Comparison of 3 evaluation criteria for potentially inappropriate medications in elderly patients with femoral neck fracture / 中国药房

OBJECTIVE To analyze the prevalence of potentially inappropriate medication （PIM） in elderly patients with femoral neck fractures at admission and compare the concordance of 3 evaluation criteria. METHODS A retrospective study was conducted to review the data of elderly patients with femoral neck fractures admitted to the Department of Orthopedics in Northern Jiangsu People’s Hospital from July 2022 to June 2023. The PIMs were identified according to the Criteria of Potentially Inappropriate Medications for Older Adults in China：2017 edition （hereinafter referred to as Chinese criteria）， American Geriatrics Society 2023 Updated AGS Beers Criteria® for Potentially Inappropriate Medication in Older Adults （hereinafter referred to as 2023 Beers criteria）， third version criteria for screening tool of older people’s prescriptions for potentially inappropriate medication （hereinafter referred to as STOPP criteria version 3）. The concordance of the 3 evaluation criteria was compared by using Kappa statistics. RESULTS A total of 246 patients were included in this study； 49 patients （19.92%） with 77 PIMs were detected by the Chinese criteria， 64 patients （26.02%） with 118 PIMs were detected by the 2023 Beers criteria， and 41 patients （16.67%） with 67 PIMs were detected by the STOPP criteria version 3； 22 patients met all three criteria simultaneously. The concordance among the three criteria showed moderate agreement （0.417≤Kappa≤0.486） when compared in pairs. CONCLUSIONS There are certain differences in the PIM evaluated by the three criteria， but the prevalence of PIMs is below 30% according to the different H202134） criteria. Benzodiazepines， antipsychotics， antidepressants， and other drugs may increase the risk of patients falling again.

Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study

ABSTRACT BACKGROUND: The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use. OBJECTIVE: To estimate the incidence and factors associated with PIMs use in intensive care units. DESIGN AND SETTING: Historical cohort study was conducted in a high-complexity hospital in Brazil. METHODS: A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a "Patient Safety Project" database. A Chi-square test, Student's t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%. RESULTS: According to Beers' criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43). CONCLUSIONS: Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.

Research progress on coping strategies of unreasonable drug use in the elderly / 中华老年医学杂志

Irrational drug use is common and inevitable in the elderly population, which leads to the occurrence of adverse drug reactions, the increase of hospital readmission rate and related mortality rate, and the increase of medical economic burden.Therefore, it is imperative to reduce irrational drug use, and the standardized drug prescription has become a new challenge for clinicians and pharmacists.Accurate detection method of irrational drug use, practical and effective drug use scheme, and intervention measures are the key to guide rational drug use in clinical practice.Mainly in terms of risk factors of irrational drug use, the status quo and its coping strategies, this paper reviews the research status at home and abroad in order to reduce irrational drug use in the elderly, reduce drug risk, and improve medication environment for the elderly.

Analysis of influential factors for potentially inappropriate medication in elderly cancer patients / 中国药房

OBJECTIVE To analyze the influential factors for potentially inappropriate medication （PIM） in elderly cancer patients. METHODS The data of elderly cancer patients hospitalized in a hospital from January to December 2021 were collected. According to the Beers standard of the American Geriatrics Society in 2019 （hereinafter referred to as the “2019 version of Beers standard”） and Criteria for Potentially Inappropriate Drug Use in Chinese Elderly （2017 version） （hereinafter referred to as the “Chinese PIM standard”）， the PIM status of elderly cancer patients was retrospectively analyzed. Multivariate Logistic regression analysis was used to identify influential factors for PIM. RESULTS A total of 293 patients were included in the study. According to the 2019 version of Beers standard， 211 patients （72.01%） had PIM， of which 204 （69.62%） had PIM related to drugs， 6 （2.05%） had PIM related to diseases or symptoms， 46 （15.70%） had PIM that should be used with caution， 32 （10.92%） had PIM with drug-drug interaction that should be avoided， and 11 （3.75%） had PIM based on renal function； the top 5 drugs in the list of incidence were proton pump inhibitors， metoclopramide， the first-generation antihistamines as promethazine， analgesics as ibuprofen and megestrol. According to the Chinese PIM standard， there were 132 patients （45.05%） with PIM， of which 119 （40.61%） had PIM related to drugs， involving 25 drugs （included 7 high-risk drugs and 18 low-risk drugs）， and 24 （8.19%） with PIM in disease status； top 4 drugs in the list of incidence were promethazine， megestrol， ibuprofen and cimetidine. Multivariate Logistic regression analysis showed that compared with patients with hospital stay≤10 days， patients with hospital 20054） stay between 11 and 30 days had a higher risk of PIM [odds ratio （OR）＝8.836 8， 95% confidence interval （CI） （3.217 8， 31.940 9）， P＝0.000 1]； compared with the patients with the 65895198。E-mail：fjman@cmpt.ac.cn number of clinical disease diagnosed≤5， patients with the number of clinical disease diagnosed≥11 had a higher risk of PIM [OR＝10.930 1， 95%CI （3.000 9， 70.922 9）， P＝0.001 8]； compared with surgical treatment， patients receiving antineoplastic drugs had a higher risk of PIM [OR＝2.209 5， 95%CI （1.180 2， 4.176 9）， P＝0.013 6]. CONCLUSIONS Elderly cancer patients have multiple diseases， complicated medication， and a high incidence of PIM. The length of hospital stay （11-30 d）， the number of clinical disease diagnosed （≥11） and anti-tumor drugs are main influential factors for PIM in patients.

