Polifarmacia y prescripción de medicamentos potencialmente no apropiados en adultos mayores hospitalizados

Introducción: las prescripciones potencialmente inapropiadas en ancianos es un hecho común, tanto en el ámbito comunitario como hospitalario, dada su frecuencia elevada de comorbilidad grave y polifarmacia, y conlleva importantes repercusiones clínicas y económicas. Objetivo: determinar la prevalencia de polifarmacia y de prescripción de medicamentos potencialmente no apropiados en adultos mayores. Métodos: se realizó un estudio analítico transversal, de series de casos, en adultos mayores hospitalizados en el hogar de ancianos "Lidia Doce Sánchez" de Bayamo entre 1ro de septiembre de 2018 al 1ro de septiembre de 2019. La información se obtuvo del análisis de las historias clínicas y la aplicación de los criterios de STOPP/START. El análisis de los datos se realizó mediante estadística descriptiva, se utilizaron pruebas de contrastación de hipótesis y se determinó la razón de prevalencia para determinar los factores asociados. Resultados: fueron frecuentes los pacientes con edades iguales o superiores a 75 años; del sexo masculino; con grado de instrucción primaria; con estado civil soltero y desnutrido. El promedio de comorbilidades por paciente fue de 4,2 ± 2,5; encontrándose como las principales afecciones las enfermedades cardiovasculares. La polifarmacia fue frecuente. La relación de riesgo frente a las potenciales prescripciones inadecuadas de medicamentos es con la edad avanzada, nivel de instrucción baja, comorbilidad, malnutrición y polimedicación. Las potenciales omisiones en la prescripción relacionan con la edad avanzada. Las potenciales interacciones medicamentosas aumentan su probabilidad de presentación con edad avanzada, un nivel bajo de instrucción, la desnutrición, la comorbilidad y la polimedicación. Conclusiones: se constató elevada polifarmacia y prescripción de medicamentos potencialmente no apropiados en los adultos mayores.

Introduction: potentially inappropriate prescription in the elderly is a common occurrence, both in the community and hospital settings, given its high frequency of severe comorbidity and polypharmacy, and has significant clinical and economic repercussions. Objective: to determine the prevalence of polypharmacy and the prescription of potentially inappropriate medications in older adults. Methods: a cross-sectional analytical study of case series was carried out in older adults hospitalized in the "Lidia Doce Sánchez" nursing home in Bayamo between September 1, 2018 and September 1, 2019. The information was obtained from the analysis of clinical records and the application of the STOPP/START criteria. The analysis of the data was carried out through descriptive statistics, hypothesis contrast tests were used and the prevalence ratio was determined to determine the associated factors. Results: patients with ages equal to or greater than 75 years were frequent; of the male sex; with a primary education degree; with single marital status and malnourished. The average number of comorbidities per patient was 4.2 ± 2.5; being found as the main affections cardiovascular diseases. Polypharmacy was frequent. The risk relationship against potential inappropriate drug prescriptions is with advanced age, low level of education, comorbidity, malnutrition and polypharmacy. The potential omissions in the prescription are related to advanced age. Potential drug interactions increase the probability of presentation with advanced age, low level of education, malnutrition, comorbidity and polypharmacy. Conclusions: high polypharmacy and prescription of potentially inappropriate medications were found in older adults.

Introdução: prescrições potencialmente inadequadas em idosos é uma ocorrência comum, tanto na comunidade quanto no hospital, dada a sua alta frequência de comorbidades graves e polifarmácia, e acarreta importantes repercussões clínicas e econômicas. Objetivo: determinar a prevalência de polifarmácia e prescrição de medicamentos potencialmente inapropriados em idosos. Métodos: foi realizado um estudo transversal analítico de série de casos em idosos hospitalizados no lar de idosos "Lidia Doce Sánchez", em Bayamo, entre 1º de setembro de 2018 e 1º de setembro de 2019. As informações foram obtidas a partir da análise dos prontuários e da aplicação dos critérios STOPP/START. A análise dos dados foi realizada por meio de estatística descritiva, teste de hipóteses e razão de prevalência foi determinada para determinar os fatores associados. Resultados: pacientes com 75 anos ou mais foram frequentes; macho; com o ensino fundamental; com estado civil solteiro e desnutrido. O número médio de comorbidades por paciente foi de 4,2 ± 2,5; sendo encontradas como principais afecções as doenças cardiovasculares. A polifarmácia era frequente. A razão de risco para potenciais prescrições inadequadas de medicamentos é com idade avançada, baixa escolaridade, comorbidade, desnutrição e polimedicação. As possíveis omissões na prescrição referem-se à idade avançada. Potenciais interações medicamentosas aumentam sua probabilidade de se apresentar com idade avançada, baixo nível de escolaridade, desnutrição, comorbidade e polimedicação. Conclusões: alta polifarmácia e prescrição de medicamentos potencialmente inapropriados foram encontrados em idosos.

