International Journal of Clinical Pharmacy

, Volume 36, Issue 3, pp 570–580 | Cite as

Potentially inappropriate medication related to weakness in older acute medical patients

  • Line Due JensenEmail author
  • Ove Andersen
  • Marianne Hallin
  • Janne Petersen
Research Article


Background The use of potentially inappropriate medications (PIMs) is common in the older population. Inappropriate medications as well as polypharmacy expose older people to a greater risk of adverse drug reactions and may result in hospitalizations. Objective To evaluate the prevalence of PIMs among acutely hospitalized patients aged ≥65 years in an acute medical unit, and to investigate the relationship between use of PIMs and weakness. Setting This longitudinal observational study was undertaken in the Acute Medical Unit, Hvidovre Hospital, University of Copenhagen, Denmark. Method Patients aged ≥65 years admitted to the acute medical unit during the period October to December 2011 were included. Patients were interviewed at admission and at a follow-up visit 30 days after discharge. Data included information about medications, social status, functional status, cognitive status, handgrip strength, health-related quality of life, visual acuity, days of hospitalization, and comorbidities, and was prospectively collected. Polypharmacy was defined as regular use of 5 or more drugs. The Charlson Comorbidity Index was used to categorize comorbidities. Main outcome measure The prevalence of PIMs and the association with PIMs and functional status handgrip strength, HRQOL, comorbidities, social demographic data and vision. Results Seventy-one patients (55 % men) with a median age of 78.7 years participated. The median number of medications was eight per person. Eighty percent were exposed to polypharmacy. PIMs were used by 85 % of patients, and PIMs were associated with low functional status (p = 0.032), low handgrip strength (p = 0.006), and reduced health-related quality of life (p = 0.005), but not comorbidities (p = 0.63), age (p = 0.60), sex (p = 0.53), education (p = 0.94), cognition (p = 0.10), pain (p = 0.46), or visual acuity (p = 0.55). Conclusions Use of PIMs was very common among older people admitted to an acute medical unit. The use of PIMs is associated with low functional status, low handgrip strength, and reduced health-related quality of life.


Comorbidity Denmark Functional Hand strength Older adults Potential inappropriate medications (PIMs) Polypharmacy Quality of life 