Research hotspots and trends on potentially inappropriate medication from 2012 to 2021 / 中国药房

OBJECTIVE To quantitatively and qualitatively analyze the progress of potentially inappropriate medication （PIM） research by means of bibliometrics， and to predict the hotspots and trends of PIM， so as to provide reference for PIM research in China. METHODS The research literature related to PIM were searched from Web of Science core database， and the publication trend of the literature was analyzed on the bibliometric online analysis platform and CiteSpace 5.8.R3 software. The research results were visualized and analyzed， and the research hotspots of PIM were summarized through gCLUTO. RESULTS About PIM research， the annual number of the literature issued from 2012 to 2021 showed a continuous growth trend totally； the United States had the largest number of literature （241 pieces）； the University of Sydney in Australia was the research institution with the largest number of literature （59 pieces）； O’Mahony D from University College Cork， Ireland， published the most literature （23 pieces）； the research of PIM involved 57 disciplines， among which there was the largest number of literature about gerontology （384 pieces）； International Journal of Clinical Pharmacy was the journal with the largest number of literature （61 pieces）； Journal of the American Geriatrics Society was cited most frequently （1 197 times）. The hotspots of PIM research mainly focused on seven aspects： the standard of PIM， the safety and economy research of PIM， the risk factors research of PIM， the PIM research of chronic patients， the PIM research of antipsychotics， the research of pharmacists’ participation in PIM management， and the PIM research about palliative care of tumor patients. CONCLUSIONS The heat of research on PIM has been on the rise， and there is little cooperation between countries and institutions， and more cooperation is needed. In the future， the focus of Chinese pharmacists’ research on PIM may be on the deep localization of PIM standards， PIM intervention and precise medication guidance， and PIM management of specific diseases and drugs.

Assessment and comparison of anticholinergic exposure in older adults at a Basic Health Unit in Porto Alegre / Avaliação e comparação da exposição anticolinérgica em idosos de uma Unidade Básica de Saúde de Porto Alegre

Objectives: To estimate the anticholinergic burden in geriatric patients using two scales and to assess the degree of agreement between them. Methods: Data from an observational study conducted in a primary health care service were used. Anticholinergic burden was assessed using the Belgian Scale Muscarinic Acetylcholinergic Receptor ANTagonist Exposure Scale and the Brazilian Scale of Medicines with Anticholinergic Activity. The cumulative anticholinergic burden score was classified using a categorical approach: Brazilian scale (0: none; 1 ­ 2: low; ≥ 3: high) and Belgian scale (0: none; 0.5 ­ 1.5: low; ≥ 2: high). The degree of agreement between the two instruments was obtained through Cohen's kappa coefficient. Results: A total of 374 older people were included, most of them female and aged between 60 and 69 years. At least one potentially inappropriate drug with anticholinergic activity was used by 60.70% of patients according to the Brazilian scale and 32.89% by the Belgian scale. On average, 20.85% were under high anticholinergic exposure. Overall, on both scales, the most commonly recurrent medications were those indicated for the treatment of psychiatric disorders. Agreement between the scales was moderate (Kappa = 0.43). Conclusions: A high percentage of older adults was exposed to drugs with an anticholinergic burden, posing risks to health and quality of life. Consensus is needed on how anticholinergic burden is calculated by these scores, as well as standardization of the list of included drugs.

