A retrospective evaluation of the association between potentially inappropriate prescribing and adverse drug reactions among hospitalized elderly Nigerians

Abstract

Background Potentially inappropriate prescribing is associated with adverse clinical outcomes in the elderly. The Beers Criteria were developed to improve the quality of medication prescribing and safety to the elderly. However, the nexus between the Criteria’s potentially inappropriate medicines (PIMs) and adverse drug reactions (ADRs) remains controversial in clinical practice. This study aimed to evaluate the association between the 2015 American Geriatrics Society-Beers’ (AGS-Beers) PIMs and ADRs among elderly inpatients. Methods A cross-sectional retrospective study was carried out among elderly patients aged ≥ 60 years that were hospitalized between 1st January and 31st December 2016 at the internal medicine wards of a Nigerian University teaching hospital. Eligible elders that were hospitalized or died within 24 hours were excluded from the study. The medical records of eligible participants were randomly selected and information including patients’ socio-demographics, medication and medical histories, and medicines utilization during hospitalization were extracted from the records. Two clinical pharmacists evaluated the medical charts for PIMs using the 2015 AGS-Beers Criteria and ADRs using the Naranjo algorithm. Bivariate analyses and subsequently, a binary logistic regression, were carried out to determine the association between independent variables and ADRs with P<0.05 being considered significant. Results A total of 268 participants mean age, 70.53 (8.22) years were evaluated. According to the AGS-Beers Criteria, 32.1% (86/268) received at least one PIM, 13.8% (37/268) experienced 43 ADRs during hospitalization of which diclofenac was the most implicated medication for it (8/43, 18.6%). The AGS-Beers’ PIMs were not associated with ADRs in the bivariate analysis (p=0.24). The diagnoses of musculoskeletal disorders (OR=7.38, 95%CI=2.68-20.34, p<0.001) and the use of anticholinergic medications (OR=4.02,95%CI=1.04-15.58, p=0.04) were significantly associated with ADRs in the logistic regression. Conclusion The elderly inpatients experienced ADRs which were associated with diagnoses of musculoskeletal disorders and anticholinergic medications but not the 2015 AGS-Beers’ PIM in the Nigerian teaching hospital. Keywords: adverse drug reaction, Beers criteria, elderly inpatient, potential inappropriate prescribing Running title: Potential inappropriate prescribing and adverse drug reactions in elderly

A review of geriatric care training in the undergraduate nursing and medical curricula at the University of KwaZulu-Natal, South Africa

“…[4] Reports of polypharmacy and adverse drug reactions in elderly patients are ascribed to fragmented and inappropriate management of older adults. [5] The World Health Organization highlights the need for greater interdisciplinary team skills among primary care providers to improve the care of older adults. [6] While interprofessional collaboration and care are inherent in general nursing practice, there is little inclusion of interprofessional education (IPE) within nursing education to prepare graduates to provide co-ordinated care to older adults.…”