Potentially inappropriate medications in Chinese older adults: a comparison of two updated Beers criteria

Examining potentially inappropriate medication use among elderly individuals in palliative care: A comprehensive study

This study aimed to evaluate the prevalence of polypharmacy, the presence of potentially inappropriate medications and related factors in older adults receiving palliative care. This cross-sectional descriptive study was performed in 213 patients who were served from palliative care services. Mini Nutritional Assessment-Short Form, Katz Activities of Daily Living Scale and Charlson Comorbidity Index were applied. Polypharmacy was defined as the use of 5 or more medicines while the use of 10 or more medicines was considered as hyper-polypharmacy. PIM was assessed according to the TIME-to START and TIME-to STOP criteria. A total of 213 patients were included, mean age was 78.00 ± 9.08 years. Polypharmacy was present in 59.2 % of the patients and hyper-polypharmacy was present in 10.8 %. There was a statistically significant correlation between polypharmacy and marital status, history of falls, mid-upper arm, and calf circumference (p = 0.017, p = 0.022, p = 0.010, p = 0.003, respectively). The rate of inappropriate medication use of the cardiovascular system, gastrointestinal system, analgesics, musculoskeletal system, and nervous system drugs was high. There was at least one inappropriate medication use in 56.3 % of older adults. PIMs use was 18.3 % according to TIME-to-START criteria and was 48.4 % according to TIME-to-STOP criteria. There was a higher rate of PIMs use according to TIME criteria in the group with polypharmacy than non-polypharmacy (p < 0.001). The prevalence of polypharmacy and the presence of PIMs is high in older adults receiving palliative care. Polypharmacy could increase the PIMs use. The use of TIME criteria to evaluate palliative care patients may be helpful in reducing inappropriate medication use.

The Role of a Clinical Pharmacist in the Identification of Potentially Inadequate Drugs Prescribed to the Geriatric Population in Low-Resource Settings Using the Beers Criteria: A Pilot Study

Population aging is a global phenomenon. Each country in the world faces an increased number of older persons in the total population. With aging, a high prevalence of multiple chronic diseases occurs, leading to the use of complex therapeutic regimens and often to polypharmacy. Potentially inappropriate medication (PIM) is a medicine prescribed to a patient for whom the risks outweigh the benefits. Today, several tools are used to evaluate the use of pharmacotherapy in older adults, one of them is the 2019 AGS Beers Criteria. In this prospective, pilot study, we aimed to investigate if the number of PIMs in elderly patients would be significantly reduced if a clinical pharmacist performed a pharmacotherapy review. The study included 66 patients over 65 years of age who were hospitalized at the 1200-bed university hospital. The intervention was conducted by a clinical pharmacist who reviewed the patients' pharmacotherapy and provided written suggestions to physicians. The pharmacotherapy was again reviewed at the patients' discharge from the hospital. A total number of 204 PIMs were identified in the pharmacotherapy of the study population. At discharge, the number of PIMs decreased to 67. A total of 67% of the pharmacist's suggestions were accepted by the physicians. The pharmacist's intervention led to significant decrease in the number of PIMs on patients' discharge letters.

A Nonsystematic Review of the Features of Pharmacotherapy in the Elderly at the Stage of Taking Medications

The human body is subservient to the age-related changes that affect not only the outer appearance but also organs and tissues. They also concern the processes of pharmacokinetics and dynamics. This means that the absorption, distribution, and metabolism of drugs used by an elderly patient will be slowed down. Therefore, it becomes necessary to prescribe a special dosing regimen for older people. An actual problem is also that, with age, many patients require more drugs than young people. This increases the risk of side effects because many drugs are difficult to combine with each other. Pharmacy of our time is a science that is constantly developing and modernizing, which allows changing therapy for the better: prescribing drugs in smaller quantities, with a smaller range of adverse reactions and a better effect. The aim of the work is to analyze the impact and relationship of older age on the pharmacotherapy of patients, as well as the risks of drug-induced diseases. To carry out this work, such research methods as analysis, synthesis, comparative analysis, classification, analogy, abstraction, induction, and generalization were used. The features of the stages of pharmacokinetics and pharmacodynamics in the elderly were considered; we studied the data of clinical studies and literature in geriatrics; and the effects of a combination or increase in the dosage of drugs have been noted. After the collection of research data and the analysis, it turned out that it is real and necessary to avoid the negative consequences of pharmacotherapy in elderly and senile patients. Considering the natural age-related changes in the condition and functioning of organs and systems, constantly monitoring the effectiveness of drugs and undesirable reactions of the body to them, adjusting treatment protocols will have a favorable result and help optimize pharmacotherapy for the elderly and reduce the risk of side effects and diseases caused by medications.

