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Potentially inappropriate medications in community-dwelling older adults undertaken as a comprehensive geriatric risk assessment

European Journal of Clinical Pharmacology volume 74, pages 645–653 (2018)Cite this article

Abstract

Purpose

The prescription of potentially inappropriate medications (PIMs) is associated with an increase in adverse events, prescribing cascades, high health-care costs, morbidity, and mortality in the elderly. The overarching objective of this study is to examine the prevalence of PIMs in the elderly, applying the 2012 American Geriatrics Society Beers criteria for the study period 2012–2014, and the updated 2015 Beers criteria for 2015.

Methods

The study population (N = 70,479) included a continuously recruited national cohort of community-dwelling older (aged ≥ 65 years) New Zealanders who had undertaken the International Resident Assessment Instrument-Home Care (interRAI-HC) assessments between September 2012 and October 2015. Exposure of PIMs 90 days before and after assessment, and 90–180 days after assessment are reported.

Results

Exposure to PIMs was highest in individuals aged over 95 years and in males. The average number of PIMs prescribed 90 days before assessment during the period 2015 was marginally higher compared to 2012–2014 (0.19 versus 0.04), and a greater number of individuals were exposed to one or more PIMs in 2015 compared to 2012–2014 (7.13 versus 2.17%). The prevalence of PIMs 90 days before and after assessment was 2.17 and 6.92% for 2012–2014, and 7.13 and 24.7% for 2015, respectively. The percent change in PIMs in 2012–2014 and 2015 after 90 days of assessment were 4.70% (confidence interval (CI) 4.50%, 5.00%, p < 0.001) and 17.60% (95% CI 16.80%, 18.30%, p < 0.001), respectively. The majority of PIMs prescribed belonged to the therapeutic class of medications acting on the central nervous system and the gastrointestinal system.

Conclusion

Geriatric risk assessments may provide a vital opportunity to review medication lists by multidisciplinary teams with a view to reducing PIMs and unnecessary polypharmacy in older adults. Comprehensive geriatric risk assessment has the potential to reduce adverse medication outcomes and costs associated with inappropriate prescribing in a vulnerable population of older adults.

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References

  1. Shenoy P, Harugeri A (2015) Elderly patients’ participation in clinical trials. Perspect Clin Res 6(4):184–189. https://doi.org/10.4103/2229-3485.167099

    Article  PubMed  PubMed Central  Google Scholar 

  2. Anathhanam S, Powis RA, Cracknell AL, Robson J (2012) Impact of prescribed medications on patient safety in older people. Ther Adv Drug Saf 3(4):165–174. https://doi.org/10.1177/2042098612443848

    Article  PubMed  PubMed Central  Google Scholar 

  3. Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, Hanlon JT (2007) Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 370(9582):173–184. https://doi.org/10.1016/S0140-6736(07)61091-5

    Article  PubMed  Google Scholar 

  4. Page RL, Linnebur SA, Bryant LL, Ruscin JM (2010) Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions. Clin Interv Aging 5:75–87

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. Sehgal V, Bajwa SJS, Sehgal R, Bajaj A, Khaira U, Kresse V (2013) Polypharmacy and potentially inappropriate medication use as the precipitating factor in readmissions to the hospital. J Family Med Prim Care 2(2):194–199. https://doi.org/10.4103/2249-4863.117423

    Article  PubMed  PubMed Central  Google Scholar 

  6. Momin TG, Pandya RN, Rana DA, Patel VJ (2013) Use of potentially inappropriate medications in hospitalized elderly at a teaching hospital: a comparison between Beers 2003 and 2012 criteria. Indian J Pharmacol 45(6):603–607. https://doi.org/10.4103/0253-7613.121372

    Article  PubMed  PubMed Central  Google Scholar 

  7. American Geriatrics Society 2015 Beers Criteria Update Expert Panel (2015) American Geriatrics Society 2015 Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 63(11):2227–2246. https://doi.org/10.1111/jgs.13702

    Article  Google Scholar 

  8. Zeenny R, Wakim S, Kuyumjian Y-M (2017) Potentially inappropriate medications use in community-based aged patients: a cross-sectional study using 2012 Beers criteria. Clin Interv Aging 12:65–73. https://doi.org/10.2147/CIA.S87564

