Pattern of Use and Prevalence of Potentially Inappropriate Medications among Elderly Patients in a Malaysia Suburban Hospital
Abstract
Introduction: Potentially inappropriate medications (PIMs) use among the elderly people is an important public health concern. Objectives: To investigate the prevalence of PIMs prescribed for the elderly patients and the factors associated with it. Methods: A cross-sectional study was conducted in a Malaysia suburban hospital involving community dwellers aged ≥60 years old who were admitted into the internal medicine discipline from 1 June to 31 December 2015. PIMs was screened with American Geriatrics Society 2015 updated Beers criteria. Results: There were 61.9% of the study subjects prescribed with at least one PIMs. The top three PIMs to avoid were proton-pump inhibitor (13.8%), prazosin (9.2%), and glibenclamide (8.7%). The most common PIMs to be used with caution in older adults was diuretic, specifically, loop diuretic 14.7%, thiazides 13.8%, and potassium–sparing diuretic 6.4%. Polymorbidity and polypharmacy were significantly associated with PIMs use, with p=0.033 and p<0.001 respectively. Study subjects with polypharmacy had an increase odds of 3 times (adjusted odds ratio=3.062, 95% CI 1.619:5.793) in having PIMs prescribed for them compared to those without polypharmacy. Conclusion: The prevalence of PIMs detected in this Malaysia suburban hospital was high. Polypharmacy was the only factor showed to be significantly associated with PIMs use.
Keywords:
Beers criteria, potentially inappropriate medications, elderly, geriatrics
Downloads
Download data is not yet available.
References
Bradley, M. C., Fahey, T., Cahir, C., Bennett, K., O’Reilly, D., Parsons, C., & Hughes, C. M. (2012). Potentially inappropriate prescribing and cost outcomes for older people: a cross-sectional study using the Northern Ireland Enhanced Prescribing Database. European journal of clinical pharmacology, 68(10), 1425-1433.
Cahir, C., Fahey, T., Teeling, M., Teljeur, C., Feely, J., & Bennett, K. (2010). Potentially inappropriate prescribing and cost outcomes for older people: a national population study. British journal of clinical pharmacology, 69(5), 543-552.
Chan, S. P., & Colagiuri, S. (2015). Systematic review and meta-analysis of the efficacy and hypoglycemic safety of gliclazide versus other insulinotropic agents. Diabetes research and clinical practice, 110(1), 75-81.
Chang, C. M., Liu, P. Y. Y., Yang, Y. H. K., Yang, Y. C., Wu, C. F., & Lu, F. H. (2005). Use of the Beers criteria to predict adverse drug reactions among first‐visit elderly outpatients. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 25(6), 831-838.
Charlesworth, C. J., Smit, E., Lee, D. S., Alramadhan, F., & Odden, M. C. (2015). Polypharmacy among adults aged 65 years and older in the United States: 1988–2010. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 70(8), 989-995.
Cheen, M. H. H., Goon, C. P., Ong, W. C., Lim, P. S., Wan, C. N., Leong, M. Y., & Khee, G. Y. (2016). Evaluation of a care transition program with pharmacist-provided home-based medication review for elderly Singaporeans at high risk of readmissions. International Journal for Quality in Health Care, 29(2), 200-205.
Endres, H. G., Kaufmann-Kolle, P., Knopf, H., & Thuermann, P. A. (2018). Which factors are associated with the use of potentially inadequate medications (PIM) in the elderly?: results from the German health interview and examination survey (DEGS1). Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 61(1), 40-51.
Fick, D. M., Mion, L. C., Beers, M. H., & L. Waller, J. (2008). Health outcomes associated with potentially inappropriate medication use in older adults. Research in nursing & health, 31(1), 42-51.
Fick, D. M., Semla, T. P., Beizer, J., Brandt, N., Dombrowski, R., DuBeau, C. E., Eisenberg, W., Epplin, J. J., Flanagan, N., Giovannetti, E., Hanlon, J., Hollmann, P., Laird, R., Linnebur, S., Sandhu, S., & Steinman, M. (2015). American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 63(11), 2227-2246.
Greco, D., Pisciotta, M., Gambina, F., & Maggio, F. (2010). Severe hypoglycaemia leading to hospital admission in type 2 diabetic patients aged 80 years or older. Experimental and clinical endocrinology & diabetes, 118(04), 215-219.
Häußinger, G., & Bachmann, K. (1983). Nitrate-induced orthostatic hypotension and long-term circulatory adaptation. Zeitschrift fur Kardiologie, 72, 255-258.
Jano, E., & Aparasu, R. R. (2007). Healthcare outcomes associated with beers' criteria: a systematic review. Annals of Pharmacotherapy, 41(3), 438-448.