Objetivos: Estimar a carga anticolinérgica em idosos com base em duas escalas e avaliar o grau de concordância entre estas. Metodologia: Foram utilizados dados de um estudo observacional realizado em um serviço de atenção primária. A carga anticolinérgica foi avaliada pela escala belga Muscarinic Acetylcholinergic Receptor ANTagonist Exposure Scale e da Escala Brasileira de Medicamentos com Atividade Anticolinérgica. A pontuação da carga anticolinérgica cumulativa foi classificada utilizando uma abordagem categórica: escala brasileira (0: nenhuma, 1 ­ 2: baixa, ≥ 3: alta) e escala belga (0: nenhuma, 0,5 ­ 1,5: baixa, ≥ 2: alta). O grau de concordância entre as duas ferramentas foi obtido por meio do coeficiente Capa de Cohen. Resultados: Foram incluídos 374 idosos, a maioria do sexo feminino e com idade entre 60 a 69 anos. O uso de pelo menos um medicamento potencialmente inapropriado com atividade anticolinérgica foi verificado em 60,70% dos idosos com a aplicação da escala brasileira e em 32,89% com a escala belga. Em média, 20.85% estavam sob alta exposição anticolinérgica. De modo geral, os medicamentos mais recorrentes, para ambas as escalas, foram os indicados para o tratamento de transtornos psiquiátricos. A concordância entre as escalas foi moderada (Capa = 0,43). Conclusão: Um percentual elevado de idosos estava exposto a medicamentos com carga anticolinérgica, representando riscos para a saúde e a qualidade de vida. É necessário um consenso sobre como calcular a carga anticolinérgica nos diferentes escores, bem como a padronização da lista de medicamentos incluídos.

Medication package inserts do not present adequate information on potential risks for older adults in Brazil / Bulas de medicamentos não apresentam informações adequadas sobre potenciais riscos para idosos no Brasil

OBJECTIVE: To compare information on the risks of potentially inappropriate medications (PIMs) for older adults in the Beers criteria with data in the package inserts made available by the Brazilian Health Regulatory Agency. METHODS: This is an observational, cross-sectional study that compared information on the package inserts of 33 brand-name drugs in the Brazilian market with specific recommendations for older adults contemplated in the Beers criteria, categorizing them into: complete, incomplete, absent, or discrepant. RESULTS: Among the analyzed package inserts, 21.21% did not present a specific section dedicated to the use of these drugs by older adults and data were scattered throughout the text; 63.64% were classified as incomplete; 33.33% lacked data; and 3.03% had discrepant information. CONCLUSION: The analyzed package inserts presented incomplete data or lacked information characterizing the drugs as PIMs for older adults. This study demonstrated that some package inserts of drugs used in Brazil are not satisfactory, warranting higher caution in the medical community when prescribing these medications and guiding patients

OBJETIVO: Comparar as informações sobre os riscos de medicamentos potencialmente inapropriados (MPIs) para idosos contidas nos critérios Beers com as informações presentes nas bulas para profissionais de saúde disponibilizadas pela Agência Nacional de Vigilância Sanitária no Brasil. METODOLOGIA: Estudo observacional e transversal que comparou informações das bulas para profissionais de saúde de 33 medicamentos de referência no mercado brasileiro com recomendações específicas para idosos contempladas nos critérios Beers e que foram categorizadas em: completas, incompletas, ausentes ou discrepantes. RESULTADOS: Dentre as bulas dos MPIs analisadas, 21,21% não apresentam seção específica destinada ao uso desses medicamentos por idosos, nas quais as informações estão dispersas pelo texto; 63,64% delas foram classificadas como incompletas; 33,33% tinham informações ausentes; e 3,03% com informações discrepantes. CONCLUSÃO: As bulas analisadas apresentaram dados incompletos ou não apresentam qualquer informação que caracterizasse o medicamento como MPI para idosos. Este estudo demonstra que algumas bulas de medicamentos utilizados no Brasil não estão satisfatórias, sugerindo maior cautela à comunidade médica na prescrição e na orientação aos seus pacientes

Sobrevida de pessoas idosas hospitalizadas com uso prévio de medicamentos potencialmente inapropriados / Survival of hospitalized older adults with prior use of potentially inappropriate medicine

Resumo Objetivos Neste estudo prospectivo, avaliamos o impacto do uso de medicamentos potencialmente inapropriados prescritos antes da internação (PIM-ph) na mortalidade de idosos. Métodos Foram incluídos 318 pacientes com idade ≥ 65 anos que procuraram atendimento de emergência e foram internados por qualquer motivo clínico. As informações sobre os indicadores clínicos e sociais foram obtidas por meio de entrevistas estruturadas, 24 a 48 horas após a internação. Os medicamentos usados por esses pacientes foram registrados e o uso de PIM-ph foi identificado pela análise brasileira baseada em consenso de uso de PIM. A análise considerou a influência de todo conjunto de PIM-ph, bem como de alguns PIM-ph específicos. O impacto do uso de PIM-ph na sobrevida de idosos hospitalizados foi determinado por meio da análise multivariada de regressão de Cox. Resultados A prevalência de PIM-ph foi 49,7% (n = 158). Um total de 85 (26,7%) pacientes faleceram durante a internação ou até 30 dias após a alta. Dezoito classes farmacológicas de uso de PIM-ph foram identificadas. O uso de PIM-ph, benzodiazepínico (IC: 1.055-3.365, p= 0.032), digoxina (IC: 1.623-7.048, p=0.001) e diuréticos de alça (IC: 1.000-3.455, p=0.05) aumentou o risco relativo de mortalidade independente de sexo, idade, causas clínicas de hospitalização, risco de fragilidade, suporte social, presença de sintomas de confusão, polifarmácia e evolução intra-hospitalar de complicações geriátricas. Conclusão O uso de PIM-ph (Benzodiazepínicos, digoxina e diuréticos de alça) pode contribuir para o risco de mortalidade em idosos hospitalizados. Esses resultados podem ser relevantes no manejo e cuidado terapêutico de pacientes hospitalizados.