Potentially inappropriate medications, drug-drug interactions, and prescribing practices in elderly patients: a cross-sectional study

SUMMARY OBJECTIVE: To evaluate potentially inappropriate medications, potential drug-drug interactions, and prescribing practices in elderly ambulatory patients. METHODS: We carried out a cross-sectional study on 275 elderly patients attending different outpatient departments. We used the Screening Tool for Older Person's Prescriptions criteria version two to identify potentially inappropriate medications, IBM Micromedex, to categorize potential drug-drug interactions as major and moderate. World Health Organization prescribing indicators were used to evaluate prescribing practices. RESULTS: The prevalence of potentially inappropriate medications in 275 prescriptions was 21.9%. Diclofenac was the most common inappropriate drug (n=23). Metoprolol is the second most inappropriate drug (n=12). Amlodipine and clopidogrel, aspirin and furosemide, and aspirin and spironolactone together accounted for 71.42% of major interactions (n=15). Atorvastatin and clopidogrel was the most common moderate drug-drug interaction in our study (n=24). The average number of drugs per encounter, the percentage of drugs with a generic name, and the percentage of drugs from the essential drugs list must be improved. CONCLUSION: There is a need to provide awareness through education about the explicit criteria to identify potentially inappropriate medications and prescribing indicators that aid in rational prescribing in the elderly.

Pharmacist intervention can reduce the potential use of inappropriate drugs medications in Indonesian geriatric patients

Intervention study design by pharmacists to doctors using face-to-face interviews conducted in this study aimsto analyze potentially inappropriate medications (PIMs) with prospective data collection in the geriatric ward ofRegional General Hospital Dr.M. M. Dunda Gorontalo, Indonesia in the period from January to March 2018. Thesampling technique was a total sampling design and obtained by the end of the study were 123 patients. Results ofanalysis with Beers and screening tool of older people’s prescriptions (STOPP) from 123 patients found 54 PIMs in48 patients (39.0%) based on Beers criteria and 6 patients (6.3%) based on STOPP criteria. Bivariate analysis showedthat there was a significant relationship between the incidence of adverse drug events (ADEs), with unresolved PIMswith a relative risk value at 1.55 (95% CI 1.26:1.91), p = 0.007 and a correlation coefficient (r) of 0.332. Based on theresults of univariate and bivariate statistical analysis, it can be concluded that there are still many PIMs occurring inthe prescription of geriatric patients based on Beers and STOPP criteria and pharmacists have a large enough role toreduce the incidence of PIMs so that the prevalence of ADEs due to inappropriate use of the drug can be minimized atRegional General Hospital Dr. M. M. Dunda Gorontalo, Indonesia.

Potentially inappropriate prescribing in elderly: a comparison of Beers and STOPP criteria in tertiary care