Jyrkkä, J., Enlund, H., Korhonen, M. J., Sulkava, R., & Hartikainen, S. (2009). Polypharmacy status as an indicator of mortality in an elderly population. Drugs & aging, 26(12), 1039-1048.
Kaufman, D. W., Kelly, J. P., Rosenberg, L., Anderson, T. E., & Mitchell, A. A. (2002). Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA, 287(3), 337-344.
Klarin, I., Wimo, A., & Fastbom, J. (2005). The association of inappropriate drug use with hospitalisation and mortality. Drugs & aging, 22(1), 69-82.
Laroche, M. L., Charmes, J. P., Nouaille, Y., Picard, N., & Merle, L. (2007). Is inappropriate medication use a major cause of adverse drug reactions in the elderly?. British journal of clinical pharmacology, 63(2), 177-186.
Lau, D. T., Kasper, J. D., Potter, D. E. B., Lyles, A., & Bennett, R. G. (2005). Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Archives of internal medicine, 165(1), 68-74.
Luisi, A. F., Owens, N. J., & Hume, A. L. (1999). Drugs and the elderly. In J. J. Gallo & W. Reichel (Eds), Reichel's care of the elderly: clinical aspects of aging (pp. 59-87). Philadelphia : Williams & Wilkins.
Lutz, B. H., Miranda, V. I. A., & Bertoldi, A. D. (2017). Potentially inappropriate medications among older adults in Pelotas, Southern Brazil. Revista de saude publica, 51, 52.
Maes, M. L., Fixen, D. R., & Linnebur, S. A. (2017). Adverse effects of proton-pump inhibitor use in older adults: a review of the evidence. Therapeutic advances in drug safety, 8(9), 273-297.
Mangoni, A. A., & Jackson, S. H. (2004). Age‐related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. British journal of clinical pharmacology, 57(1), 6-14.
Montiel-Luque, A., Núñez-Montenegro, A. J., Martín-Aurioles, E., Canca-Sánchez, J. C., Toro-Toro, M. C., González-Correa, J. A., & Polipresact Research Group. (2017). Medication-related factors associated with health-related quality of life in patients older than 65 years with polypharmacy. PloS one, 12(2), e0171320.
Morin, L., Laroche, M. L., Texier, G., & Johnell, K. (2016). Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. Journal of the American Medical Directors Association, 17(9), 862-e1.
Niccoli, T., & Partridge, L. (2012). Ageing as a risk factor for disease. Current Biology, 22(17), R741-R752.
Onda, M., Imai, H., Takada, Y., Fujii, S., Shono, T., & Nanaumi, Y. (2015). Identification and prevalence of adverse drug events caused by potentially inappropriate medication in homebound elderly patients: a retrospective study using a nationwide survey in Japan. BMJ open, 5(8), e007581.
Oscanoa, T. J., Lizaraso, F., & Carvajal, A. (2017). Hospital admissions due to adverse drug reactions in the elderly. A meta-analysis. European journal of clinical pharmacology, 73(6), 759-770.
Perri III, M., Menon, A. M., Deshpande, A. D., Shinde, S. B., Jiang, R., Cooper, J. W., Cook, C. L., Griffin, S. C., & Lorys, R. A. (2005). Adverse outcomes associated with inappropriate drug use in nursing homes. Annals of Pharmacotherapy, 39(3), 405-411.
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., Falk, V., González‐Juanatey, J. R., Harjola, V. P., Jankowska, E. A., & Jessup, M. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure, 18(8), 891-975.
Reich, O., Rosemann, T., Rapold, R., Blozik, E., & Senn, O. (2014). Potentially inappropriate medication use in older patients in Swiss managed care plans: prevalence, determinants and association with hospitalization. PloS one, 9(8), e105425.
Schmader, K. E., Hanlon, J. T., Landsman, P. B., Samsa, G. P., Lewis, I. K., & Weinberger, M. (1997). Inappropriate prescribing and health outcomes in elderly veteran outpatients. Annals of Pharmacotherapy, 31(5), 529-533.
Stockl, K. M., Le, L., Zhang, S., & Harada, A. S. (2010). Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly. The American journal of managed care, 16(1), e1-10.
Storms, H., Marquet, K., Aertgeerts, B., & Claes, N. (2017). Prevalence of inappropriate medication use in residential long-term care facilities for the elderly: A systematic review. European Journal of General Practice, 23(1), 69-77.
Taylor, A. L., Ziesche, S., Yancy, C., Carson, P., D'Agostino Jr, R., Ferdinand, K., Taylor, M., Adams, K., Sabolinski, M., Worcel, M., & Cohn, J. N. (2004). Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. New England Journal of Medicine, 351(20), 2049-2057.