    Article  PubMed  PubMed Central  Google Scholar 

  9. Workgroup AGSCW (2013) American Geriatrics Society identifies five things that healthcare providers and patients should question. J Am Geriatr Soc 61(4):622–631. https://doi.org/10.1111/jgs.12226

    Article  Google Scholar 

  10. Lim Y-J, Kim H-Y, Choi J, Lee JS, Ahn A-L, E-J O, Cho D-Y, Kweon H-J (2016) Potentially inappropriate medications by Beers criteria in older outpatients: prevalence and risk factors. Korean J Family Med 37(6):329–333. https://doi.org/10.4082/kjfm.2016.37.6.329

    Article  Google Scholar 

  11. Chang C-B, Yang S-Y, Lai H-Y, R-S W, Liu H-C, Hsu H-Y, Hwang S-J, Chan D-C (2015) Application of three different sets of explicit criteria for assessing inappropriate prescribing in older patients: a nationwide prevalence study of ambulatory care visits in Taiwan. BMJ Open 5(11):e008214. https://doi.org/10.1136/bmjopen-2015-008214

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen MLG, Extermann M, Falandry C, Artz A, Brain E, Colloca G, Flamaing J, Karnakis T, Kenis C, Audisio RA, Mohile S, Repetto L, Leeuwen BV, Milisen K, Hurria A (2014) International Society of Geriatric Oncology Consensus on geriatric assessment in older patients with cancer. J Clin Oncol 32(24):2595–2603. https://doi.org/10.1200/jco.2013.54.8347

    Article  PubMed  PubMed Central  Google Scholar 

  13. Schluter PJ, Ahuriri-Driscoll A, Anderson TJ, Beere P, Brown J, Dalrymple-Alford J, David T, Davidson A, Gillon DA, Hirdes J, Keeling S, Kingham S, Lacey C, Menclova AK, Millar N, Mor V, Jamieson HA (2016) Comprehensive clinical assessment of home-based older persons within New Zealand: an epidemiological profile of a national cross-section. Aust N Z J Public Health 40(4):349–355. https://doi.org/10.1111/1753-6405.12525

    Article  PubMed  Google Scholar 

  14. Schluter PJ, Lacey C, Porter RJ, Jamieson HA (2017) An epidemiological profile of bipolar disorder among older adults with complex needs: a national cross-sectional study. Bipolar Disord 19(5):375–385. https://doi.org/10.1111/bdi.12511

    Article  PubMed  Google Scholar 

  15. Nishtala PS, Jamieson HA (2017) New Zealand’s interRAI: a resource for examining health outcomes in geriatric pharmacoepidemiology. J Am Geriatr Soc 65(4):876–877. https://doi.org/10.1111/jgs.14778

    Article  PubMed  Google Scholar 

  16. Nishtala PS, Salahudeen MS (2015) Temporal trends in polypharmacy and hyperpolypharmacy in older New Zealanders over a 9-year period: 2005-2013. Gerontology 61(3):195–202. https://doi.org/10.1159/000368191

    Article  PubMed  Google Scholar 

  17. Pharmaceutical Claims Data Mart data dictionary. http://www.health.govt.nz/publication/pharmaceutical-claims-data-mart-data-dictionary

  18. Morris JN, Fries BE, Mehr DR, Hawes C, Phillips C, Mor V, Lipsitz LA (1994) MDS Cognitive Performance Scale. J Gerontol 49(4):M174–M182. https://doi.org/10.1093/geronj/49.4.M174

    CAS  Article  PubMed  Google Scholar 

  19. Campanelli CM (2012) American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults: the American Geriatrics Society 2012 Beers Criteria Update Expert Panel. J Am Geriatr Soc 60(4):616–631. https://doi.org/10.1111/j.1532-5415.2012.03923.x

    Article  PubMed Central  Google Scholar 

  20. von Elm EAD, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008

    Article  Google Scholar 

  21. Wilson EB (1927) Probable inference, the law of succession, and statistical inference. J Am Stat Assoc 22(158):209–212. https://doi.org/10.1080/01621459.1927.10502953

    Article  Google Scholar 

  22. Gillian Smeith KD Ethnic population projections: issues and trends—article. Demography Division of Statistics New Zealand http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/ethnic-pop-projections-issues-and-trends.aspx

  23. Health NZsMo Our changing population. http://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/older-peoples-health-data-and-stats/our-changing-population

  24. J CJaD Impact of population ageing in new zealand on the demand for health and disability support services, and workforce implications.

