International Journal of Clinical Pharmacy

, Volume 36, Issue 2, pp 316–324 | Cite as

Factors associated with potentially inappropriate medications use by the elderly according to Beers criteria 2003 and 2012

  • André de Oliveira BaldoniEmail author
  • Lorena Rocha Ayres
  • Edson Zangiacomi Martinez
  • Nathalie de Lourdes Souza Dewulf
  • Vânia dos Santos
  • Leonardo Régis Leira Pereira
Research Article


Background Potentially inappropriate medications (PIMs) should be avoided by the elderly because they possess a significant high risk for this population when a safer alternative is available. Therefore, the identification of prevalence and factors associated with PIMs should be considered as they provide valuable information that can be used to develop strategies to ensure patients’ safety. Objective To identify the prevalence and the clinical and socioeconomic–demographic factors that may be associated with PIMs use in the elderly, according to Beers criteria 2003 and its updated version 2012. And, as a secondary objective, a comparison between both criteria was performed. Setting Pharmacy of the Basic Health District Unit of the western district of Ribeirão Preto. Methods This cross-sectional observational study was conducted with the elderly, assisted by the Brazilian public health system. Data from patients were collected through a structured interview form. Beers criteria 2003 and 2012 were used to classify PIMs. The association between PIMs used and independent variables were analyzed by odds ratios. The differences between PIMs use according to Beers criteria 2003 and 2012 were analyzed by McNemar’s test and the agreement by kappa coefficient. Main outcome measure Prevalence and factors associated with PIMs use in Brazilian elderly outpatients. Results One thousand elderly patients were interviewed. High prevalence of PIMs use was observed, 48.0 and 59.2 % according to Beers criteria 2003 and 2012, respectively. The factors associated with PIMs use, common for both criteria, are female gender, self-medication, use of over the counter drugs, complaints related to adverse drug event, psychotropic medication, polypharmacy and some categories of drugs. PIMs use is different between Beers criteria 2003 and 2012 (McNemar’s test, p < 0.01), although a substantial agreement between these classifications was observed (kappa coefficient 0.635, 95% confidence intervals (0.588, 0.681). Conclusions Our study showed a high prevalence of PIMs use, which is associated with various clinical and social–demographic factors. When comparing both criteria through McNemar’s test, PIMs use was considered different. The differences may have occurred because medications with high prevalence of use in Brazil were included in Beers criteria 2012 .


Beers criteria Brazil Elderly Pharmacoepidemiology Potentially inappropriate medications 



The authors would like to thank School of Pharmaceutical Sciences of Ribeirão Preto—University of São Paulo for its support during the research.


The study was supported by Coordenação de Aperfeicoamento de Pessoal de Nível Superior (CAPES).