Abstract Objectives We aimed to evaluate the impact of potentially inappropriate medications prescribed prior to hospitalization (PIM-ph) on the mortality Methods We included 318 patients, aged ≥65 who sought emergency care and were hospitalized for any clinical reasons. Information on patients' clinical and social indicators was obtained via structured interviews conducted 24 to 48 hours after hospitalization. All medications used by older adults prior to hospitalization were recorded, and PIM-ph were identified using the Brazilian PIM Consensus. The study considered the influence of the entire set of PIM-ph and specific PIM-ph used by these patients. The impact of PIM-ph use during hospitalization and after 30 days of this event was statistically determined by multivariable Cox proportional hazard regression analysis, which included sex, age, and other clinical and functional indicators as intervening variables. Results The prevalence of PIM-ph use was 49.7% (n=158). A total of 85 (26.7%) patients died during hospitalization or within 30 days after discharge. Eighteen pharmacological classes of PIM-ph use were identified. The use of total PIM-ph, benzodiazepines (IC: 1.055-3.365, p= 0.032), digoxin(IC: 1.623-7.048, p=0.001), and loop diuretics (IC: 1.000-3.455, p=0.05) increased the relative risk of mortality independent of sex, age, clinical causes of hospitalization, frailty risk, social support, presence of confusion symptoms, polypharmacy, and in-hospital evolution of geriatric complications. Conclusion PIM-ph use, especially benzodiazepines, digoxin, and loop diuretics, could contribute to mortality risk in hospitalized older adults. These results could be relevant in the management and therapeutic care of hospitalized patients.

Potentially inappropriate prescribing among older patients and associated factors: comparison of two versions of STOPP/START criteria

Abstract The study aimed to estimate and compare the prevalence and type of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) between the STOPP/START original (v1) and updated version (v2) among older patients in various settings, as well as associated factors. The study included 440 patients attending a community pharmacy, 200 outpatients and 140 nursing home users. An increase in the prevalence of STOPP v2 (57.9%) compared to v1 (56.2%) was not statistically significant in the total sample and within each setting (p>0.05). A decrease in the prevalence of START v1 (55.8%) to v2 (41.2%) was statistically significant (p<0.001) in the total sample and within each setting (p<0.05). Drug indication (32.9%) and fall-risk medications (32.2%) were most commonly identified for STOPP v2, while cardiovascular system criteria (30.5%) were the most frequently detected for START v2. The number of medications was the strongest predictor for both STOPP v1 and v2, with odds ratio values of 1.35 and 1.34, respectively. Patients' characteristics associated with the occurrence of STOPP and START criteria were identified. According to both STOPP/START versions, the results indicate a substantial rate of potentially inappropriate prescribing among elderly patients. The prevalence of PIMs was slightly higher with the updated version, while the prevalence of PPOs was significantly lower

Declínio cognitivo e uso de medicamentos na população de idosos institucionalizados de uma cidade do interior de Minas Gerais, Brasil / Neurocognitive disorders and medication used by the institutionalized elderly population of the interior of Minas Gerais, Brazil

Resumo Introdução Idosos institucionalizados possuem maiores riscos para a prescrição de cinco ou mais medicamentos, ou polifarmácia, e, por consequência, de eventos adversos, por apresentarem problemas de saúde limitantes, fragilidade e baixa funcionalidade. Esse risco é ainda maior quanto maior o declínio cognitivo. Objetivo Determinar a prevalência de declínio cognitivo (DC) e a relação com o uso de medicamentos em idosos institucionalizados. Método Estudo transversal descritivo realizado por análise de prontuários dos idosos institucionalizados portadores ou não de DC, conforme resultados de testes validados. Foram levantados os medicamentos utilizados e os medicamentos potencialmente inadequados (MPI) por meio dos Critérios de Beers (2015). Resultados Foram avaliados 88 idosos, com idade média de 77,6 (9,2) anos. A prevalência de DC foi de 75%, sendo maior no sexo feminino (82,5%, p = 0,01) e em idosos acima de 80 anos (85%, p = 0,04). Antieméticos e inibidores de bomba de prótons foram significativamente mais utilizados nos idosos com DC. A prevalência de polifarmácia foi de 69,3%, e 71 idosos (80,68%) utilizavam pelo menos um MPI, com maior prevalência do uso de MPI na faixa etária de 60 a 79 anos (p = 0,004). Os idosos que utilizavam pelo menos um MPI também usavam maior número de medicamentos (p = 0,014). Conclusão A presença de DC teve relação com a maior utilização de antieméticos e inibidores de bomba de prótons, mas não com o maior uso de MPI. Além disso, foi observada elevada prevalência de polifarmácia e MPI em prescrições dos idosos institucionalizados.