Potentially Inappropriate Medications Use and Associated Factors Among Older Patients on Follow-Up at the Chronic Care Clinic of Hiwot Fana Comprehensive Specialized Hospital in Eastern Ethiopia

Background

Potentially inappropriate medications (PIMs) use often cause to poor health outcomes in older patients. There is a dearth of information on PIMS use in this population of patients seeking treatment at Hiwot Fana Comprehensive Specialized Hospital.

Objective

To assess PIMs use and associated factors among older patients receiving follow-up treatment at the chronic care clinic of Hiwot Fana Comprehensive Specialized Hospital in eastern Ethiopia.

Methods

A retrospective cross-sectional study using medical records of 419 older patients was conducted. older patients, aged 65 years or older, treated in the ambulatory care clinic were included. Simple random sampling technique was used. PIMs use was identified by using the 2023 American Geriatrics Society Beers Criteria (AGS Beers Criteria) and Screening Tool of Older People's Potentially Inappropriate Prescriptions Criteria and Screening Tool to Alert Doctors to Right Treatment (STOPP/START) version 2 criteria. The multivariable logistic regression analysis was employed to identify factors associated with PIMs use. The strength of statistical association was measured by adjusted odds ratio (aOR) and 95% CI. P values < 0.05 were considered statistically significant.

Results

A total of 419 patients' medical records were reviewed. Of these, 411 patients' medical records fulfilled the inclusion criteria and were considered for final analysis. About 56.9% (n= 234) of the study population was women. The prevalence of PIMs use was 28.5% and 18.5%, according to 2023 AGS Beers Criteria and STOPP/START version 2 criteria, respectively. In accordance with 2023 AGS Beers Criteria, male sex (aOR = 1.78; 95% CI, 1.10-2.87), diabetes mellitus (aOR = 0.35; 95% CI, 0.19-0.62), and chronic kidney disease (aOR = 6.68; 95% CI, 2.55-9.32) were found to be the determining factors for PIMs use. According to STOPP/START version 2 criteria, deep vein thrombosis, diabetes mellitus, hypertension, and advanced age were the primary factors influencing PIMs use.

Conclusions

Compared with other study findings from across the world, the prevalence of PIMs use was low. Based on 2023 AGS Beers Criteria, male sex, diabetes mellitus, and chronic kidney disease were found to be the determinant factors for PIMs use. Deep vein thrombosis, diabetes mellitus, hypertension, and advanced age were significant factor of PIMs use according STOPP/START version 2 criteria.

Potentially inappropriate medicine use and predicting risk factors in hospitalized older adult patients: findings of a prospective observational study from Ethiopia

BACKGROUND

Older patients are fragile and more susceptible to medication-related problems requiring a strict assessment of their medicine list. The present study was conducted with the intention to assess the quality use of medicines in older adult patients by detecting potentially inappropriate medicine use and its predictive risk factors.

METHODS

This prospective cross-sectional study involved 162 older medical patients admitted to Jimma Medical Center. A data abstraction format is employed to capture relevant information. Each patient was assessed for the presence of potentially inappropriate medicine using the 2019 American Geriatrics Associations Beers Criteria. Descriptive statistics and logistic regression analysis were conducted using STATA 15.0. A p value < 5% was considered a cutoff point for declaring statistical significance.

