Skip to main content

Advertisement

Log in

Prevalence and predictors of potentially inappropriate medications among home care elderly patients in Qatar

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background Older patients receiving home health care are particularly at risk of receiving potentially inappropriate medications compared to community-dwelling population. Data on appropriateness of prescribing in these patients is limited. Objective To investigate the prevalence, patterns and determinants of potentially inappropriate medications among elderly patients receiving Home Health Care Services in Qatar. Setting Home Health Care Services department in Hamad Medical Corporation-Qatar. Methods A cross-sectional study, conducted over a 3 months period. Patients 65 years and older, taking at least one medication and receiving home care services were included. Potentially inappropriate medications were identified and classified in accordance with the American Geriatrics Society 2012 Beers Criteria. Main outcome measure Prevalence of potentially inappropriate medications using updated Beers criteria. Results A total of 191 patients (38.2 %) had at least one potentially inappropriate medication. As per Beers criteria, 35 % of medications were classified as medications to be avoided in older adults regardless of conditions and 9 % as potentially inappropriate medications when used with certain diseases or syndromes. The majority of potentially inappropriate medications (56 %) were classified as medications to be used with caution. The two leading classes of potentially inappropriate medications were antipsychotics (27.4 %) and selective serotonin reuptake inhibitors (16 %). Significant predictors of inappropriate prescribing were hypertension [adjusted OR 1.7; 95 % CI (1.0, 2.8)], dementia [adjusted OR 2.0; 95 % CI (1.2, 3.1)], depression [adjusted OR 21.6; 95 % CI (2.8, 168.4)], and taking more than ten prescribed medications [adjusted OR 1.9; 95 % CI (1.3, 2.8)]. Conclusion Prescribing potentially inappropriate medications is common among older adults receiving home health care services in Qatar, a finding that warrants further attention. Polypharmacy, hypertension, depression and dementia were significantly associated with potentially inappropriate prescribing.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Spinewine A. Adverse drug reactions in elderly people: the challenge of safer prescribing. BMJ. 2008;336:956–7.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Spinewine A, et al. Appropriate prescribing in elderly people: How well can it be measured and optimised? Lancet. 2007;370:173–84.

    Article  PubMed  Google Scholar 

  3. Gurwitz JH, Soumerai SB, Avorn J. Improving medication prescribing and utilization in the nursing home. J Am Geriatr Soc. 1990;38:542–52.

    Article  CAS  PubMed  Google Scholar 

  4. Hanlon JT, Schmader KE, Ruby CM, Weinberger M. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc. 2001;49:200–9.

    Article  CAS  PubMed  Google Scholar 

  5. Simonson W, Feinberg JL. Medication-related problems in the elderly: defining the issues and identifying solutions. Drugs Aging. 2005;22:559–69.

    Article  PubMed  Google Scholar 

  6. Bao Y, Shao H, Bishop TF, Schackman BR, Bruce ML. Inappropriate medication in a national sample of US elderly patients receiving home health care. J Gen Intern Med. 2012;27(3):304–10.

  7. Goulding MR. Inappropriate medication prescribing for elderly ambulatory care patients. Arch Intern Med. 2004;164(3):305–12.

    Article  PubMed  Google Scholar 

  8. Viswanathan H, Bharmal M, Thomas J. Prevalence and correlates of potentially inappropriate prescribing among ambulatory older patients in the year 2001: comparison of three explicit criteria. Clin Ther. 2005;27(1):88–99.

    Article  PubMed  Google Scholar 

  9. Buck MD, Atreja A, Brunker CP, Jain A, Suh TT, Palmer RM, et al. Potentially inappropriate medication prescribing in outpatient practices: prevalence and patient characteristics based on electronic health records. Am J Geriatr Pharmacother. 2009;7(2):84–92.

    Article  PubMed  Google Scholar 

  10. Fialová D, Topinková E, Gambassi G, et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005;293(11):1348–58.

    Article  PubMed  Google Scholar 

  11. Hamano J, Tokuda Y. Inappropriate prescribing among elderly home care patients in Japan: prevalence and risk factors. J Prim Care Community Health. 2014;5(2):90–6. doi:10.1177/2150131913518346.

    Article  PubMed  Google Scholar 

  12. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–631. doi:10.1111/j.1532-5415.2012.03923.x.