Abstract Background Institutionalized elderly are at greater risk of prescribing five or more medications and consequently of higher occurence of adverse events, as they have limiting health problems, frailty and low functionality. This risk is even greater if they also have cognitive decline. Objective To determine the prevalence of cognitive disorders (CDs) and its association with the medication used by the institutionalized elderly population of the interior of Minas Gerais, Brazil. Method Descriptive cross-sectional study for analysis of medical records of institutionalized elderly with or without CDs, according to validated tests. The medicine used and the potentially inappropriate medications (PIMs) were determined as per the Beers criteria (2015). Results Eighty eight elderly people, with mean age of 77.6 (9.2) years, were included. CD prevalence was 75% higher in females (82.5%, p = 0.01) and in older age groups, with 80 years and above (85%, p = 0.04). Antiemetics and proton pump inhibitors were significantly more used by the elderly with CDs. The prevalence of polypharmacy was 69.3%, 71 elderlies (80.7%) used at least one PIM, and a higher prevalence of PIM use was observed in elderly people of 60 to 79 years old (p = 0.004). The elderly who used at least one PIM was also observed to use a higher number of medications (p = 0.014). Conclusion CDs was found to be related to the higher use of antiemetics and proton pump inhibitors, but not to the use of PIMs in regards to the institutionalized elderlies. Furthermore, a high prevalence of polypharmacy and PIMs were detected in the prescriptions of the institutionalized elderly subjects.

Potentially inappropriate medication use in hospitalized elderly patients

SUMMARY OBJECTIVE: This study aimed to assess the prevalence of potentially inappropriate medication prescription in hospitalized elderly patients according to the 2019 American Geriatrics Society Beers Criteria. METHODS: This study is a prospective analysis of electronic medical records of elderly patients admitted to the Department of Medicine, Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo, between 1 September 2020 and 30 April 2021. RESULTS: A total of 142 patients (85 women and 57 men) with a mean age of 74.5±7.3 years (65-99 years) were assessed. Of these, 108 (76.1%) were elderly (age ≥65 years and <80 years) and 34 (23.9%) long-lived (age ≥80 years). The average length of stay found in the sample was 25.3±28.7 days (between 2 and 235 days), and 102 out of the 140 patients assessed remained in the hospital for up to 29 days. Sixteen drugs considered potentially inappropriate medication were found in the patients' prescriptions, with at least one potentially inappropriate medication having been prescribed to 141 (99.3%) patients. Elderly patients had a mean of 2.57±0.94 potentially inappropriate medication prescribed versus 2.56±0.89 among long-lived patients. The most prescribed potentially inappropriate medication were as follows: regular human insulin as required (85.2%), and omeprazole (73.9%) and metoclopramide as required (61.3%). CONCLUSION: The study sample showed significant percentages of potentially inappropriate medication prescriptions for the elderly admitted to the hospital.

Medication Appropriateness among Older Persons Admitted to a General Hospital in Malaysia

@#Introduction: Many tools have been developed to determine medication appropriateness in older persons including the 2015 American Geriatric Society (AGS) Beers criteria and the Screening Tool of Older People’s Prescriptions (STOPP) criteria. We aimed to determine and compare the prevalence of potentially inappropriate medications (PIMs) based on the Beers criteria 2015 and the STOPP criteria v2 among older persons admitted to a general hospital in Malaysia. Methods: A cross-sectional study comprising of 160 patients aged 65 years old and above admitted to the general medical wards of a tertiary teaching hospital were recruited. Beers criteria 2015 and the STOPP criteria v2 were used to evaluate participants’ medication list on admission, during hospitalisation and on discharge for PIMs. Prevalence of PIMs which was calculated as the total number of patients with one or more PIMs over the total number of patients. Results: The prevalence of PIMs identified by Beers criteria 2015 on admission, during hospitalisation and on discharge were 54.85%, 64.40% and 48.80% respectively. The prevalence of PIM based on STOPP criteria v2 were 33.08%, 47.50% and 42.50% respectively. The most prevalent PIMs according to Beers criteria 2015 and STOPP criteria v2 were diuretics, tramadol, ticlopidine, proton pump inhibitor, benzodiazepines and antipsychotics. Conclusion: The prevalence of PIMs use is high among hospitalised older persons in Malaysia. While it is not possible to avoid all PIMs listed in the Beers and STOPP criteria, clinicians should exercise caution in prescribing drugs such as benzodiazepines, antipsychotics and proton pump inhibitors for older persons weighing the risk versus benefit of the drugs.