RESULTS

Over the hospital stay, 103 (63.6%) participants were on polypharmacy (5-9 concurrent medicines per patient), while 16 (9.9%) were on hyper polypharmacy (≥ 10 concurrent medicines per patient). On medicine use assessment using the Beers criteria, at least one potentially inappropriate medicine was detected in 118 (73%) participants. Overall, 191 potentially inappropriate medicines (range, 0 to 4) were identified, and 27 (14.1%) of these were associated with avoiding recommendations. Furosemide [83 (43%)], tramadol [26 (14.5%)], and spironolactone [22 (11.4%)] were the top three most frequent potentially inappropriate medicines identified. In terms of mode of prescription, 187 (96.9%) potentially inappropriate medicines were prescribed on a scheduled basis. Older adult patients with thrombocytopenia had a lower probability of taking potentially inappropriate medicine, while the odds of potentially inappropriate medicine use were 7.35 times higher in patients diagnosed with heart failure.

CONCLUSIONS

Nearly three-fourths of the participants had potentially inappropriate medicine in their medicine list. Therefore, generating local evidence on the clinical, economic, and humanistic consequences may help in determining whether the Beers criteria should be taken into account when prescribing medicine to older adults. Interventions targeting older adult patients with heart failure might reduce inappropriate medicine use.

Evaluation of potentially inappropriate medications use and medication complexity in elderly patients applying to community pharmacy in Turkey

BACKGROUND

Older adults often use multiple medicines to manage comorbidities well or to prevent associated complications. This study aims to determine polypharmacy, the use of potentially inappropriate medications (PIMs) using the 2019 Beers Criteria and to determine the Medication Regimen Complexity Index (MRCI) score. It also aims to identify factors associated with the presence of PIMs and the MRCI score.

METHODS

This cross-sectional study was carried out between 6 and 2023 and 5 May 2023 in a community pharmacy in Turkey. Elderly patients over 65 years of age, who used at least one drug, and who came to the pharmacy for any reason were included in the study. PIMs were determined according to the 2019 Beers Criteria. The Turkish validated version of the MRCI was used to determine the medication complexity score.

RESULTS

200 patients were included in this study. 59.5% of the patients were female and the median age was 70 (IQR, 66-74.75). Polypharmacy was detected in 33% of patients. The use of PIMs was determined in 63.5% of the patients. The median of the MRCI score was 11 (IQR, 7-15). The number of chronic diseases and drugs, presence of polypharmacy, MRCI score and mental disorders were found to be significantly higher in those with PIMs than in those without (p < 0.05). Having less than eight years of education, presence of polypharmacy, the presence of comorbidity (diabetes mellitus, cardiovascular disease, thyroid, chronic obstructive pulmonary disease (COPD), asthma and mental disorders) were associated with significantly higher MRCI scores (p < 0.05).

CONCLUSIONS

According to the results of our study, it was found that the elderly patients who came to the pharmacy had low MRCI scores, but had high PIMs use. Community pharmacists have an important role in identifying inappropriate drug use, so they should be trained to develop skills in identifying and reducing PIMs in older patients.

Evaluation of potentially inappropriate medications in older patients admitted to the cardiac intensive care unit according to the 2019 Beers criteria, STOPP criteria version 2 and Chinese criteria

WHAT IS KNOWN AND OBJECTIVES

Potential inappropriate medications (PIMs) can increase the risk of medication-induced harm. However, there are no studies regarding PIMs in older and critically ill patients with cardiovascular diseases in China. Therefore, studies evaluating PIMs in these patients can help in the implementation of more effective interventions to reduce the risk of drug use. Our objective was to analyse the prevalence of PIMs in elderly patients admitted to the cardiac intensive care unit (CICU) comparing the 2019 Beers criteria (Beers criteria), Screening Tool of Older People's Potentially Inappropriate Prescriptions (STOPP) criteria version 2 (STOPP criteria) and criteria of potentially inappropriate medications for older adults in China (Chinese criteria); and analyse the factors influencing the PIMs.