Background: Prescribing in elderly is a challenging task as they have age related physiological changes, various co-morbidities, altered pharmacological properties and higher propensity for adverse events. They are often prescribed medications which are potentially inappropriate for them, sometimes may even be unnecessary. The medicines are considered as inappropriate if the risk associated with them outweighs benefits. The objective of this study is to assess the prevalence of potentially inappropriate medications (PIM) at a tertiary care teaching hospital according to the Beers updated 2015 criteria and STOPP criteria and to compare the two criteria in detection of PIMs.Methods: A prospective observational study involving 228 elderly patients (>65years) of medicine wards was conducted from October 2015 to March 2016. Relevant information was recorded in a predesigned proforma. The use of potentially inappropriate medications is assessed using Beers updated 2015 criteria and STOPP criteria using descriptive statistics.Results: The prevalence of PIM use in the sample was 26.31% according to the 2015 Beers criteria and 14.03% using the STOPP criteria. The most prevalent PIM according to the Beers criteria were sliding scale insulin (17.54%) and long acting benzodiazepines (5.26%); according to the STOPP criteria, they were aspirin in heart failure (5.26%) and chlorpheniramine (3.07%).Conclusions: The prevalence of PIM varied when different criteria were applied. The 2015 Beers criteria identified more PIM than the STOPP criteria.

Evaluation of Polypharmacy and Inappropriate Prescription among Elderly Inpatients at the Department of General Internal Medicine at Sendai Medical Center / 日本プライマリ・ケア連合学会誌

Introduction: Polypharmacy is the practice of prescribing many medications. In this study, we assessed the current status of polypharmacy among elderly patients and cases of inappropriate prescription (IP) at the Department of General Internal Medicine (GIM) at Sendai Medical Center.Methods: We retrospectively surveyed 136 inpatients who were over 65 years old between April 2015 and March 2016 at the Department of GIM.We examined the patient's current medications and used the STOPP (screening tool of older person's potentially inappropriate prescriptions) criteria version 2 to analyze potentially inappropriate medication (PIM) cases.Results: Of 136 study patients, 77 (56.6%) patients were taking more than 6 medications. For patients over 75 years old, the average number of current medications increased.In addition, 33 cases of PIM were confirmed and the number increased in proportion to the number of current medications. Furthermore, there were 4 cases of adverse reactions in which the STOPP criteria version 2 were not applied.Conclusion: In this study, we confirmed polypharmacy in the examined patients.In order to solve the problem of polypharmacy, all medical staff must cooperate and review the prescriptions of individual patients.General physicians should assume the leading role in the distribution and improvement of polypharmacy and IP.

Exposure to potentially inappropriate medications in Brazilian elderly outpatients with metabolic diseases

ABSTRACT Management of pharmacotherapy in elderly with metabolic diseases is challenging and potentially inappropriate medications (PIMs) are risk factors for drug interactions and adverse events. The exposure to PIMs in elderly outpatients with metabolic diseases and its relationship with polypharmacy and other variables was investigated. PIMs prescribed to 207 elderly patients (aged 60 to 96 years) with metabolic diseases who attended a University Hospital of Sao Paulo city, Brazil, from April/2010 to January/2011, were evaluated. PIMs were detected using both 2003 Beers and 2008 STOPP criteria. The association between PIMs and age, gender and polypharmacy was also examined. 2008 STOPP criteria detected more PIMs (44.4 %) than 2003 Beers criteria (16.0%, p<0.001). Beers detected mainly PIMs antihypertensive (clonidine, 20.0%; doxazosin, 10.0%) and antidepressant (fluoxetine, 15.0%; amitriptyline, 10.0%) PIMs. Medicines used for cardiovascular (aspirin, 53.7%) and endocrine system (glibenclamide, 21.3%) were PIMs more frequently detected by 2008 STOPP. Unlike age and gender, polypharmacy increased the risk of PIMs by both 2003 Beers (OR: 4.0, CI95%: 1.2-13.8, p<0.031) and 2008 STOPP (OR: 6.8, CI95%: 3.0-15.3, p<0.001). Beers and STOPP criteria are important tools to evaluate the exposure to PIMs, which is strongly associated with polypharmacy in elderly outpatients with metabolic diseases.