Potential inappropriate medication and its influencing factors among elderly hypertensive patients in community general practice clinic / 中华全科医师杂志

Objective:To investigate the status quo of potentially inappropriate medication (PIM) among elderly hypertensive patients in community general practice clinic and related influencing factors.Methods:A total of 767 prescriptions for elderly hypertensive patients in a community health service center in Beijing from October 2020 to August 2021 were reviewed. The prevalence of PIM was assessed based on the criteria of potentially inappropriate medications for older adults in China(2017). Logistic regression analysis was employed to analyze the influencing factors for PIM. Results:The survey showed that 198 elderly patients had PIM with 244 person-doses. The top three drugs with high rate of PIM were benzodiazepine-estazolam (64 person-doses), clopidogrel (53 person-doses) and insulin (35 person-doses). Univariate analysis showed that PIM was significantly associated with types of medication;and underlying diseases hypertension with hyperlipidemia, coronary heart disease, type 2 diabetes, osteoarthritis, upper respiratory tract infection and insomnia (χ 2=82.58, 13.65, 17.74, 7.52, 10.34, 68.19,respectively,all P<0.05). Multivariate logistic regression analysis showed that the types of medication, hypertension complicated with upper respiratory tract infection, and insomnia were independent influencing factors for PIM ( OR=1.55, 2.47, 9.05; P<0.05). Conclusion:The study shows that PIM is more common in elderly hypertensive patients in community general practice clinics,which is associated with types of medication, hypertension complicated with upper respiratory tract infection and insomnia. It is suggested that general practitioner working in community clinics should be aware of PIM, minimize the number of prescription drugs, and choose new drugs or non-drug treatments to reduce the occurrence of PIM.

Effect of potentially inappropriate medication on frailty among community-dwelling elderly patients with mild cognitive impairment: a propensity score-matched analysis / 中华行为医学与脑科学杂志

Objective:To explore the effect of potentially inappropriate medication (PIM) on frailty among community-dwelling elderly patients with mild cognitive impairment (MCI).Methods:From March to July 2021, a total of 252 elderly patients with MCI in Hefei community were selected.The data of basic information and PIM of subjects were collected.All subjects were assessed by the comprehensive frailty assessment instrument (CFAI), Montreal cognitive assessment scale-basic (MoCA-B), and the Barthel index (BI). The subjects were divided into PIM group ( n=136) and non-PIM group ( n=94) according to whether there was PIM.Taking the confounding factors as the matching condition, the subjects of the two groups were matched with 1∶1 propensity score.After matching, there were 52 in the PIM group and 52 in the non-PIM group.SPSS 23.0 was used for data analysis.Multivariate Logistic regression analysis was performed to analyze the effect of PIM on frailty of subjects. Results:(1)Before matching, the incidence of frailty in PIM group and non-PIM group were 80.9% and 19.1%, respectively, with statistically significant differences ( P<0.01). Logistic regression analysis revealed that PIM was a risk factor for the frailty ( β=1.704, OR=5.495, 95% CI=2.539-11.892). (2)After matching, the confounders of age, hearing status, chewing function, activities of daily living, Charlson comorbidity index, handgrip strength, and cognitive function were balanced and comparable between the two groups.The incidence of frailty in PIM group and non-PIM group were 67.9% and 32.1%, respectively.The differences remained statistically significant ( P<0.01). PIM remained a risk factor for frailty ( β=1.791, OR=5.998, 95% CI=2.393-15.032). Conclusion:PIM is a risk factor for the occurrence of frailty in elderly patients with MCI.Therefore, the accurate screening and standardized management of PIM will provide a new target for the frailty management of elderly patients with MCI.

Comparison of commonly used judgment criteria for potentially inappropriate medication in the elderly / 中国药房

OBJECTIVE To compare five com monly used judgment criteria for potentially inappropriate medication （PIM）in the elderly ，and to provide reference for clinical selection of appropriate PIM evaluation tools for the elderly. METHODS From the aspects of applicable age ，content and scale characteristics ，five commonly used PIM judgment criteria for the elderly at home and abroad were analyzed and compared ，namely Beer ’s criteria ，STOPP/START v 2 criteria，ACOVE 3 criteria，PIM-Check criteria and“Judgment Criteria for Potentially Inappropriate Medication for Chinese Elderly ”（Chinese criteria ）. RESULTS The five standards both overlapped and focused in terms of scale characteristics. In each study ，the incidence of PIM was different according to different standards. Proton pump inhibitors ，diuretics，non-steroidal anti-inflammatory drugs and anticoagulants were the most frequently occurring PIM drugs for the elderly. CONCLUSIONS Combining with the specific conditions of patients and fully considering the benefits and risks of treatment ，rational selection and combination of five PIM judgment criteria ，and necessary supplements to my country ’s PIM judgment criteria ，will help clinicians and pharmacists to improve the efficacy and safety of the medication in the elderly patients.