  13. O’Mahony D, Gallagher P, Ryan C, Byrne S, Hamilton H, Barry P, O’Connor M, Kennedy J. STOPP & START criteria: a new approach to detecting potentially inappropriate prescribing in old age. Eur Geriatr Med. 2010;1(1):45–51.

    Article  Google Scholar 

  14. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–8. doi:10.1093/ageing/afu145.

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

    Article  CAS  PubMed  Google Scholar 

  16. Gallagher P, O’Mahony D. STOPP (screening tool of older persons’ potentially inappropriate prescriptions) application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing. 2008;37:673–9.

    Article  PubMed  Google Scholar 

  17. Miquel MDC, Cuervo MS, Silveira ED, Machuca IS, Blazquez Sg, Errasquin BM, et al. Potentially Potentially inappropriate drug prescription in older subjects across health care settings. Eur Geriatr Med. 2010;1(1):9–14. doi:10.1016/j.eurger.2009.12.002.

  18. Hamilton H, Gallagher P, Ryan C, Byrne S, O’Mahony D. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med. 2011;171:1013–9.

  19. Ryan C, O’Mahony D, Kennedy J, Weedle P, Byrne S. Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol. 2009;68:936–47.

  20. O’Sullivan DP, O’Mahony D, Parsons C, Hughes C, Murphy K, Patterson S, Byrne S. A prevalence study of potentially inappropriate prescribing in Irish long-term care residents. Drugs Aging. 2013;30(1):39–49. doi:10.1007/s40266-012-0039-7.

    Article  PubMed  Google Scholar 

  21. Pasina L, Djade CD, Tettamanti M, Franchi C, Salerno F, Corrao S, Marengoni A, Marcucci M, Mannucci PM, Nobili A, REPOSI Investigators. Prevalence of potentially inappropriate medications and risk of adverse clinical outcome in a cohort of hospitalized elderly patients: results from the REPOSI Study. J Clin Pharm Ther. 2014;39(5):511–5. doi:10.1111/jcpt.12178.

    Article  CAS  PubMed  Google Scholar 

  22. Blanco-Reina E, Ariza-Zafra G, Ocaña-Riola R, León-Ortiz M. 2012 American Geriatrics Society Beers criteria: enhanced applicability for detecting potentially inappropriate medications in European older adults? A comparison with the screening tool of older person’s potentially inappropriate prescriptions. J Am Geriatr Soc. 2014;62(7):1217–23. doi:10.1111/jgs.12891.

    Article  PubMed  Google Scholar 

  23. World Bank. Population ages 65 and above (% of total). 2014. http://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS. Accessed 12 March 2015.

  24. Centers for Disease Control and Prevention. National Center for Health Statistics. Home Health Care Patients: Data from the 2000 National Home and Hospice Care Survey. 2004 [updated 2010]; http://www.cdc.gov/nchs/pressroom/04facts/patients.htm. Last accessed 12 March 2015.

  25. Liu GG, Christensen DB. The continuing challenge of inappropriate prescribing in the elderly: an update of the evidence. J Am Pharm Assoc (Wash). 2002;42(6):847–57.

    Article  Google Scholar 

  26. Cahir C, Fahey T, Teeling M, Teljeur C, Feely J, Bennett K. Potentially, inappropriate prescribing and cost, outcomes for older people: a national, population study. Br J Clin Pharmacol. 2010;69:543–52.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Liperoti R, Onder G, Lapane KL, et al. Conventional or atypical antipsychotics and the risk of femur fracture among elderly patients: results of a case control study. J Clin Psycyhiatry. 2007;68:929–34.

    Article  CAS  Google Scholar 

  28. Pratt N, Roughead EE, Ramsay E, Salter A, Ryan P. Risk of hospitalization for hip fracture and pneumonia associated with antipsychotic prescribing in the elderly: a self-controlled case-series analysis in an Australian health care claims database. Drug Saf. 2011;34:567–75.

    Article  PubMed  Google Scholar 

  29. Rigler SK, Shireman TI, Cook-Wiens GJ, et al. Fracture risk in nursing home residents initiating antipsychotic medications. J Am Geriatr Soc. 2013;61(5):715–22. doi:10.1111/jgs.12216.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Ensrud KE, Blackwell T, Mangione CM, Bowman PJ, Study of Osteoporotic Fractures Research Group, et al. Central nervous system active medications and risk for fractures in older women. Arch Intern Med. 2003;163(8):949–57. doi:10.1001/archinte.163.8.949.