  25. Narayan SW, Nishtala PS (2015) Associations of potentially inappropriate medicine use with fall-related hospitalisations and primary care visits in older New Zealanders: a population-level study using the updated 2012 Beers criteria. Drugs Real World Outcomes 2(2):137–141. https://doi.org/10.1007/s40801-015-0020-y

    Article  PubMed  PubMed Central  Google Scholar 

  26. Nishtala PS, Bagge ML, Campbell AJ, Tordoff JM (2014) Potentially inappropriate medicines in a cohort of community-dwelling older people in New Zealand. Geriatr Gerontol Int 14(1):89–93. https://doi.org/10.1111/ggi.12059

    Article  PubMed  Google Scholar 

  27. Narayan SW, Nishtala PS (2015) Prevalence of potentially inappropriate medicine use in older New Zealanders: a population-level study using the updated 2012 Beers criteria. J Eval Clin Pract 21(4):633–641. https://doi.org/10.1111/jep.12355

    Article  PubMed  Google Scholar 

  28. Fick D, Kolanowski A, Waller J (2007) High prevalence of central nervous system medications in community-dwelling older adults with dementia over a three-year period. Aging Ment Health 11(5):588–595. https://doi.org/10.1080/13607860601086629

    CAS  Article  PubMed  Google Scholar 

  29. Chitty KM, Evans E, Torr JJ, Iacono T, Brodaty H, Sachdev P, Trollor JN (2015) Central nervous system medication use in older adults with intellectual disability: results from the successful ageing in intellectual disability study. Aust N Z J Psychiatry 50(4):352–362. https://doi.org/10.1177/0004867415587951

    Article  PubMed  Google Scholar 

  30. San-José A, Agustí A, Vidal X, Formiga F, Gómez-Hernández M, García J, López-Soto A, Ramírez-Duque N, Torres OH, Barbé J (2015) Inappropriate prescribing to the oldest old patients admitted to hospital: prevalence, most frequently used medicines, and associated factors. BMC Geriatr 15(1):42. https://doi.org/10.1186/s12877-015-0038-8

    Article  PubMed  PubMed Central  Google Scholar 

  31. Scott Metcalfe GL, Arnold J (2013) Variation in the use of medicines by ethnicity during 2006/07 in New Zealand: a preliminary analysis. N Z Med J 126(1384)

  32. Aspinall SL, Zhao X, Semla TP, Cunningham FE, Paquin AM, Pugh MJ, Schmader KE, Stone RA, Hanlon JT, for the VACLCPRG (2015) Epidemiology of drug-disease interactions in older veteran nursing home residents. J Am Geriatr Soc 63(1):77–84. https://doi.org/10.1111/jgs.13197

    Article  PubMed  Google Scholar 

  33. Campbell AJ, Diep C, Reinken J, McCosh L (1985) Factors predicting mortality in a total population sample of the elderly. J Epidemiol Community Health 39(4):337–342. https://doi.org/10.1136/jech.39.4.337

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. Morris V, Wagg A (2007) Lower urinary tract symptoms, incontinence and falls in elderly people: time for an intervention study. Int J Clin Pract 61(2):320–323. https://doi.org/10.1111/j.1742-1241.2006.01174.x

    CAS  Article  PubMed  Google Scholar 

  35. Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP (2013) The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer’s Dement 9(1):63–75.e62. https://doi.org/10.1016/j.jalz.2012.11.007

    Article  Google Scholar 

  36. Peppas G, Alexiou VG, Mourtzoukou E, Falagas ME (2008) Epidemiology of constipation in Europe and Oceania: a systematic review. BMC Gastroenterol 8(1):5. https://doi.org/10.1186/1471-230x-8-5