METHODS

This cross-sectional and retrospective study was performed with elderly patients (≥65 years) admitted to the CICU of the Beijing Tongren Hospital in China from January 2019 to June 2020. The PIMs were identified based on the Chinese, STOPP and Beers criteria at admission and discharge. The three criteria were compared using the Kappa statistic. Multiple regression analysis was used to investigate the influencing factors associated with PIMs.

RESULTS AND DISCUSSION

A total of 369 patients who met the inclusion/exclusion criteria were included in this study. According to the three criteria used to evaluate the PIMs, the prevalence was 78.3% and 72.6% at admission and discharge, respectively. The prevalence rate of PIMs determined by the Chinese criteria was 62.1% at admission versus 56.6% at discharge (p = 0.134); the Beers criteria was 53.9% at admission versus 46.9% at discharge (p = 0.056); by the STOPP criteria was 20.6% at admission versus 13.8% at discharge (p = 0.015). Moreover, 28.9% (STOPP criteria), 56.8% (Beers criteria) and 73.4% (Chinese criteria) of patients taking PIMs on admission still had the same problem at discharge. The most common PIMs screened by the Beers, STOPP and Chinese criteria were diuretics, benzodiazepines and clopidogrel, respectively. Besides, the three criteria showed poor agreement. Finally, the stronger predictor of PIMs was the increased number of medications (p < 0.05).

WHAT IS NEW AND CONCLUSION

The prevalence of PIMs in elderly patients admitted to the CICU was high. The Chinese, STOPP and Beers criteria are effective screening tools to detect PIMs, but the consistency between them was poor. The increased number of medications was a significant predictor of PIMs.

Potentially inappropriate medications in older Chinese outpatients based on the Beers criteria and Chinese criteria

Objective: Polypharmacy increases the prevalence of potentially inappropriate drugs potentially inappropriate medications among older persons, lowering their quality of life. PIMs use can lead to higher mortality in older patients. This study aimed to compare the prevalence of PIMs in older Chinese outpatients according to the Beers criteria and the Chinese criteria and to analyze the risk factors. Second, we describe the differences between the two criteria, focusing on the inappropriate prescription of drugs in older outpatients.

Methods: In Chengdu, Southwest China, a cross-sectional study was undertaken using electronic medical data from 9 general hospitals s. Outpatients above the age of 60 who were treated in the Geriatrics Center of these medical institutions were included. The 2019 Beers criteria and the 2017 Chinese criteria were used to evaluate the PIM status of older outpatients, and binary logistic regression was used to identify potential risk factors for PIMs.

Results: There were 44,458 prescriptions from 2016 to 2018. The prevalence of PIMs among older outpatients was 30.05% (according to the Beers criteria) and 35.38% (according to the Chinese criteria), with statistical difference. Estazolam, hydrochlorothiazide and alprazolam were the top three PIMs in the Beers criteria, while the top three PIMs in the Chinese criteria were clopidogrel, estazolam and insulin. The prevalence of PIMs was associated with age, the number of diseases and the number of drugs. PIMs were shown to be more common in patients aged 70 and above, with more than 2 kinds of diseases and more than 4 kinds of drugs.

Conclusion: PIMs were shown to be common among older outpatients in China, according to this study. The detection rate of the Chinese criteria was higher than that of the Beers criteria.

The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review

In the context of an ageing population, the burden of disease and medicine use is also expected to increase. As such, medicine safety and preventing avoidable medicine-related harm are major public health concerns, requiring further research. Potentially suboptimal medicine regimens is an umbrella term that captures a range of indicators that may increase the risk of medicine-related harm, including polypharmacy, underprescribing and high-risk prescribing, such as prescribing potentially inappropriate medicines. This narrative review aims to provide a background and broad overview of the patterns and implications of potentially suboptimal medicine regimens among older adults. Original research published between 1990 and 2021 was searched for in MEDLINE, using key search terms including polypharmacy, inappropriate prescribing, potentially inappropriate medication lists, medication errors, drug interactions and drug prescriptions, along with manual checking of reference lists. The review summarizes the prevalence, risk factors and clinical outcomes of polypharmacy, underprescribing and potentially inappropriate medicines. A synthesis of the evidence regarding the longitudinal patterns of polypharmacy is also provided. With an overview of the existing literature, we highlight a number of key gaps in the literature. Directions for future research may include a longitudinal investigation into the risk factors and outcomes of extended polypharmacy, research focusing on the patterns and implications of underprescribing and studies that evaluate the applicability of tools measuring potentially inappropriate medicines to study settings.