Evaluation of Potentially Inappropriate Medication among Elderly Inpatients in Internal Medicine Depart-ment of Our Hospital by Beers Criteria and STOPP/START Criteria / 中国药房

OBJECTIVE:To improve rational drug use and reduce potentially inappropriate medication (PIM). METHODS:PIM of 700 elderly inpatients in internal medicine department of our hospital was evaluated by Beers criteria(2012 edition)and STOPP/START criteria. RESULTS:700 inpatients whose mean ages were (76.3 ± 7.2) years old took (12.1 ± 4.9) kinds of drugs per patient. 144 cases involved PIM(20.6%). The number of PIM was 220 in total,among which there were 117 cases/times relat-ed to drugs and 22 cases/times related to disease in according to Beers criteria,9 cases/times of STOPP and 72 cases/times of START. Drug with most frequency of PIM in accordance with Beers was benzodiazepines and most frequency in STOPP was thia-zides that used by patients with gout histonry. The most omission frequency of START prescription were absence of metformin thera-py for type 2 diabetes and absence of antiplatelet therapy for diabetes complicated with cardiovascular risk. CONCLUSIONS:A high prevalence of PIM in elderly inpatients in our hospital requires various measures to prevent its occurrence.

Evaluation of pharmacotherapy used on geriatric population in an institution of special regime with the screening tool of older persons' potentially inappropriate prescriptions (STOPP) criteria / Evaluación de la farmacoterapia en población geriátrica de una institución de régimen especial con los criterios the screening tool of older persons' potentially inappropriate prescriptions (STOPP)

Background: Geriatric patients represent a major challenge for appropriate prescription because they have significant changes in vital areas, multiple comorbidities among other things that encourage their fragility. In light of current evidence, the number of prescription errors increases with age and with the number of drugs USED, showing that people over 65 is at greater risk of medical error when more than 8 drugs are consumed. Objectives: To identify and describe the inappropriate medicines in elderly people in order to propose an institutional prescription guide based on the results of the application of the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) assessment methodology. Methods: A cross-section observational study with a retrospective collection of information was carried out in order to identify the frequency of inappropriate prescriptions in 300 elderly patients that were over 65 years, with a consumption of more than 5 medications and applying the STOPP criteria. The study was made in a special regime medical institution, reviewing medical records and considering variables such as number of medications, indications, dosage, therapeutic duplication, interactions and contraindications, among others. Results: The principal diagnosis was hipertension (47%) followed by diabetes mellitus (10%) and other hypothyroidisms (4%).After applying the STOPP criteria to each of the medical records, it was found that 50.7% (152) of the studied population had at least one inappropriate prescription distributed as follows: 2 prescriptions had 4 STOPP criteria, 7 prescriptions had 3 STOPP criteria, 28 had 2 STOPP criteria and 115 had 1 STOPP criteria. Conclusions: It was found that half of the prescriptions have at least one inadequate prescribed criteria, being the most important the inappropriate use of not indicated drugs or without an indication. Finally, guidelines for the rational use of drugs in the elderly with every detail of this institution are proposed.

Antecedentes: Los pacientes geriátricos representan un reto importante para la prescripción apropiada porque tienen cambios significativos en sus funciones vitales y múltiples comorbilidades, entre otros, que los hacen frágiles. A la luz de la evidencia actual, el número de errores de prescripción aumenta con la edad y con el número de fármacos, demostrando que las personas mayores de 65 años tienen mayor riesgo de sufrir un error médico cuando se consumen más de 8 medicamentos. Objetivos: Identificar y describir los medicamentos inapropiados en adultos mayores con el fin de proponer una guía de prescripción institucional basada en los resultados de la aplicación de los criterios de evaluación de prescripción potencialmente inapropiados en adultos mayores (STOPP). Métodos: Se llevó a cabo un estudio observacional descriptivo de corte transversal, con recolección retrospectiva de información. Se cuantificó la frecuencia de prescripciones inadecuadas en 300 pacientes mayores de 65 años y con un consumo de más de 5 medicamentos. Posterior a esto se aplicaron los criterios STOPP por revisión de historias clínicas en una institución de régimen especial teniendo en cuenta variables como el número de medicamentos, indicación, posología, duplicidad terapéutica, interacciones, contraindicaciones, entre otros. Los criterios STOPP de prescripciones potencialmente inadecuadas contemplan el análisis por sistemas fisiológicos buscando posibles interacciones medicamentosas, contraindicaciones, duplicidad terapéutica y medicamentos que puedan representar un riesgo en adultos mayores por presentar cambios en su farmacocinética. Resultados: El diagnóstico principal es la presión arterial alta (47%), seguida de la diabetes mellitus (10%) y otros hipotiroidismos (4%). Después de aplicar los criterios STOPP para cada una de las historias clínicas, se encontró que el 50,7% (152) de la población del estudio tenía al menos una prescripción inadecuada distribuida de la siguiente manera: 2 recetas tenían 4 criterios STOPP, 7 recetas tenían 3 criterios STOPP, 28 tenían dos criterios STOPP y 115 tenían 1 criterios STOPP. Conclusiones: Se encontró que la mitad de las recetas tienen al menos un criterio de prescripción inadecuado, siendo el más importante el uso inadecuado de los medicamentos no indicados o sin indicación aparente. Por último, se proponen directrices para el uso racional de los medicamentos en los ancianos con todos los detalles de esta institución.

