, 2021

Page: [24 - 33] Pages: 10

DOI: 10.2174/1574886316666210423113916

Price: $65


Background: Inappropriate medication use poses a sizable health safety hazard in the elderly owing to aging-associated physiological and anatomic changes. Inappropriate drug prescribing and polypharmacy in this population elevate the risk of adverse drug reactions (ADR). The study aimed at assessing the prevalence and predictors of Potentially Inappropriate Medication (PIM) use in elderly patients according to updated Beers Criteria 2019.

Methods: Medical records of 402 patients aged ≥65 years admitted to a tertiary care hospital from June 2018 to May 2019 were analyzed. The patients who received at least one PIM based on the 2019 Updated Beers Criteria were considered as test cases and others as control. Data were presented as descriptive statistics, and logistic regression was performed to assess the factors affecting the outcomes.

Results: The mean age was found to be 73.7 ±6.4 years in the test and 70.5±5.5 years in the control group. The prevalence of PIMs to be used with caution was found to be 54%. Whereas the prevalence of PIMs to be avoided and to be used with reduced dose was found to be 45% and 1%, respectively. The most prescribed PIMs were aspirin, diuretics, long-acting sulfonylureas, and proton pump inhibitors (PPIs). Increasing age, polypharmacy, and the number of drugs in medication history were significantly (p<0.05) correlated with a substantial risk of PIM use. The risk of developing serious and moderate drug-drug interactions (DDIs) was significantly high in the test group (p<0.05) when compared to the control group.

Conclusion: A high prevalence of PIMs was observed in this study. Age, polypharmacy, and ≥ 3 drugs in medication history were identified as risk factors for PIM use, and at a higher risk of developing DDIs. Continuous medication reviews by clinical pharmacists can aid in reducing the occurrence of PIMs amongst geriatrics.

Keywords: Inappropriate prescribing, potentially inappropriate medication, beers criteria, polypharmacy, medication, elderly, drug-related problem.