Prevalence of Polypharmacy and Potentially Inappropriate Medications Use in Elderly Chinese Patients: A Systematic Review and Meta-Analysis

Objectives: Polypharmacy and potentially inappropriate medication (PIM) use among elderly Chinese patients have not yet been investigated by systematic review and meta-analysis. The purposes of this study were to investigate the prevalence of polypharmacy and PIM use and the risk factors associated with PIM use in elderly Chinese patients.

Methods: Databases including PubMed, EMBase, and Web of Science were searched to collect studies which used Chinese criteria, Beers criteria, or STOPP criteria to evaluate the PIM status of elderly Chinese patients from inception to August 2021 (PROSPERO Code No: CRD42021262821). Observational studies reporting the prevalence of polypharmacy and PIM use in elderly Chinese patients were meta-analyzed. The pooled prevalence and risk ratio (RR) were calculated with a 95% confidence interval (CI).

Results: A total of 8 articles involving 4,558,786 patients were included. The overall prevalence of polypharmacy (concomitant use of more than 5 medicines) and PIM use pooled by meta-analysis in Chinese older patients was 48% (95% CI: 0.17, 0.79, p = 0.003) (inpatients 73%, outpatients 23%) and 39% (95% CI: 0.25, 0.54, p < 0.001) (inpatients 50%, outpatients 29%), respectively. Polypharmacy (RR: 2.03, 95% CI: 1.13, 3.64) was significantly associated with PIM use.

Conclusion: This meta-analysis demonstrated a high prevalence of polypharmacy and PIM use among elderly patients in China. Affected by the quantity and quality of the included studies, the aforementioned conclusions need to be confirmed by large samples and high-quality studies.

Factors associated with potentially inappropriate prescriptions and barriers to medicines optimisation among older adults in primary care settings: a systematic review

Objective

To identify factors that likely contribute to potentially inappropriate prescriptions (PIPs) among older adults in primary care settings, as well as barriers to medicines optimisation and recommended potential solutions.

Design

Systematic review.

Eligibility criteria

Quantitative studies that analysed the factors associated with PIPs among older adults (≥65 years) in primary care settings, and qualitative studies that explored perceived barriers and potential solutions to medicines optimisation for this population.

Information sources

PubMed, EMBASE, Scopus, CINAHL, PsycINFO, Web of Science, CNKI and Wanfang.

Results

Of the 13 167 studies identified, 50 were included (14 qualitative, 34 cross-sectional and 2 cohort). Nearly all quantitative studies examined patient-related non-clinical factors (eg, age) and clinical factors (eg, number of medications) and nine studies examined prescriber-related factors (eg, physician age). A greater number of medications were identified as positively associated with PIPs in 25 quantitative studies, and a higher number of comorbidities, physical comorbidities and psychiatric comorbidities were identified as patient-related clinical risk factors for PIPs. However, other factors showed inconsistent associations with the PIPs. Barriers to medicines optimisation emerged within four analytical themes: prescriber related (eg, inadequate knowledge, concerns of adverse consequences, clinical inertia, lack of communication), patient related (eg, limited understanding, patient non-adherence, drug dependency), environment related (eg, lack of integrated care, insufficient investment, time constraints) and technology related (eg, complexity of implementation and inapplicable guidance). Recommended potential solutions were based on each theme of the barriers identified accordingly (eg, prescriber-related factors: incorporating training courses into continuing medical education).

Conclusions

Older adults with more drugs prescribed and comorbidities may have a greater risk of receiving PIPs in the primary care setting, but it remains unclear whether other factors are related. Barriers to medicines optimisation among primary care older adults comprise multiple factors, and evidence-based and targeted interventions are needed to address these difficulties.

