Incorporating the Beers Criteria May Reduce ED Visits in Elderly Persons

Inappropriate Medication Use Among Underserved Elderly African Americans

OBJECTIVE

The goal of this study is to identify correlates and the prevalence of potentially inappropriate medication (PIM) use among underserved elderly African Americans.

METHOD

This cross-sectional study recruited 400 elderly African Americans living in South Los Angeles, and used structured, face-to-face surveys. These elicited data pertaining to the type, frequency, dosage, and indications of all medications used by participants.

RESULTS

Seventy percent of participants engaged in PIM use and used at least one medication that was classified as "Avoid" (27%) and "Use Conditionally" (43%) through Beers Criteria. Significant correlations emerged between PIM use and the number of autonomic and central nervous system, neurological and psychotherapeutic medications, medication duplications, and drug-drug interactions.

DISCUSSION

Our findings point to the need for multidisciplinary team programs of health care providers that include primary and specialist physicians, pharmacists, nurses, and social workers. Together, they can improve health outcomes, enhance the quality of life, and reduce morbidity and mortality due to inappropriate medication use.

Inappropriate prescribing in older fallers presenting to an Irish emergency department

BACKGROUND

certain medications increase falls risk in older people.

OBJECTIVE

to assess if prescribing modification occurs in older falls presenting to an emergency department (ED).

DESIGN

before-and-after design: presentation to ED with a fall as the index event.

SUBJECTS

over 70's who presented to ED with a fall over a 4-year period.

METHODS

dispensed medication in the 12 months pre- and post-fall was identified using a primary care reimbursement services pharmacy claims database. Screening Tool of Older Person's PIP (STOPP) and Beers prescribing criteria were applied to identify potentially inappropriate prescribing (PIP). Polypharmacy was defined as four or more regular medicines. Psychotropic medication was identified using the WHO Anatomical Therapeutic Chemical classification system. Changes in prescribing were compared using McNemar's test (significance P < 0.05).

RESULTS

One thousand sixteen patients were eligible for analysis; 53.1% had at least one STOPP criteria pre-fall with no change post-fall (53.7%, P = 0.64). Beers criteria were identified in 44.0% pre-fall, with no change post-fall (41.5%, P = 0.125). The most significant individual indicators to change were neuroleptics, which decreased from 17.5 to 14.7% (P = 0.02) and long-acting benzodiazepines decreased from 10.7 to 8.6% (P = 0.005). Polypharmacy was observed in 63% and was strongly predictive of PIP, OR 4.0 (95% CI 3.0, 5.32). A high prevalence of psychotropic medication was identified pre-fall: anxiolytics (15.7%), antidepressants (26%), hypnosedatives (30%). New initiation of anxiolytics and hypnosedatives occurred in 9-15%, respectively, post-fall.

CONCLUSION

a significant prevalence of PIP was observed in older fallers presenting to the ED. No substantial improvements in PIP occurred in the 12 months post-fall, suggesting the need for focused intervention studies to be undertaken in this area.