Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review
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Potentially inappropriate prescribing (PIP) is one of the main risk factors for adverse drug events (ADEs) in older people.
This systematic literature review aims to determine prevalence and type of PIP in community-dwelling older people across Europe, as well as identifying risk factors for PIP.
The PubMed and Web of Science database were searched systematically for relevant manuscripts (January 1, 2000–December 31, 2014). Manuscripts were included if the study design was observational, the study participants were community-dwelling older patients in Europe, and if a published screening method for PIP was used. Studies that focused on specific pathologies or that focused on merely one inappropriate prescribing issue were excluded. Data analysis was performed using R statistics.
Fifty-two manuscripts were included, describing 82 different sample screenings with an estimated overall PIP prevalence of 22.6 % (CI 19.2–26.7 %; range 0.0–98.0 %). Ten of the sample screenings were based on the Beers 1997 criteria, 19 on the Beers 2003 criteria, 14 on STOPP criteria (2008 version), 8 on START-criteria (2008 version), and 7 on the PRISCUS list. The 24 remaining sample screenings were carried out using compilations of screening methods or used country-specific lists such as the Laroche criteria. It appears that only PIP prevalence calculated from insurance data significantly differs from the other data collection method categories. Furthermore, risk factors most often positively associated with PIP prevalence were polypharmacy, poor functional status, and depression. Drug groups most often involved in PIP were anxiolytics (ATC-code: N05B), antidepressants (N06A), and nonsteroidal anti-inflammatory and anti-rheumatic products (M01A).
PIP prevalence in European community-dwelling older adults is high and depends partially on the data collection method used. Polypharmacy, poor functional status, and depression were identified as the most common risk factors for PIP.
KeywordsCommunity-dwelling Primary care Aged Inappropriate prescribing
- 1.Statistical Office of the European Communities. EUROSTAT: population data—proportion of population aged 65 and over. Secondary EUROSTAT: population data—proportion of population aged 65 and over. http://ec.europa.eu/eurostat/tgm/table.do?tab=table&init=1&language=en&pcode=tps00028&plugin=1
- 10.Opondo D, Eslami S, Visscher S, et al. (2012) Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review. PloS one 7(8)Google Scholar
- 14.(2012) American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society 60(4):616-3.Google Scholar
- 15.O'Mahony D, O'Sullivan D, Byrne S, et al. (2014) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age and ageingGoogle Scholar
- 16.Holt S, Schmiedl S, Thurmann PA (2010) Potentially inappropriate medications in the elderly: the PRISCUS list. DtschArztebl Int 107(31-32):543–51Google Scholar
- 17.Hill-Taylor B, Sketris I, Hayden J et al (2013) Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. J Clin Pharm Ther 38(5):360–72CrossRefPubMedGoogle Scholar
- 24.Kovacevic SV, Simisic M, Rudinski SS, et al. (2014) Potentially inappropriate prescribing in older primary care patients. PloS one 9(4)Google Scholar
- 25.Primejdie D, Bojita M, Popa A (2012) Potential inappropriate medication use in community-dwelling elderly patients. A qualitative study. Farmacia 60(3):366–78Google Scholar
- 26.Blanco-Reina E, Ariza-Zafra G, Ocana-Riola R et al (2014) 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 62(7):1217–23CrossRefPubMedGoogle Scholar
- 27.Shamseer L, Moher D, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. Br Med J (Clin Res Ed) 349:g7647Google Scholar
- 28.WHO collaborating centre for drug statistics methodology. ATC/DDD Index 2015Google Scholar
- 39.Finnish Medicines Agency. Database of medication for the elderly. Secondary database of medication for the elderly 2010. http://www.fimea.fi/development/medicines_information/database_of_medication_for_the_elderly
- 52.Ryan C, O'Mahony D, Kennedy J et al (2009) Appropriate prescribing in the elderly: an investigation of two screening tools, Beers criteria considering diagnosis and independent of diagnosis and improved prescribing in the elderly tool to identify inappropriate use of medicines in the elderly in primary care in Ireland. J Clin Pharm Ther 34(4):369–76CrossRefPubMedGoogle Scholar
- 53.McLeod PJ, Huang AR, Tamblyn RM et al (1997) Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ Can Med Assoc J J de l'Assoc Med Can 156(3):385–91Google Scholar
- 55.Ryan C, O'Mahony D, Kennedy J et al (2008) Screening tools for elderly patients in primary care: STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) and START (Screening Tool to Alert doctors to Right, i.e., appropriate, indicated Treatment). Pharmacoepidemiol Drug Saf 17(7):746–47Google Scholar
- 76.National Board of Health and Welfare (Socialstyrelsen). Indikatorer för god läkemedelsterapi hos äldre Secondary Indikatorer för god läkemedelsterapi hos äldre 2003. http://www.socialstyrelsen.se/publikationer2010/2010-6-29
- 82.Yayla ME, Bilge U, Binen E, et al. (2013) The use of START/STOPP criteria for elderly patients in primary care. Scientific World JournalGoogle Scholar
- 85.Bradley MC, Motterlini N, Padmanabhan S, et al. (2014) Potentially inappropriate prescribing among older people in the United Kingdom. BMC geriatrics 14Google Scholar
- 88.Tommelein E, Petrovic M, Somers A, et al. (2015) Older patients’ prescriptions screening in the community pharmacy: development of the Ghent Older People’s Prescriptions community pharmacy screening (GheOP(3)S) tool. J Public Health (Oxf)Google Scholar
- 93.Pugh MJV, Starner CI, Amuan ME et al (2011) Exposure to potentially harmful drug-disease interactions in older community-dwelling veterans based on the healthcare effectiveness data and information set quality measure: who is at risk? J Am Geriatr Soc 59(9):1673–78PubMedCentralCrossRefPubMedGoogle Scholar
- 97.Meid AD, Lampert A, Burnett A, et al. (2015) The impact of pharmaceutical care interventions for medication underuse in older people: a systematic review and meta-analysis. British journal of clinical pharmacologyGoogle Scholar