PROSPERO registration number

CRD42020216258.

The prevalence and risk factors of potentially inappropriate medication use in older Chinese inpatients with multimorbidity and polypharmacy: a cross-sectional study

Background

Multimorbidity and polypharmacy are common problems among the older population globally. They not only reduce the quality of life of older adults but also increase the prevalence of potentially inappropriate medication (PIM) use. This study aimed to examine the prevalence and the predictors of PIMs in hospitalized geriatric patients with multimorbidity and polypharmacy in Chengdu based on the 2015 American Geriatric Society Beers Criteria (2015 AGS Beers Criteria) and 2019 American Geriatric Society Beers Criteria (2019 AGS Beers Criteria).

Methods

From 2016 to 2018, a cross-sectional study was conducted using electronic medical data from nine tertiary hospitals in Chengdu. The 2019 and 2015 AGS Beers Criteria were used to evaluate the PIM status of older inpatients (age ≥65 years), and logistic regression was used to identify the risk factors for PIM use.

Results

A total of 17,352 inpatients were included in the study between 2016 and 2018. The prevalence of PIM use based on the 2019 AGS Beers Criteria (72.54%) was slightly higher than that based on the 2015 AGS Beers Criteria (70.10%). Further, the prevalence of PIM use based on the 2019 AGS Beers Criteria showed an increasing trend, from 71.17% in 2016 to 73.39% in 2018. Logistic regression demonstrated that female, advanced age, and polypharmacy were positively associated with PIM use in older adults. The most frequently used PIMs in the inpatients were diuretics, benzodiazepines, non-steroidal anti-inflammatory drugs, antipsychotics, and selective serotonin reuptake inhibitors.

Conclusions

There is a high prevalence of PIM use in older inpatients with multimorbidity and polypharmacy in Chengdu. The 2019 AGS Beers Criteria is more sensitive for evaluating older adults in Chengdu than the 2015 AGS Beers Criteria. Further, based on the 2019 AGS Beers Criteria, the prevalence of PIM use is increasing year by year. Research on interventions rationing PIM use in the geriatric population in Chengdu are necessary in the future.

Potentially inappropriate medications use and its associated factors among geriatric patients: a cross-sectional study based on 2019 Beers Criteria

The aims of this study were to estimate the prevalence of potentially inappropriate medications (PIMs) in a community-dwelling Jordanian population of geriatrics according to the 2019 American Geriatrics Society Beers Criteria, to identify the most used PIMs and factors independently associated with PIMs use.

This was an observational, descriptive, cross-sectional study. The sample population included 386 participants. Data were collected by face-to-face interviews. A total of 2894 medications were evaluated. The prevalence of patients using at least one PIM was 49.2%. The most used PIMs were proton pump inhibitors (24.6%) and long-acting sulfonylurea (20.5%). Participants who had diabetes mellitus, peptic ulcer, or irritable bowel syndrome had significantly higher numbers of PIMs.

The use of PIMs was high in Jordanian geriatric patients. The results of this study might help healthcare providers to detect high-risk patients and reconsider the necessity of using PIMs to decrease the risk of adverse drug events.

Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

Few studies have been conducted on multimorbidity (two or more chronic diseases) and rational geriatric prescribing in Africa. This study examined the prevalence and determinants of multimorbidity, polypharmacy (five or more long-term medications), and potentially inappropriate medication (PIM) use according to the 2019 Beers criteria among the older adults attending chronic care clinics from a single institution in Ethiopia. A hospital-based cross-sectional study was conducted among 320 randomly selected older adults from 12 March 2020 to 30 August 2020. A multivariable logistic regression analysis was performed to identify the predictor variables. The prevalence of multimorbidity, polypharmacy, and PIM exposure was 59.1%, 24.1%, and 47.2%, respectively. Diuretics (10%), insulin sliding scale (8.8%), amitriptyline (7.8%), and aspirin (6.9%) were among the most frequently prescribed PIMs. Older patients experiencing pain flare-ups were more likely to have multimorbidity (adjusted odds ratio (AOR): 1.64, 95% confidence intervals: 1.13–2.39). Persistent anger (AOR: 3.33; 1.71–6.47) and use of mobility aids (AOR: 2.41, 1.35–4.28) were associated with polypharmacy. Moreover, cognitive impairment (AOR: 1.65, 1.15–2.34) and health deterioration (AOR: 1.61, 1.11–2.32) increased the likelihood of PIM exposure. High prevalence of multimorbidity and PIM use was observed in Ethiopia. Several important determinants that can be modified by applying PIM criteria in routine practice were also identified.