Thomas, R. E. (2016). Assessing medication problems in those≥ 65 using the STOPP and START criteria. Current aging science, 9(2), 150-158.
Wan, H., Goodkind, D., & Kowal, P. (2016). An aging world: 2015. International population reports.
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., & MacLaughlin, E. J. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71(19), e127-e248.
World Health Organization, 2013. 18th Model list of essential medicines. http://www.who.int/medicines/publications/essentialmedicines/en/index.html (accessed 10 October 2018).
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., Fonarow, G. C., Geraci, S. A., Horwich, T., Januzzi, J. L., & Johnson, M. R. (2013). 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16), e147-e239.
Cahir, C., Fahey, T., Teeling, M., Teljeur, C., Feely, J., & Bennett, K. (2010). Potentially inappropriate prescribing and cost outcomes for older people: a national population study. British journal of clinical pharmacology, 69(5), 543-552.
Chan, S. P., & Colagiuri, S. (2015). Systematic review and meta-analysis of the efficacy and hypoglycemic safety of gliclazide versus other insulinotropic agents. Diabetes research and clinical practice, 110(1), 75-81.
Chang, C. M., Liu, P. Y. Y., Yang, Y. H. K., Yang, Y. C., Wu, C. F., & Lu, F. H. (2005). Use of the Beers criteria to predict adverse drug reactions among first‐visit elderly outpatients. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 25(6), 831-838.
Charlesworth, C. J., Smit, E., Lee, D. S., Alramadhan, F., & Odden, M. C. (2015). Polypharmacy among adults aged 65 years and older in the United States: 1988–2010. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 70(8), 989-995.
Cheen, M. H. H., Goon, C. P., Ong, W. C., Lim, P. S., Wan, C. N., Leong, M. Y., & Khee, G. Y. (2016). Evaluation of a care transition program with pharmacist-provided home-based medication review for elderly Singaporeans at high risk of readmissions. International Journal for Quality in Health Care, 29(2), 200-205.
Endres, H. G., Kaufmann-Kolle, P., Knopf, H., & Thuermann, P. A. (2018). Which factors are associated with the use of potentially inadequate medications (PIM) in the elderly?: results from the German health interview and examination survey (DEGS1). Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 61(1), 40-51.
Fick, D. M., Mion, L. C., Beers, M. H., & L. Waller, J. (2008). Health outcomes associated with potentially inappropriate medication use in older adults. Research in nursing & health, 31(1), 42-51.
Fick, D. M., Semla, T. P., Beizer, J., Brandt, N., Dombrowski, R., DuBeau, C. E., Eisenberg, W., Epplin, J. J., Flanagan, N., Giovannetti, E., Hanlon, J., Hollmann, P., Laird, R., Linnebur, S., Sandhu, S., & Steinman, M. (2015). American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 63(11), 2227-2246.
Greco, D., Pisciotta, M., Gambina, F., & Maggio, F. (2010). Severe hypoglycaemia leading to hospital admission in type 2 diabetic patients aged 80 years or older. Experimental and clinical endocrinology & diabetes, 118(04), 215-219.
Häußinger, G., & Bachmann, K. (1983). Nitrate-induced orthostatic hypotension and long-term circulatory adaptation. Zeitschrift fur Kardiologie, 72, 255-258.
Jano, E., & Aparasu, R. R. (2007). Healthcare outcomes associated with beers' criteria: a systematic review. Annals of Pharmacotherapy, 41(3), 438-448.
Jyrkkä, J., Enlund, H., Korhonen, M. J., Sulkava, R., & Hartikainen, S. (2009). Polypharmacy status as an indicator of mortality in an elderly population. Drugs & aging, 26(12), 1039-1048.
Kaufman, D. W., Kelly, J. P., Rosenberg, L., Anderson, T. E., & Mitchell, A. A. (2002). Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA, 287(3), 337-344.
Klarin, I., Wimo, A., & Fastbom, J. (2005). The association of inappropriate drug use with hospitalisation and mortality. Drugs & aging, 22(1), 69-82.
Laroche, M. L., Charmes, J. P., Nouaille, Y., Picard, N., & Merle, L. (2007). Is inappropriate medication use a major cause of adverse drug reactions in the elderly?. British journal of clinical pharmacology, 63(2), 177-186.
Lau, D. T., Kasper, J. D., Potter, D. E. B., Lyles, A., & Bennett, R. G. (2005). Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Archives of internal medicine, 165(1), 68-74.