Conflicts of interest



  1. 1.
    WHO (World Health Organization). The uses of Epidemiology in the study of the elderly. Geneva: WHO; 1984. (technical report series, 706).Google Scholar
  2. 2.
    Instituto Brasileiro de Geografia e Estatística. Séries estatísticas & séries históricas. O Instituto. [Statistics and Historical Series. The Institute.] Rio de Janeiro. (2010). Accessed 16 July 2012.
  3. 3.
    Instituto Brasileiro de Geografia e Estatística. Sala de Imprensa: Tábuas Completas de Mortalidade 2008. [Press room: Complete Mortality tables 2008]. (2009). Accessed 21 Nov 2012.
  4. 4.
    Gallagher P, Barry P, O’mahony D. Inappropriate prescribing in the elderly. J Clin Pharm Ther. 2007;32:113–21.PubMedCrossRefGoogle Scholar
  5. 5.
    Castro Filho JM, Marcopito LF, Castelo A. Perfil de utilização de medicamentos por idosos em área urbana do Nordeste do Brasil. [Medication use patterns among elderly people in urban area in Northeastern Brazil]. Rev Saúde Públ. 2004;38:557–64.CrossRefGoogle Scholar
  6. 6.
    Coelho Filho AIL, Uchoa E, Costa MFL. Estudo epidemiológico de base populacional sobre uso de medicamentos entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil. [A population-based study on use of medication by the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil]. Cad Saude Publica. 2006;22:2657–67.CrossRefGoogle Scholar
  7. 7.
    Mosegui GB, Rozenfeld S, Veras RP, Vianna CM. Avaliação da qualidade do uso de medicamentos em idosos [Quality assessment of drug use in the elderly]. Rev Saúde Públ. 1999;33:437–44.CrossRefGoogle Scholar
  8. 8.
    Loyola Filho AI, Uchoa E, Firmo Jde O, Lima-Costa MF. Estudo de base populacional sobre o consumo de medicamentos entre idosos: Projeto Bambuí. [A population-based study on use of medications by elderly Brazilians: the Bambuí Health and Aging Study]. Cad Saude Publica. 2005;21:545–53.PubMedCrossRefGoogle Scholar
  9. 9.
    Lemos M, Souza NR, Mendes MMR. Perfil da população idosa cadastrada em uma Unidade de Saúde da Família. [Profile of elderly people enrolled in a family health unit]. Reme Rev Min de Enferm. 2006;10:218–25.Google Scholar
  10. 10.
    Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults. Arch Intern Med. 2003;163:2716–24.PubMedCrossRefGoogle Scholar
  11. 11.
    Beers MH, Ouslander JG, Rollingher I, et al. Explicit criteria for determining inappropriate medication use in nursing homes residents. Arch Intern Med. 1991;151:1825–32.PubMedCrossRefGoogle Scholar
  12. 12.
    Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med. 1997;157:1531–6.PubMedCrossRefGoogle Scholar
  13. 13.
    The American Geriatrics Society. Beers criteria update expert panel. AGS updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;2012(60):616–31.CrossRefGoogle Scholar
  14. 14.
    World Health Organization Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2012. Oslo: Norwegian Institute of Public Health. Available from (2009). Accessed in 04 April 2013.
  15. 15.
    Brasil. RDC no 138, de 29 de maio de 2003. Dispõe sobre o enquadramento de medicamentos categoria de venda livre. [Regulates the framework of the over-the-counter medications category]. Diário Oficial da União, Brasília, DF, 29 maio 2003.Google Scholar
  16. 16.
    Brasil. Portaria no 344, de12 de maio 1998. Dispõe sobre os medicamentos de Controle Especial. [Regulates special control medications] Diário Oficial da União, Brasília, DF, 12 de maio de 1998.Google Scholar
  17. 17.
    Varallo FR, Capucho HC, Planeta CS, Mastroianni PC. Safety assessment of potentially inappropriate medications (pim) use in older people and the factors associated with hospital admission. J Pharm Pharm Sci. 2011;14:283–90.PubMedGoogle Scholar
  18. 18.
    Allison PD. Logistic regression using the SAS system: theory and application. Cary: SAS Books; 2001.Google Scholar
  19. 19.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.PubMedCrossRefGoogle Scholar
  20. 20.
    Brasil, More Health: a right for everyone: 2008 – 2011. Ministério da Saúde, Secretaria-Executiva. – 3. ed. rev. – Brasília : Ministério da Saúde, 2010.138 p. : il. – (Série C. Projetos, Programas e Relatórios) ISBN 978-85-334-1635-2.Google Scholar
  21. 21.
    Seade, Fundação Sistema Estadual de Análise de Dados. Região Administrativa de Ribeirão Preto. (Accessed 21 Nov 2012).
  22. 22.
    Fadare JO, Agboola SM, Opeke OA, Alabi RA. Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital. Ther Clin Risk Manag. 2013;6:115–20.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    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.PubMedCrossRefGoogle Scholar
  24. 24.
