Skip to main content
SpringerLink
Log in

Prevalence and predictors of potentially inappropriate medication use among ambulatory older adults in Northern Nigeria

  • Short Communication
  • Published:
Drugs & Therapy Perspectives Aims and scope Submit manuscript

Abstract

Objectives

There is a paucity of data describing the prevalence of and factors associated with the use of potentially inappropriate medications (PIMs) among older adults in Northern Nigeria. This study evaluates the prevalence and predictors of PIMs used among older adults attending outpatient clinics.

Methods

This cross-sectional study involved patients aged ≥ 65 years attending outpatient clinics in two public hospitals and was conducted from June to September 2016. PIMs were detected using the American Geriatrics Society (AGS) 2015 updated Beers criteria and the Screening Tool of Older People’s potentially inappropriate Prescriptions (STOPP) [version 2] criteria.

Results

A total of 244 older adults (mean age 71.1 ± 6.1 years) were included. The prevalence of PIM measured using Beers (67.2%) and STOPP criteria (40.2%) varied significantly (p = 0.047). Both Beers and STOPP criteria identified at least one PIM in 73 patients (29.9%). Nonsteroidal anti-inflammatory drugs (NSAIDs) and α-methyldopa were the most common PIMs identified using the Beers criteria. Concurrent use of an angiotensin-converting enzyme inhibitor and amiloride was observed in 32.4% of older adults. “Glibenclamide and glimepiride” and “NSAIDs with concurrent antiplatelet without proton pump inhibitor” were the most common PIMs detected by the STOPP criteria. The number of medications being taken and the hospital attended were significant predictors of PIM.

Conclusion

The prevalence of PIMs among ambulatory older adults was relatively high. A higher number of medications and the hospital attended were associated with a greater risk of PIMs. The 2015 Beers criteria detected significantly higher PIMs than the STOPP criteria (version 2). These observations highlight the need for interventions to improve the use of medications in older adults.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Dotchin CL, Akinyemi RO, Gray WK, et al. Geriatric medicine: services and training in Africa. Age Ageing. 2012;42(1):124–8.

    Article  Google Scholar 

  2. Salomon JA, Wang H, Freeman MK, et al. Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010. Lancet. 2012;380(9859):2144–62.

    Article  Google Scholar 

  3. National Population Commission. Federal Republic of Nigeria. 2006 population and housing census priority table volume IV; Population distribution by age and sex (state and local government area). National Population Commission. 2010.

  4. Sanya E, Akande TM, Opadijo G, et al. Pattern and outcome of medical admission of elderly patients seen at University of Ilorin Teaching Hospital, Ilorin. Afr J Med Sci. 2008;37:375–81.

    CAS  Google Scholar 

  5. Sanya E, Abiodun AA, Kolo P, et al. Profile and causes of mortality among elderly patients seen in a tertiary care hospital in Nigeria. Ann Afr Med. 2011;10(4):278–83.

    Article  Google Scholar 

  6. Akanji BO, Ogunniyi A, Baiyewu O. Healthcare for older persons, a country profile: Nigeria. J Am Geriatr Soc. 2002;50:1289–92.

    Article  Google Scholar 

  7. Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2003;57(1):6–14.

    Article  Google Scholar 

  8. Chung JY. Geriatric clinical pharmacology and clinical trials in the elderly. Transl Clin Pharm. 2014;22(2):64–9.

    Article  Google Scholar 

  9. Bradley MC, Motterlini N, Padmanabhan S, et al. Potentially inappropriate prescribing among older people in the United Kingdom. BMC Geriatr. 2014;14(1):72.

    Article  Google Scholar 

  10. Pardo-Cabello AJ, Manzano-Gamero V, Zamora-Pasadas M, et al. Potentially inappropriate prescribing according to STOPP-2 criteria among patients discharged from internal medicine: prevalence, involved drugs and economic cost. Arch Gerontol Geriatr. 2018;74:150–4.

    Article  Google Scholar 

  11. American Geriatrics Society. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46.

    Article  Google Scholar 

  12. O’Mahony D, O’Sullivan D, Byrne S, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–8.

    Article  Google Scholar 

  13. Fadare JO, Agboola SM, Opeke OA, et al. Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital. Ther Clin Risk Manag. 2013;9:115–20.

    Article  Google Scholar 

  14. Pannoi T, Chapman RS, Panza A. Prevalence of potentially inappropriate medication (PIM) and factors associated with PIM in elderly outpatient prescriptions at a district hospital in the Southern region of Thailand. J Health Res. 2014;28(2):101–8.

    Google Scholar 

  15. Simões PA, Santiago LM, et al. Prevalence of potentially inappropriate medication in the older adult population within primary care in Portugal: a nationwide cross-sectional study. Patient Prefer Adherences. 2019;13:1569.

    Article  Google Scholar 

  16. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41.

    Article  CAS  Google Scholar 

  17. Melloni C, Peterson ED, Chen AY, et al. Cockcroft–Gault versus modification of diet in renal disease: importance of glomerular filtration rate formula for classification of chronic kidney disease in patients with non-ST-segment elevation acute coronary syndromes. J Am Coll Cardiol. 2008;51(10):991–6.

    Article  Google Scholar 

  18. Péquignot R, Belmin J, Chauvelier S, et al. Renal function in older hospital patients is more accurately estimated using the Cockcroft–Gault formula than the modification diet in renal disease formula. J Am Geriatr Soc. 2009;57(9):1638–43.