Conflicts of interest



  1. 1.
    Schaefer K, Maerkedahl H, Birk HO, Henriksen LO. Polypharmacy in general practice. Dan Medl Bull. 2010;57:1–5.Google Scholar
  2. 2.
    Hanlon JT, Schmader KE, Ruby CM, Weinberger M. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc. 2001;49:200–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Turnheim K. Drug therapy in the elderly. Exp Gerontol. 2004;39:1731–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57:6–14.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA division of geriatric medicine. Arch Intern Med. 1991;151:1825–32.PubMedCrossRefGoogle Scholar
  6. 6.
    Laroche M-L, Charmes J-P, Nouaille Y, Fourrier A, Merle L. Impact of hospitalisation in an acute medical geriatric unit on potentially inappropriate medication use. Drugs Aging. 2006;23:49–59.PubMedCrossRefGoogle Scholar
  7. 7.
    Klarin I, Wimo A, Fastbom J. The association of inappropriate drug use with hospitalisation and mortality: a population-based study of the very old. Drugs Aging. 2005;22:69–82.PubMedCrossRefGoogle Scholar
  8. 8.
    Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163:2716–24.PubMedCrossRefGoogle Scholar
  9. 9.
    Opondo D, Eslami S, Visscher S, de Rooij SE, Verheij R, Korevaar JC, et al. Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review. PLoS ONE. 2012;7:e43617.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Aparasu RR, Mort JR. Inappropriate prescribing for the elderly: beers criteria-based review. Ann Pharmacother. 2000;34:338–46.PubMedCrossRefGoogle Scholar
  11. 11.
    Jano E, Aparasu RR. Healthcare outcomes associated with beers’ criteria: a systematic review. Ann Pharmacother. 2007;41:438–47.PubMedCrossRefGoogle Scholar
  12. 12.
    Glintborg D. Drugs for which indication should be reconsidered in older persons [in Danish]. Institute of Rational Pharmacotherapy, Copenhagen. 2011 [cited 2014 Apr 1]; Available from:
  13. 13.
    Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med. 1997;157:1531.PubMedCrossRefGoogle Scholar
  14. 14.
    Swedish National Board of Health and Welfare (Socialstyrelsen). Indicators for evaluation of the quality of drug use in the elderly [in Swedish]. Sweden; 2003. Available from:
  15. 15.
    Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (screening tool of older person’s prescriptions) and START (screening tool to alert doctors to right treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46:72–83.PubMedCrossRefGoogle Scholar
  16. 16.
    Rognstad S, Brekke M, Fetveit A, Spigset O, Wyller TB, Straand J. The Norwegian general practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients: a modified Delphi study. Scand J Prim Health Care. 2009;27:153–9.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Bonnichsen B, Glintborg D. Survey of drug-related problems in the elderly +65 year old users of antipsychotics in nursing homes and in home care in Allerød, Hillerød and Slangerup municipality. [in Danish]. 2006 Dec.Google Scholar
  18. 18.
    Lau DT, Kasper JD, Potter DEB, Lyles A. Potentially inappropriate medication prescriptions among elderly nursing home residents: their scope and associated resident and facility characteristics. Health Serv Res. 2004;39:1257–76.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Ay P, Akici A, Harmanc H. Drug utilization and potentially inappropriate drug use in elderly residents of a community in Istanbul, Turkey. Int J Clin Pharmacol Ther. 2005;43:195–202.PubMedCrossRefGoogle Scholar
  20. 20.
    Rajska-Neumann A, Wieczorowska-Tobis K. Polypharmacy and potential inappropriateness of pharmaco-logical treatment among community-dwelling elderly patients. Arch Gerontol Geriatr. 2007;44(Suppl 1):303–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Pitkala KH, Strandberg TE, Tilvis RS. Inappropriate drug prescribing in home-dwelling, elderly patients: a population-based survey. Arch Intern Med. 2002;162:1707–12.PubMedCrossRefGoogle Scholar
  22. 22.
    Van Der Hooft CS, Jong GW, Dieleman JP, Verhamme KMC, Van Der Cammen TJM, Stricker BHC, et al. Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria—a population-based cohort study. Br J Clin Pharmacol. 2005;60:137–44.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    De Wilde S, Carey IM, Harris T, Richards N, Victor C, Hilton SR, et al. Trends in potentially inappropriate prescribing amongst older UK primary care patients. Pharmacoepidemiol Drug Saf. 2007;16:658–67.PubMedCrossRefGoogle Scholar
  24. 24.
    de O Martins S, Soares MA, van Mil JWF, Cabrita J. Inappropriate drug use by Portuguese elderly outpatients—effect of the Beers criteria update. Pharm World Sci. 2006;28:296–301.CrossRefGoogle Scholar
  25. 25.
    Fialová D, Topinková E, Gambassi G, Finne-Soveri H, Jónsson PV, Carpenter I, et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005;293:1348–58.PubMedCrossRefGoogle Scholar
  26. 26.
    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.PubMedCrossRefGoogle Scholar
  27. 27.
    Corsonello A, Pedone C, Lattanzio F, Lucchetti M, Garasto S, Di Muzio M, et al. Potentially inappropriate medications and functional decline in elderly hospitalized patients. J Am Geriatr Soc. 2009;57:1007–14.PubMedCrossRefGoogle Scholar
  28. 28.
    Gallagher PF, O’Connor MN, O’Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther. 2011;89:845–54.PubMedCrossRefGoogle Scholar
  29. 29.
    Landi F, Russo A, Liperoti R, Barillaro C, Danese P, Pahor M, et al. Impact of inappropriate drug use on physical performance among a frail elderly population living in the community. Eur J Clin Pharmacol. 2007;63:791–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Hanlon JT, Fillenbaum GG, Kuchibhatla M, Artz MB, Boult C, Gross CR, et al. Impact of inappropriate drug use on mortality and functional status in representative community dwelling elders. Med Care. 2002;40:166–76.PubMedCrossRefGoogle Scholar