    Opondo D, Eslami S, Visscher S. Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review. PLoS ONE. 2012;7:e43617.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Goltz L, Kullak-Ublick GA, Kirch W. Potentially inappropriate prescribing for elderly outpatients in Germany: a retrospective claims data analysis. Int J Clin Pharmacol Ther. 2012;50:185–94.PubMedCrossRefGoogle Scholar
  26. 26.
    Ghadimi H, Esmaily HM, Wahlstrom R. General practitioners’ prescribing patterns for the elderly in a province of Iran. Pharmacoepidemiol Drug Saf. 2011;20:482–7.PubMedCrossRefGoogle Scholar
  27. 27.
    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;42:95–8.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Nishtala PS, Bagge ML, Campbell AJ, Tordoff JM. Potentially inappropriate medicines in a cohort of community-dwelling older people in New Zealand. Geriatr Gerontol Int. 26 Mar 2013. doi: 10.1111/ggi.12059. (Epub ahead of print).
  29. 29.
    de Oliveira MA, Francisco PM, Costa KS, Barros MB. Self-medication in the elderly population of Campinas, São Paulo State, Brazil: prevalence and associated factors. Cad Saude Publica. 2012;28:335–45.PubMedCrossRefGoogle Scholar
  30. 30.
    Amoako EP, Richardson-Campbell L, Kennedy-Malone L. Self-medication with over-the-counter drugs among elderly adults. J Gerontol Nurs. 2003;29:10–5.PubMedGoogle Scholar
  31. 31.
    Onder G, Landi F, Della Vedova C, et al. Moderate alcohol consumption and adverse drug reactions among older adults. Pharmacoepidemiol Drug Saf. 2002;11:385–92.PubMedCrossRefGoogle Scholar
  32. 32.
    van der Hooft CS, Dieleman JP, Siemes C, Aarnoudse AJ, Verhamme KM, Stricker BH, et al. Adverse drug reaction-related hospitalisations: a population-based cohort study. Pharmacoepidemiol Drug Saf. 2008;17:365–71.PubMedCrossRefGoogle Scholar
  33. 33.
    Stockl KM, Le L, Zhang S, Harada AS. Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly. Am J Manag Care. 2010;16:1–10.Google Scholar
  34. 34.
    Micromedex Healthcare Series. (2012). Accessed 29 Nov 2012.
  35. 35.
    Bierman AS, Pugh MJ, Dhalla I, Amuan M, Fincke BG, Rosen A, et al. Sex differences in inappropriate prescribing among elderly veterans. Am J Geriatr Pharmacother. 2007;5:147–61.PubMedCrossRefGoogle Scholar
  36. 36.
    Faustino CG, Passarelli MC, Jacob-Filho W. Potentially inappropriate medications among elderly Brazilian outpatients. Sao Paulo Med J. 2013;131:19–26.PubMedGoogle Scholar
  37. 37.
    Hofer-Dückelmann C. Gender and polypharmacotherapy in the elderly: a clinical challenge. Handb Exp Pharmacol. 2012;214:169–82.PubMedCrossRefGoogle Scholar
  38. 38.
    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;37:96–101.PubMedCrossRefGoogle Scholar
  39. 39.
    Johnell K, Fastbom J. Multi-dose drug dispensing and inappropriate drug use: a nationwide register-based study of over 700,000 elderly. Scand J Prim Health Care. 2008;26:86–91.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Prudent M, Dramé M, Jolly D, Trenque T, Parjoie R, Mahmoudi R, et al. Potentially inappropriate use of psychotropic medications in hospitalized elderly patients in France: cross-sectional analysis of the prospective, multicentre SAFEs cohort. Drugs Aging. 2008;25:933–46.PubMedCrossRefGoogle Scholar
  41. 41.
    Castelino RL, Bajorek BV, Chen TF. Targeting suboptimal prescribing in the elderly: a review of the impact of pharmacy services. Ann Pharmacother. 2009;43:1096–106.PubMedCrossRefGoogle Scholar
  42. 42.
    Smith DH, Perrin N, Feldstein A, Yang X, Kuang D, Simon SR, et al. The impact of prescribing safety alerts for elderly persons in an electronic medical record: an interrupted time series evaluation. Arch Intern Med. 2006;166:1098–104.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • André de Oliveira Baldoni
    • 1
    Email author
  • Lorena Rocha Ayres
    • 1
  • Edson Zangiacomi Martinez
    • 2
  • Nathalie de Lourdes Souza Dewulf
    • 3
  • Vânia dos Santos
    • 4
  • Leonardo Régis Leira Pereira
    • 1
  1. 1.Pharmaceutical Services and Clinical Pharmacy Research Center (CPAFF), Department of Pharmaceutical Sciences, School of Pharmaceutical Science of Ribeirão PretoUniversity of São Paulo (FCFRP-USP)Ribeirão PretoBrazil
  2. 2.Department of Social Medicine, School of Medicine of Ribeirão PretoUniversity of São Paulo (FMRP-USP)Ribeirão PretoBrazil
  3. 3.School of PharmacyFederal University of Goiás (UFG)GoiâniaBrazil
  4. 4.Department of Clinical Analysis, Toxicology and Bromatology, School of Pharmaceutical Science of Ribeirão PretoUniversity of São Paulo (FCFRP-USP)Ribeirão PretoBrazil

Personalised recommendations