Potentially inappropriate medications in community-dwelling older adults undertaken as a comprehensive geriatric risk assessment
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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.
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.
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.
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.
KeywordsElderly Inappropriate prescribing New Zealand International Resident Assessment Instrument-Home Care
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.
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.
Compliance with ethical standards
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.
Conflict of interest
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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