Luisi, A. F., Owens, N. J., & Hume, A. L. (1999). Drugs and the elderly. In J. J. Gallo & W. Reichel (Eds), Reichel's care of the elderly: clinical aspects of aging (pp. 59-87). Philadelphia : Williams & Wilkins.
Lutz, B. H., Miranda, V. I. A., & Bertoldi, A. D. (2017). Potentially inappropriate medications among older adults in Pelotas, Southern Brazil. Revista de saude publica, 51, 52.
Maes, M. L., Fixen, D. R., & Linnebur, S. A. (2017). Adverse effects of proton-pump inhibitor use in older adults: a review of the evidence. Therapeutic advances in drug safety, 8(9), 273-297.
Mangoni, A. A., & Jackson, S. H. (2004). Age‐related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. British journal of clinical pharmacology, 57(1), 6-14.
Montiel-Luque, A., Núñez-Montenegro, A. J., Martín-Aurioles, E., Canca-Sánchez, J. C., Toro-Toro, M. C., González-Correa, J. A., & Polipresact Research Group. (2017). Medication-related factors associated with health-related quality of life in patients older than 65 years with polypharmacy. PloS one, 12(2), e0171320.
Morin, L., Laroche, M. L., Texier, G., & Johnell, K. (2016). Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. Journal of the American Medical Directors Association, 17(9), 862-e1.
Niccoli, T., & Partridge, L. (2012). Ageing as a risk factor for disease. Current Biology, 22(17), R741-R752.
Onda, M., Imai, H., Takada, Y., Fujii, S., Shono, T., & Nanaumi, Y. (2015). Identification and prevalence of adverse drug events caused by potentially inappropriate medication in homebound elderly patients: a retrospective study using a nationwide survey in Japan. BMJ open, 5(8), e007581.
Oscanoa, T. J., Lizaraso, F., & Carvajal, A. (2017). Hospital admissions due to adverse drug reactions in the elderly. A meta-analysis. European journal of clinical pharmacology, 73(6), 759-770.
Perri III, M., Menon, A. M., Deshpande, A. D., Shinde, S. B., Jiang, R., Cooper, J. W., Cook, C. L., Griffin, S. C., & Lorys, R. A. (2005). Adverse outcomes associated with inappropriate drug use in nursing homes. Annals of Pharmacotherapy, 39(3), 405-411.
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., Falk, V., González‐Juanatey, J. R., Harjola, V. P., Jankowska, E. A., & Jessup, M. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure, 18(8), 891-975.
Reich, O., Rosemann, T., Rapold, R., Blozik, E., & Senn, O. (2014). Potentially inappropriate medication use in older patients in Swiss managed care plans: prevalence, determinants and association with hospitalization. PloS one, 9(8), e105425.
Schmader, K. E., Hanlon, J. T., Landsman, P. B., Samsa, G. P., Lewis, I. K., & Weinberger, M. (1997). Inappropriate prescribing and health outcomes in elderly veteran outpatients. Annals of Pharmacotherapy, 31(5), 529-533.
Stockl, K. M., Le, L., Zhang, S., & Harada, A. S. (2010). Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly. The American journal of managed care, 16(1), e1-10.
Storms, H., Marquet, K., Aertgeerts, B., & Claes, N. (2017). Prevalence of inappropriate medication use in residential long-term care facilities for the elderly: A systematic review. European Journal of General Practice, 23(1), 69-77.
Taylor, A. L., Ziesche, S., Yancy, C., Carson, P., D'Agostino Jr, R., Ferdinand, K., Taylor, M., Adams, K., Sabolinski, M., Worcel, M., & Cohn, J. N. (2004). Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. New England Journal of Medicine, 351(20), 2049-2057.
Thomas, R. E. (2016). Assessing medication problems in those≥ 65 using the STOPP and START criteria. Current aging science, 9(2), 150-158.
Wan, H., Goodkind, D., & Kowal, P. (2016). An aging world: 2015. International population reports.
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., & MacLaughlin, E. J. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71(19), e127-e248.
World Health Organization, 2013. 18th Model list of essential medicines. http://www.who.int/medicines/publications/essentialmedicines/en/index.html (accessed 10 October 2018).
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., Fonarow, G. C., Geraci, S. A., Horwich, T., Januzzi, J. L., & Johnson, M. R. (2013). 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16), e147-e239.
Statistics
791 Views | 510 Downloads
How to Cite
Lau, B., Ng, S., Anuar, M. A., & Shuhaila, A. (2019). Pattern of Use and Prevalence of Potentially Inappropriate Medications among Elderly Patients in a Malaysia Suburban Hospital. International Journal of Advancement in Life Sciences Research, 2(3), 30-38. Retrieved from https://ijalsr.org/index.php/journal/article/view/60
Section
Research Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
.