Potentially inappropriate medications based on TIME criteria and risk of in-hospital mortality in COVID-19 patients

SUMMARY OBJECTIVE: This study aimed to evaluate the relationship between hospital admission potentially inappropriate medications use (PIM) and in-hospital mortality of COVID-19, considering other possible factors related to mortality. METHODS: The Turkish inappropriate medication use in the elderly (TIME) criteria were used to define PIM. The primary outcome of this study was in-hospital mortality. RESULTS: We included 201 older adults (mean age 73.1±9.4, 48.9% females). The in-hospital mortality rate and prevalence of PIM were 18.9% (n=38) and 96% (n=193), respectively. The most common PIM according to TIME to START was insufficient vitamin D and/or calcium intake per day. Proton-pump inhibitor use for multiple drug indications was the most prevalent PIM based on TIME to STOP findings. Mortality was related to PIM in univariate analysis (p=0.005) but not in multivariate analysis (p=0.599). Older age (hazards ratio (HR): 1.08; 95% confidence interval (CI): 1.02-1.13; p=0.005) and higher Nutritional Risk Screening 2002 (NRS-2002) scores were correlated with in-hospital mortality (HR: 1.29; 95%CI 1.00-1.65; p=0.042). CONCLUSION: Mortality was not associated with PIM. Older age and malnutrition were related to in-hospital mortality in COVID-19.

Potentially inappropriate medication use in a comprehensive therapy management service: clinical outcomes and interventions

Abstract This study aimed to describe potentially inappropriate medication (PIM) use according to the Beers criteria among older adults followed in a comprehensive medication management (CMM) service, the pharmacists´ interventions, and the clinical outcomes of PIM use. All older adults in a CMM service delivered in the Brazilian public primary care system were included in the study (n = 389). Two methodological approaches were developed: (I) cross-sectional - prevalence of PIM use and associated factors were identified (univariate analysis - Pearson's chi-square; multivariate - logistic regression); (II) documental analysis of the negative clinical outcomes potentially associated with PIM use and pharmacists' interventions. The prevalence of PIM use was 48.3%, and it was independently and positively associated with the use of ≥ 5 drugs. For 21.3% of PIMs, a potential negative clinical outcome was identified. The most common negative clinical outcome was hypotension (35.1% of the negative outcomes), fractures or diagnosis of osteoporosis (21.1%), and hypoglycemia (14.0%). For most of them (78.9%), an intervention was performed to mitigate harm or discontinue use. A high prevalence of PIM was detected and was associated with polypharmacy. A significant proportion of PIM showed potential negative clinical outcomes that were identified by clinical pharmacists, and the majority of pharmacists' interventions aimed at its mitigation or deprescription. Overall, our findings reinforce the potential of CMM services for reducing PIM use and the occurrence of negative outcomes.

Use of potentially inappropriate medications and adverse events in older outpatients with acute conditions

ABSTRACT Objective To examine associations between potentially inappropriate medication, use and the risk of falls, unplanned hospitalization and death in older patients receiving initial care in a geriatric day hospital due to acute conditions. Methods Cohort study with older adults referred to a geriatric day hospital from 2014 to 2017 due to acute conditions. Patients were submitted to comprehensive geriatric assessment. Use of medications was analyzed according to Beers Criteria 2019. Outcome assessment was based on monthly follow-up telephone calls made over the course of one year. Results In this sample, 40.6% of patients had been prescribed at least one potentially inappropriate medication, particularly proton pump inhibitors (66.5%). Over the course of follow-up, 44.7% of patients receiving potentially inappropriate medications sustained at least one fall (p=0.0043) and 70% visited the emergency department (p=0.0452). These outcomes were more common among patients using two or more of drugs. Use of potentially inappropriate medication was associated with a 64% increase in the odds of unplanned hospitalization and a two-fold increase in risk of death. Conclusion Associations between potentially inappropriate medication use and unfavorable outcomes such as falls and unplanned hospitalizations within one year of admission to a geriatric day hospital support the application of Beers Criteria and emphasize the importance of periodic prescription review, deprescription and rational use of these drugs whenever possible.