    Article  PubMed  Google Scholar 

  31. Jeste DV, Blazer D, Casey D, Meeks T, Salzman C, Schneider L, Tariot P, Yaffe K. ACNP White Paper: update on use of antipsychotic drugs in elderly persons with dementia. Neuropsychopharmacology. 2008;33:957–70. doi:10.1038/sj.npp.1301492.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. US Food and Drug Administration. Public health advisory: deaths with antipsychotics in elderly patients with behavioral disturbances. 4/11/2005. Cited 2015 March 17. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm053171.htm (2015).

  33. US Food and Drug Administration. Information for healthcare professionals: conventional antipsychotics. 6/16/2008. Cited 2015 March 17. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124830.htm (2008).

  34. Schneider LS, Dagerman K, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA. 2005;294:1934–43.

    Article  CAS  PubMed  Google Scholar 

  35. Trifirò G, Spina E, Gambassi G. Use of antipsychotics in elderly patients with dementia: Do atypical conventional agents have a similar safety profile? Pharmacol Res. 2009;59:1–12.

    Article  PubMed  Google Scholar 

  36. Gill SS, et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med. 2007;146:775–86.

    Article  PubMed  Google Scholar 

  37. Schneeweiss S, et al. Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients. CMAJ. 2007;176:627–32.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Schneider LS, Dagerman K, Insel PS. Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trial. Am J Geriatr Psychiatry. 2006;14:191–210.

    Article  PubMed  Google Scholar 

  39. Spinewine A, Fialová D, Byrne S. The role of the pharmacist in optimizing pharmacotherapy in older people. Drugs Aging. 2012;29(6):495–510. doi:10.2165/11631720-000000000-00000.

    Article  PubMed  Google Scholar 

  40. Davis RG, Hepfinger CA, Sauer KA, Wilhardt MS. Retrospective evaluation of medication appropriateness and clinical pharmacist drug therapy recommendations for home-based primary care veterans. Am J Geriatr Pharmacother. 2007;5(1):40–7.

    Article  PubMed  Google Scholar 

  41. Fick DM, Semla TP. 2012 American Geriatrics Society Beers Criteria: new year, new criteria, new perspective. J Am Geriatr Soc. 2012;60(4):614–5. doi:10.1111/j.1532-5415.2012.03922.x.

    Article  PubMed  Google Scholar 

  42. Onder G, Landi F, Liperoti R, Fialova D, Gambassi G, Bernabei R. Impact of inappropriate drug use among hospitalized older adults. Eur J Clin Pharmacol. 2005;61(5–6):453–9.

    Article  PubMed  Google Scholar 

  43. Laroche ML, Charmes JP, Nouaille Y, Picard N, Merle L. Is inappropriate medication use a major cause of adverse drug reactions in the elderly? Br J Clin Pharmacol. 2007;63(2):177–86.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Chang CM, Liu PY, Yang YH, Yang YC, Wu CF, Lu FH. Use of the Beers criteria to predict adverse drug reactions among first-visit elderly outpatients. Pharmacotherapy. 2005;25(6):831–8.

    Article  PubMed  Google Scholar 

  45. Passarelli MC, Jacob-Filho W, Figueras A. Adverse drug reactions in an elderly hospitalised population: inappropriate prescription is a leading cause. Drugs Aging. 2005;22(9):767–77.

    Article  PubMed  Google Scholar 

  46. Chrischilles EA, VanGilder R, Wright K, Kelly M, Wallace RB. Inappropriate medication use as a risk factor for self-reported adverse drug effects in older adults. J Am Geriatr Soc. 2009;57(6):1000–6.

    Article  PubMed  Google Scholar 

Download references

Funding

This study received funding from the medical research centre in Hamad Medical Corporation, Doha-Qatar.

Conflicts of interest

The authors have no (potential) conflict of interest to declare.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eman Alhmoud.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alhmoud, E., Khalifa, S. & Bahi, A.A. Prevalence and predictors of potentially inappropriate medications among home care elderly patients in Qatar. Int J Clin Pharm 37, 815–821 (2015). https://doi.org/10.1007/s11096-015-0125-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-015-0125-0

Keywords

Navigation