Graphical Abstract
Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 1991; 151(9): 1825-32.
[] [PMID: 1888249]
Khamis S, Abdi AM, Uzan A, Basgut B. Applying beers criteria for elderly patients to assess rational drug use at a university hospital in Northern Cyprus. J Pharm Bioallied Sci 2019; 11(2): 133-41.
[] [PMID: 31148889]
Harugeri A, Joseph J, Parthasarathi G, Ramesh M, Guido S. Potentially inappropriate medication use in elderly patients: a study of prevalence and predictors in two teaching hospitals. J Postgrad Med 2010; 56(3): 186-91.
[] [PMID: 20739763]
Charlesworth CJ, Smit E, Lee DSH, Alramadhan F, Odden MC. Polypharmacy among adults aged 65 years and older in the United States: 1988-2010. J Gerontol A Biol Sci Med Sci 2015; 70(8): 989-95.
[] [PMID: 25733718]
Salwe KJ, Kalyansundaram D, Bahurupi Y. A study on polypharmacy and potential drug-drug interactions among elderly patients admitted in department of medicine of a tertiary care hospital in puducherry. J Clin Diagn Res 2016; 10(2): FC06-10.
[] [PMID: 27042480]
Stewart RB, Cooper JW. Polypharmacy in the aged. Practical solutions. Drugs Aging 1994; 4(6): 449-61.
[] [PMID: 8075473]
Polypharmacy SN, Management I. Research J Pharm and Tech 2014; 7(3): 335-9.
Sharma P, Gupta NL, Chauhan HS. Prevalence of Polypharmacy: Comparing the Status of Indian States. Indian J Community Fam Med 2019; 5(1): 4.
Komagamine J. Prevalence of potentially inappropriate medications at admission and discharge among hospitalised elderly patients with acute medical illness at a single centre in Japan: a retrospective cross-sectional study. BMJ Open 2018; 8(7): e021152.
[] [PMID: 30030316]
Al-Azayzih A, Alamoori R, Altawalbeh SM. Potentially inappropriate medications prescribing according to Beers criteria among elderly outpatients in Jordan: a cross sectional study. Pharm Pract (Granada) 2019; 17(2): 1439.
[] [PMID: 31275497]
Vieira de Lima TJ, Garbin CAS, Garbin AJÍ, Sumida DH, Saliba O. Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes. BMC Geriatr 2013; 13(1): 52.
[] [PMID: 23718678]
By the 2019 american geriatrics society beers criteria® update expert panel. American geriatrics society 2019 updated ags beers criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019; 67(4): 674-94.
[] [PMID: 30693946]
Blanco-Reina E, Valdellós J, Aguilar-Cano L, et al. 2015 Beers Criteria and STOPP v2 for detecting potentially inappropriate medication in community-dwelling older people: prevalence, profile, and risk factors. Eur J Clin Pharmacol 2019; 75(10): 1459-66.
[] [PMID: 31338540]
Steinman MA, Beizer JL, DuBeau CE, Laird RD, Lundebjerg NE, Mulhausen P. How to Use the American Geriatrics Society 2015 Beers Criteria-A Guide for Patients, Clinicians, Health Systems, and Payors. J Am Geriatr Soc 2015; 63(12): e1-7.
[] [PMID: 26446776]
Momin TG, Pandya RN, Rana DA, Patel VJ. Use of potentially inappropriate medications in hospitalized elderly at a teaching hospital: a comparison between Beers 2003 and 2012 criteria. Indian J Pharmacol 2013; 45(6): 603-7.
[] [PMID: 24347769]
Traub SL. Special Projects Division Basic Skills in Interpreting Laboratory Data: Illustrated with Case Studies. Bethesda, Md.: ASHP 1996.
Alhawassi TM, Alatawi W, Alwhaibi M. Prevalence of potentially inappropriate medications use among older adults and risk factors using the 2015 American Geriatrics Society Beers criteria. BMC Geriatr 2019; 19(1): 154.
[] [PMID: 31142286]
Shah KN, Joshi HM, Christian RP, Patel KP, Malhotra SD. Prevalence of potentially inappropriate medications and prescription cost analysis among older cardiac patients in an outpatient department of a tertiary care hospital in India. J Basic Clin Pharm 2016; 7(4): 110-5.
[] [PMID: 27999470]
Narayan SW, Nishtala PS. Prevalence of potentially inappropriate medicine use in older New Zealanders: a population-level study using the updated 2012 Beers criteria. J Eval Clin Pract 2015; 21(4): 633-41.
[] [PMID: 25940302]
Lim Y-J, Kim H-Y, Choi J, et al. Potentially inappropriate medications by beers criteria in older outpatients: prevalence and risk factors. Korean J Fam Med 2016; 37(6): 329-33.
[] [PMID: 27900070]
Zeenny R, Wakim S, Kuyumjian Y-M. Potentially inappropriate medications use in community-based aged patients: a cross-sectional study using 2012 Beers criteria. Clin Interv Aging 2017; 12: 65-73.
[] [PMID: 28115835]
Baldoni A de O, Ayres LR, Martinez EZ, Dewulf NdeL, Dos Santos V, Pereira LR. Factors associated with potentially inappropriate medications use by the elderly according to Beers criteria 2003 and 2012. Int J Clin Pharm 2014; 36(2): 316-24.
[] [PMID: 24271923]
Skaar DD, O’Connor H. Using the Beers criteria to identify potentially inappropriate medication use by older adult dental patients. J Am Dent Assoc 2017; 148(5): 298-307.
[] [PMID: 28284416]
Zaveri HG, Mansuri SM, Patel VJ. Use of potentially inappropriate medicines in elderly: A prospective study in medicine out-patient department of a tertiary care teaching hospital. Indian J Pharmacol 2010; 42(2): 95-8.
[] [PMID: 20711374]
Wawruch M, Fialova D, Zikavska M, et al. Factors influencing the use of potentially inappropriate medication in older patients in Slovakia. J Clin Pharm Ther 2008; 33(4): 381-92.
[] [PMID: 18613856]
Bradbury F. How important is the role of the physician in the correct use of a drug? An observational cohort study in general practice. Int J Clin Pract Suppl 2004; (144): 27-32.
[] [PMID: 16035400]
Mamun K, Lien CTC, Goh-Tan CYE, Ang WST. Polypharmacy and inappropriate medication use in Singapore nursing homes. Ann Acad Med Singapore 2004; 33(1): 49-52.
[PMID: 15008562]
Sharma R, Chhabra M, Vidyasagar K, Rashid M, Fialova D, Bhagavathula AS. Potentially inappropriate medication use in older hospitalized patients with type 2 diabetes: a cross-sectional study. Pharmacy (Basel) 2020; 8(4): E219.
[] [PMID: 33212819]
Gallagher PF, Barry PJ, Ryan C, Hartigan I, O’Mahony D. Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers’ Criteria. Age Ageing 2008; 37(1): 96-101.
[] [PMID: 17933759]
Venkataraman R, Rashid M, Shrestha H. Inappropriate medication use and cost comparison analysis of proton pump inhibitors: evidence from an Indian tertiary care facility. Current drug safety 2020; 15(2): 147-55.
[] [PMID: 32160850]

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