Potentially inappropriate medications in Chinese older outpatients in tertiary hospitals according to Beers criteria: A cross-sectional study

OBJECTIVES

Multimorbidity and polypharmacy in older adults always increase the prevalence of potentially inappropriate medications (PIMs) and affect the quality of life of older adults. Currently, the data of PIMs on Chinese geriatric outpatients based on Beers criteria 2015 and 2019 have not been studied. The purposes of this study were aimed to investigate the prevalence of PIMs prescription and the most frequent PIMs amongst outpatients according to the two criteria and to explore related risk factors for PIMs.

METHODS

The cross-sectional retrospective study was conducted amongst geriatric outpatients in Chengdu in tertiary hospitals from January 2018 to December 2018. The Beers criteria 2015 and 2019 were used to assess PIMs in geriatric outpatients. Univariate analysis and multivariate logistic regression analysis were adopted to determine the factors that may affect the prevalence of PIMs.

RESULTS

A total of 12 005 patient prescriptions were enrolled. The prevalence of PIMs in the Beers criteria 2015 and 2019 was 30.98% and 34.39%, respectively. Benzodiazepines, diuretics and selective serotonin reuptake inhibitors (SSRIs) were the most frequent PIMs used according to both criteria. Logistic regression analysis showed that patients with female, advanced age, polypharmacy and sleep disorder were the most important factors associated with PIMs use.

CONCLUSION

The results showed a high prevalence of PIMs amongst geriatric outpatients in China. The Beers criteria 2019 had a higher detection rate of PIMs, and it was more sensitive to assess the Chinese geriatric population.

Potentially Inappropriate Medication and Associated Factors Among Older Patients with Chronic Coronary Syndrome at Hospital Discharge in Beijing, China

Purpose

Medication therapy is crucial in the management of chronic coronary syndrome (CCS). The use of potentially inappropriate medications (PIMs) contributes to poor outcomes in older patients, making it a major public health concern. However, few studies are available on PIMs use in older Chinese CCS patients. To investigate the frequency of prescribed PIMs at discharge and explore risk factors in older adults with CCS.

Patients and Methods

The cross-sectional study was conducted in a tertiary hospital in China over three months, from 1st October to 31st December, 2019. CCS patients aged over 60 years who were discharged alive were recruited. Information on demographics and medications at discharge was collected. Clinical data including diagnoses, frailty status, New York Heart Association (NYHA) class and age-adjusted Charlson Comorbidity Index (ACCI) were evaluated in each patient. PIMs were identified using the 2019 Beers criteria. Binary logistic regression was performed to recognize variables related to PIMs.

Results

A total of 447 eligible patients with 2947 medications were included. The prevalence of PIMs use was 38%. Medications to be avoided, to be used with caution, and with drug–drug interactions were 38.4%, 48.9% and 12.7% of the PIMs, respectively. Medications with drug–disease/syndrome interactions and those adjusted for kidney function were not identified. The common PIMs were diuretics (37.1%), benzodiazepines and benzodiazepine receptor agonist hypnotics (15.2%), glimepiride (13.1%), and co-prescription of potassium-sparing diuretics and renin-angiotensin system (RAS) inhibitors (9.7%). Individuals with frailty syndrome, polypharmacy, multiple comorbidities, atrial fibrillation, psychiatric disorders and greater NYHA class severity were more likely to receive PIMs.

Conclusion

Prescription of PIMs was a common burden in older adults. A CCS multidisciplinary team is needed to control PIMs, especially in vulnerable older patients.