Introduction of STOPP & START Criteria-A Tool for Guiding Rational Drug Use in Old People / 中国药师

With the development of aging population,the rational drug use in old people was paid more attention nowadays. So far, a number of studies in Europe, Asia and North America showed that lots of prescriptions with potential irrational drug use could be found out using STOPP & START criteria. In China, there is no systematic tool for guiding the rational drug use in old people yet, therefore, we can learn the content of STOPP&START criteria and use them for reference to promote the rational drug use in Chinese old people and lay the foundation for establishing rational drug use judgment criteria suitable for Chinese old people.

Survey of Potentially Inappropriate Prescription Using STOPP/START Criteria in Inha University Hospital / 가정의학회지

BACKGROUND: Prescribing potentially harmful drugs and omitting essential drugs to older patients is a common problem because they take so many medications. In this study, our goal was to identify potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) using Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to the Right Treatment (START) criteria to improve proper prescription and reduce improper prescription. METHODS: Enrolled in this study were 117 patients older than 65 years old who were hospitalized at Inha University Hospital in Incheon due to pneumonia from January 2012 to March 2012. Patient data, including medical histories, current diagnoses, current medications, and biochemical data were recorded from electronic records. STOPP and START were applied to their clinical datasheets. RESULTS: STOPP criteria identified 24 patients who had 29 PIMs. Most potential inappropriate prescribing was of cardiovascular medications, followed by drugs whose primary effect is on the urogenital system and gastrointestinal system. START criteria identified 31 patients who had 46 PPOs. The cardiovascular system drugs comprised most of the PPOs. No PPOs were identified under the central nervous system criteria. CONCLUSION: Given the current Korean medical system conditions and considering the many clinically important situations when prescribing drugs, STOPP/START criteria are not absolute criteria to prevent improper prescription, but sagacious usage of these standards can help physicians to prescribe properly in clinical practice.

Comparison Between Beers Criteria and Screening Tool of Older Person's Prescriptions as a Screening Tool for the Detection of Potentially Inappropriate Medicines and Adverse Drug Events in the Elderly Patients

BACKGROUND: Beers criteria are used to identify the potentially inappropriate medications (PIMs) in elderly patients. However, the criteria have limitations such as lacking consideration of drug-drug and duplicated prescriptions. The aim of this study is to compare the efficacy of newly developed screening tool of older person's prescriptions (STOPP) with Beers criteria in identifying PIMs and adverse drug events (ADEs) in elderly patients. METHODS: We included 115 elderly patients older than 65 years who visited the outpatients' clinic or have been hospitalized for medical illness. Comprehensive geriatric assessments including medication review by the pharmacists were performed by the multidisciplinary team. Beers criteria and STOPP were used to find out PIMs. The association between PIMs defined by both criteria with ADEs was also evaluated. RESULTS: A total of 59 patients (50.4%) by Beers criteria and 76 patients (65.0%) by STOPP had been prescribed with PIMs. Compared with Beers criteria, STOPP had advantage in identifying more PIMs. In addition, STOPP could identify more ADEs related medications than Beers criteria. STOPP was also useful to detect duplicate drug class prescription and nonsteroidal anti-inflammatory drugs for renal impaired patients. CONCLUSION: STOPP criteria PIMs can detect more duplicated prescription and are significantly associated with avoidable ADEs in older individuals compared with that of Beers criteria PIMs.