    Article  Google Scholar 

  19. Faustino CG, Passarelli MCG, Jacob-Filho WJ. Potentially inappropriate medications among elderly Brazilian outpatients. Sao Paulo Med J. 2013;131(1):19–26.

    Article  Google Scholar 

  20. Jang IY, Lee YS, Jeon MK, et al. Potentially inappropriate medications in elderly outpatients by the 2012 version of Beers criteria: a single tertiary medical center experience in South Korea. J Korean Geriatr Soc. 2013;17(3):126–33.

    Article  Google Scholar 

  21. 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;37:329–33.

    Article  Google Scholar 

  22. Akoria O. Establishing in-hospital geriatrics services in Africa: insights from the University of Benin Teaching Hospital geriatrics project. Ann Afr Med. 2016;15(3):145–53.

    Article  Google Scholar 

  23. O’Sullivan DP, O’Mahony D, Parsons C, et al. A prevalence study of potentially inappropriate prescribing in Irish long-term care residents. Drugs Aging. 2013;30(1):39–49.

    Article  Google Scholar 

  24. Bahat G, Bay I, Tufan A, et al. Prevalence of potentially inappropriate prescribing among older adults: a comparison of the Beers 2012 and Screening Tool of Older Person’s Prescriptions criteria version 2. Geriatr Gerontol Int. 2017;17:1245–51.

    Article  Google Scholar 

  25. Chen LL, Tangiisuran B, Shafie AA, et al. Evaluation of potentially inappropriate medications among older residents of Malaysian nursing homes. Int J Clin Pharm. 2012;34:596–603.

    Article  CAS  Google Scholar 

  26. Popović B, Quadranti NR, Matanović SM, et al. Potentially inappropriate prescribing in elderly outpatients in Croatia. Eur J Clin Pharmacol. 2014;70:737–44.

    Article  Google Scholar 

  27. Lai HY, Hwang SJ, Chen YC, et al. Prevalence of the prescribing of potentially inappropriate medications at ambulatory care visits by elderly patients covered by the Taiwanese National Health Insurance Program. Clin Ther. 2009;31(8):1859–70.

    Article  Google Scholar 

  28. Hedna K, Hakkarainen KM, Gyllensten H, et al. Potentially inappropriate prescribing and adverse drug reactions in the elderly: a population-based study. Eur J Clin Pharmacol. 2015;71:1525–33.

    Article  CAS  Google Scholar 

  29. Wallace E, McDowell R, Bennett K, et al. Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: a prospective cohort study. J Gerontol A Biol Sci Med Sci. 2017;72(2):271–7.

    Article  Google Scholar 

  30. Harrison SL, Kouladjian O’Donnell L, Milte R, et al. Costs of potentially inappropriate medication use in residential aged care facilities. BMC Geriatr. 2018;18(9):1–10.

    Google Scholar 

  31. Najjar MF, Sulaiman SAS, Al Jeraisy M, et al. The impact of a combined intervention program: an educational and clinical pharmacist’s intervention to improve prescribing pattern in hospitalized geriatric patients at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Ther Clin Risk Manag. 2018;14:557–64.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors wish to thank the staff of the medical records and medical outpatient departments in the two hospitals for their assistance during data collection.

Author information

Authors and Affiliations

  1. Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang, Malaysia

    Usman Abubakar

  2. Pharmacy Department, IBB Specialist Hospital, Minna, Niger, Nigeria

    Usman Abubakar

  3. National Poison Centre, Universiti Sains Malaysia (USM), 11800, Gelugor, Pulau Pinang, Malaysia

    Balamurugan Tangiisuran

  4. School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800, Gelugor, Pulau Pinang, Malaysia

    Balamurugan Tangiisuran, Mohamed Anwar Hammad & Syed Azhar Syed Sulaiman

  5. Pharmacy Department, General Hospital, Minna, Niger, Nigeria

    Mohammad Kolo & Abdulkadir Ibrahim Yamma

  6. Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200, Pulau Pinang, Malaysia

    Syed Azhar Syed Sulaiman

Authors
  1. Usman Abubakar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Balamurugan Tangiisuran
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohammad Kolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abdulkadir Ibrahim Yamma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mohamed Anwar Hammad
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Syed Azhar Syed Sulaiman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Usman Abubakar.

Ethics declarations

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors declare they have no conflicts of interest.

Ethics approval

Approved by the Research and Ethics Committee of the hospitals (reference numbers IBBSH/SUB/654/VOL.I/05 and HMB/GHM/STA/136/VOL.III/387).

Consent to participate

Patient medical records were evaluated after clinic hours; thus, patient informed consent was not obtained. However, permission to access patient medical records was granted by hospital management.

Consent for publication

Not applicable.

Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable

Authors contributions

UA, MK, and AIY designed the study and collected the data. UA, MAH, MK, and AIY analyzed the data and wrote the first draft of the manuscript. BT and SASS critically reviewed the manuscript. All the authors approved the manuscript for submission.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abubakar, U., Tangiisuran, B., Kolo, M. et al. Prevalence and predictors of potentially inappropriate medication use among ambulatory older adults in Northern Nigeria. Drugs Ther Perspect 37, 94–99 (2021). https://doi.org/10.1007/s40267-020-00800-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40267-020-00800-3

Search

Navigation