Conhecimento dos prescritores sobre medicamentos potencialmente inapropriados para idosos em uma Unidade Básica de Saúde / Prescribers' knowledge of potentially inappropriate medications in older adults in a Primary Care Unit

Introdução: O conhecimento dos prescritores sobre medicamentos potencialmente inapropriados (MPI) pode reduzir o risco de resultados adversos à saúde em idosos, uma vez que esses medicamentos podem trazer mais risco do que benefício a esses pacientes. O objetivo deste estudo é obter informações sobre o conhecimento dos prescritores em relação aos cuidados na prescrição de medicamentos para idosos e analisar o conhecimento destes em relação a critérios explícitos de classificação de MPI.Métodos: Trata-se de um estudo exploratório e observacional, de delineamento transversal, desenvolvido com a aplicação de questionário on-line respondido de forma anônima por prescritores de uma unidade básica de saúde.Resultados: Dos 20 profissionais que responderam ao questionário, 9 eram professores, 7 médicos residentes e 4 médicos contratados. Em relação aos idosos, 70% dos prescritores percebem boa adesão ao tratamento e 40% maior frequência de reações adversas a medicamentos, quando comparados à população em geral. Somente 30% dos profissionais relataram conhecimento sobre algum critério de classificação de MPI, e 25% destes já utilizou/utiliza algum dos critérios na prática clínica. Porém, os prescritores citaram as classes mais presentes no Critério de Beers para MPI como candidatas à desprescrição e ajuste de dose.Conclusão: O conhecimento e aplicação de critérios de classificação de MPI na prática clínica é ainda incipiente, mesmo em Unidade vinculada a Hospital Universitário.

Introduction: Knowledge of potentially inappropriate medications (PIMs) may reduce the risk of adverse health outcomes in older patients, given that PIMs may be more harmful than beneficial to this population. To investigate prescribers' knowledge of appropriate drug prescription in older adults and evaluate their knowledge of explicit criteria for PIM classification.Methods: We conducted a cross-sectional, exploratory, observational study. We developed an online questionnaire, which was anonymously answered by prescribers from a primary care unit.Results: A total of 20 prescribers answered the questionnaire, of whom 9 were professors, 7 were medical residents, and 4 were physicians. In older patients, 70% of prescribers reported good adherence to treatment and 40% reported a higher rate of adverse drug reactions compared with the general population. Only 30% of prescribers reported some knowledge of the criteria for PIM classification, and 25% of them had already used/use some of the criteria in clinical practice. However, the most prevalent drug classes in the Beers Criteria for PIM were mentioned by prescribers as potentially requiring deprescription and dose adjustment.Conclusion: Knowledge and application of the PIM classification in clinical practice is still incipient, even in a primary care unit affiliated with a teaching hospital.

Prescrição de medicamentos potencialmente inapropriados para idosos segundo os Critérios de Beers: revisão sistemática / Prescribing potentially inappropriate medications for the elderly according to Beers Criteria: systematic review

Resumo Objetivou-se realizar uma revisão sistemática para identificar e avaliar a prevalência da prescrição de medicamentos potencialmente inapropriados (MPI), segundo os Critérios de Beers, em idosos hospitalizados com ≥65 anos. Foram consultadas cinco bases de dados: BVS, Cochrane Library, CINAHL, MEDLINE e Web of Science. Foram identificados 19 artigos, selecionados a partir de critérios de elegibilidade. A média de idade foi 78,2 anos e o critério mais utilizado para a identificação dos MPI para idosos foi o de Beers 2015 (57,9%). Um total de 221.879 idosos recebeu prescrição inapropriada, a prevalência média foi de 65.0%, com destaque para o sistema gastrointestinal (15,3%) e os inibidores da bomba de prótons (27,7%) como a principal classe de medicamento prescrita. Conclui-se que os Critérios de Beers possibilitaram a identificação da alta prevalência na prescrição dos MPI. Os resultados desta revisão poderão auxiliar na tomada de decisão dos profissionais de saúde, no intuito de se evitar a administração dos MPI e propor melhores práticas que garantam a segurança do idoso hospitalizado.

Abstract The study aimed to perform a systematic review to identify and evaluate the prevalence of potentially inappropriate medicines (PIM) prescriptions for the elderly, according to Beers Criteria, in hospitalized elderly individuals aged 65 years or older. Five databases consulted: VHL; Cochrane Library; CINAHL; MEDLINE and Web of Science. Nineteen articles identified, selected based on eligibility criteria. The mean age was 78.2 years and the most used criterion for the identification of PIM for the elderly was Beers 2015 (57.9%). A total of 221,879 elderly received a prescription for PIM, the mean prevalence was 65.0%, for the gastrointestinal system (15.3%) and proton-pump inhibitors (27.7%) highlighted as the main class of medicine prescribed. It concluded that the Beers Criteria have made it possible to identify the high prevalence in the prescription of PIM. The results of this review may help in the decision making of health professionals, to avoid the administration of PIM and to propose best practices to ensure the safety of the elderly hospitalized.