  31. 31.
    Pugh MJV, Palmer RF, Parchman ML, Mortensen E, Markides K, Espino DV. Association of suboptimal prescribing and change in lower extremity physical function over time. Gerontology. 2007;53:445–53.PubMedCrossRefGoogle Scholar
  32. 32.
    Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145:247–54.PubMedCrossRefGoogle Scholar
  33. 33.
    Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.PubMedCrossRefGoogle Scholar
  34. 34.
    Anthony JC, LeResche L, Niaz U, von Korff MR, Folstein MF. Limits of the “Mini-Mental State” as a screening test for dementia and delirium among hospital patients. Psychol Med. 1982;12:397–408.PubMedCrossRefGoogle Scholar
  35. 35.
    WHO. List of Official ICD-10 2006 Updates. WHO. 2006 [cited 2014 Apr 1]. Available from:
  36. 36.
    Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol. 2012;96:614–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993;75:797–8.PubMedGoogle Scholar
  38. 38.
    Wang C-Y, Chen L-Y. Grip strength in older adults: test-retest reliability and cutoff for subjective weakness of using the hands in heavy tasks. Arch Phys Med Rehabil. 2010;91:1747–51.PubMedCrossRefGoogle Scholar
  39. 39.
    Rabin R, Charro F. EQ-SD: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–43.PubMedCrossRefGoogle Scholar
  40. 40.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.PubMedCrossRefGoogle Scholar
  41. 41.
    Foss S, Schmidt JR, Andersen T, Rasmussen JJ, Damsgaard J, Schaefer K, et al. Congruence on medication between patients and physicians involved in patient course. Eur J Clin Pharmacol. 2004;59:841–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Andersen SE, Pedersen AB, Bach KF. Medication history on internal medicine wards: assessment of extra information collected from second drug interviews and GP lists. Pharmacoepidemiol Drug Saf. 2003;12:491–8.PubMedCrossRefGoogle Scholar
  43. 43.
    WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment. Norwegian Institute of Public Health; 2011. Report No.: 14th edition.Google Scholar
  44. 44.
    Yong TY, Lau SY, Li JY, Hakendorf P, Thompson CH. Medication prescription among elderly patients admitted through an acute assessment unit. Geriatr Gerontol Int. 2012;12:93–101.PubMedCrossRefGoogle Scholar
  45. 45.
    Veehof L, Stewart R, Haaijer-Ruskamp F, Jong BM. The development of polypharmacy. A longitudinal study. Fam Pract. 2000;17:261–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivelä S-L, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol. 2002;55:809–17.PubMedCrossRefGoogle Scholar
  47. 47.
    Gallagher P, Lang P, Cherubini A, Topinková E, Cruz-Jentoft A, Montero Errasquín B, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol. 2011;67:1175–88.PubMedCrossRefGoogle Scholar
  48. 48.
    Page RL 2nd, Ruscin JM. The risk of adverse drug events and hospital-related morbidity and mortality among older adults with potentially inappropriate medication use. Am J Geriatr Pharmacother. 2006;4:297–305.PubMedCrossRefGoogle Scholar
  49. 49.
    Viktil KK, Blix HS, Moger TA, Reikvam A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol. 2007;63:187–95.PubMedCentralPubMedCrossRefGoogle Scholar
  50. 50.
    Gnjidic D, Couteur DGL, Abernethy DR, Hilmer SN. Drug burden index and beers criteria: impact on functional outcomes in older people living in self-care retirement villages. J Clin Pharmacol. 2012;52:258–65.CrossRefGoogle Scholar
  51. 51.
    Bohannon RW. Hand-grip dynamometry predicts future outcomes in aging adults. J Geriatr Phys Ther. 2008;31:3–10.PubMedCrossRefGoogle Scholar
  52. 52.
    Neuberg GW, Miller AB, O’Connor CM, Belkin RN, Carson PE, Cropp AB, et al. Diuretic resistance predicts mortality in patients with advanced heart failure. Am Heart J. 2002;144:31–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Peron EP, Gray SL, Hanlon JT. Medication use and functional status decline in older adults: a narrative review. Am J Geriatr Pharmacother. 2011;9:378–91.PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Fried TR, Bradley EH, Williams CS, Tinetti ME. Functional disability and health care expenditures for older persons. Arch Intern Med. 2001;161:2602–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Guralnik JM, Fried LP, Salive ME. Disability as a public health outcome in the aging population. Annu Rev Public Health. 1996;17:25–46.PubMedCrossRefGoogle Scholar
  56. 56.
    Fu AZ, Liu GG, Christensen DB. Inappropriate medication use and health outcomes in the elderly. J Am Geriatr Soc. 2004;52:1934–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Olson DP, Windish DM. Communication discrepancies between physicians and hospitalized patients. Arch Intern Med. 2010;170:1302–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Karkov LL, Schytte-Hansen S, Haugbølle LS. Discrepancies between sources providing the medication histories of acutely hospitalised patients. Pharm World Sci. 2010;32:449–54.PubMedCrossRefGoogle Scholar
  59. 59.
    Bodilsen AC, Pedersen MM, Petersen J, Beyer N, Andersen O, Smith LL, et al. Acute hospitalization of the older patient: changes in muscle strength and functional performance during hospitalization and 30 days after discharge. Am J Phys Med Rehabil. 2013;92:789–96.PubMedCrossRefGoogle Scholar
  60. 60.
    Fick DM, Semla TP. 2012 American geriatrics society beers criteria: New Year, new criteria, new perspective. J Am Geriatr Soc. 2012;60:614–5.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Line Due Jensen
    • 1
    Email author
  • Ove Andersen
    • 1
  • Marianne Hallin
    • 1
  • Janne Petersen
    • 1
  1. 1.Optimed, Clinical Research Centre, Hvidovre HospitalUniversity of CopenhagenHvidovreDenmark

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