    Article  PubMed  PubMed Central  Google Scholar 

  37. Miller GE, Sarpong EM, Davidoff AJ, Yang EY, Brandt NJ, Fick DM (2017) Determinants of potentially inappropriate medication use among community-dwelling older adults. Health Serv Res 52(4):1534–1549. https://doi.org/10.1111/1475-6773.12562

    Article  PubMed  Google Scholar 

  38. Novaes PH, da Cruz DT, Lucchetti ALG, Leite ICG, Lucchetti G (2017) The “iatrogenic triad”: polypharmacy, drug-drug interactions, and potentially inappropriate medications in older adults. Int J Clin Pharm 39(4):818–825. https://doi.org/10.1007/s11096-017-0470-2

    CAS  Article  PubMed  Google Scholar 

  39. Novaes PH, da Cruz DT, Lucchetti ALG, Leite ICG, Lucchetti G (2017) Comparison of four criteria for potentially inappropriate medications in Brazilian community-dwelling older adults. Geriatr Gerontol Int. https://doi.org/10.1111/ggi.12944

  40. López-Sáez A, Sáez-López P, Paniagua-Tejo S, Tapia-Galán MA (2012) Prescripción inadecuada de medicamentos en ancianos hospitalizados según criterios de Beers. Farm Hosp 36(4):268–274. https://doi.org/10.1016/j.farma.2011.05.003

    Article  PubMed  Google Scholar 

  41. Clyne B, Cooper JA, Hughes CM, Fahey T, Smith SM, on behalf of the O-Sst (2016) ‘Potentially inappropriate or specifically appropriate?’ Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people. BMC Fam Pract 17(1):109. https://doi.org/10.1186/s12875-016-0507-y

    Article  PubMed  PubMed Central  Google Scholar 

  42. A practical guide to stopping medicines in older people. Best Pract J. http://www.bpac.org.nz/BPJ/2010/April/stopguide.aspx

  43. Monica Gupta MA (2013) Understanding medication errors in the elderly The New Zealand Medical Journal 126 (1385)

  44. Hulisz D Updated Beers criteria: a more comprehensive guide to medication safety in older adults. American Pharmacists Association

  45. Donna M. Fick TPS 2015 The 2015 u\pdated AGS Beers criteria: what’s new. HealthinAging.org. http://www.healthinaging.org/blog/the-2015-updated-ags-beers-criteria-whats-new/

  46. interRAI. http://www.interrai.org/

  47. Hirdes JP, Poss JW, Caldarelli H, Fries BE, Morris JN, Teare GF, Reidel K, Jutan N (2013) An evaluation of data quality in Canada’s Continuing Care Reporting System (CCRS): secondary analyses of Ontario data submitted between 1996 and 2011. BMC Med Inform Decision Making 13(1):27–27. https://doi.org/10.1186/1472-6947-13-27

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank the Analytical Services, Ministry of Health of New Zealand, for supplying the prescription data extracted from the interRAI-HC and Pharms database.

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Affiliations

  1. New Zealand’s National School of Pharmacy, University of Otago, Dunedin, New Zealand

    Sharmin S. Bala, Sujita W. Narayan & Prasad S. Nishtala

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  1. Sharmin S. Bala
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  2. Sujita W. Narayan
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  3. Prasad S. Nishtala
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Contributions

Author S.B had full access to all the data in the study, and takes reponsibility for the integrity of the data and the accuracy of data analysis. P. N. designed the study. S. N. and S. B. performed the research. S. N. analyzed the data. P. N. contributed to the new methods or models. S. B. wrote the paper. All authors contributed to the data interpretation, critically commented on the manuscript for intellectual content, and approved the final manuscript.

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Correspondence to Sharmin S. Bala.

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Statement of human rights Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors declare that they have no conflict of interest.

Research involving human participants

For this type of study, formal consent is not required, since complete anonymity is maintained.

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Bala, S.S., Narayan, S.W. & Nishtala, P.S. Potentially inappropriate medications in community-dwelling older adults undertaken as a comprehensive geriatric risk assessment. Eur J Clin Pharmacol 74, 645–653 (2018). https://doi.org/10.1007/s00228-018-2412-x

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Keywords

  • Elderly
  • Inappropriate prescribing
  • New Zealand
  • International Resident Assessment Instrument-Home Care