American Geriatrics Society-Beers Criteria and adverse drug reactions: a comparative cross-sectional study of Nigerian and South African older inpatients

Abstract

BackgroundThe Beers Criteria were developed with the aim of improving the safety of medicines among older persons. While the association between the Beers’ list of potentially inappropriate medicines (PIMs) and adverse drug reactions (ADRs) among older Caucasians is contentious, the ability of the Criteria to predict ADRs among older persons in Africa remains unexplored.ObjectivesThis study aimed to compare the prevalence of PIMs and ADRs among hospitalized older persons in Nigeria and South Africa, and to determine the association between the 2015 American Geriatrics Society-Beers (AGS-Beers) PIMs and ADRs.MethodsThe medical records of older persons aged ≥60 years who were hospitalized in teaching hospitals in Nigeria and South Africa were randomly selected, and retrospectively evaluated for ADRs by two clinical pharmacists using the Naranjo algorithm. The PIMs were assessed using the 2015 AGS-Beers Criteria. A multivariate logistic regression was used to determine the associated factors for ADRs among the hospitalized older persons, with P<0.05 being considered significant.ResultsThe samples which comprised 268 and 339 hospitalized older persons (mean age 70.53±8.22; 95% CI −0.21 to 2.32 vs mean age 69.49±7.64; 95% CI −0.25 to 2.34, P=0.11) were evaluated in Nigeria and South Africa, respectively. The PIMs among the older persons in Nigeria were 32.1% (86/268) and 30.1% (102/339, OR=0.91, 95% CI 0.64–1.29, P=0.6) for South Africa; 13.8% (37/268) of the hospitalized older persons in Nigeria experienced 43 cases of ADRs compared to 9.1% (31/339) in South Africa (95% CI 0.38–1.04, P=0.07). The multivariate analysis showed no association between PIMs and ADRs among the hospitalized older persons in Nigeria (OR=1.48 95% CI 0.70–3.17, P=0.31) and South Africa (OR=1.09, 95% CI 0.48–2.49, P=0.83).ConclusionThe 2015 AGS-Beers PIMs were not associated with ADRs among the hospitalized older persons in Nigeria and South Africa. However, physicians should be cautious when prescribing certain medications in the AGS-Beers list.

Physician’s Knowledge of Appropriate Prescribing for the Elderly—A Survey Among Family and Internal Medicine Physicians in Nigeria

“…The body of research in the area of prescription of potentially inappropriate medications and its consequences in elderly patients continues to grow in developing countries, like Nigeria and South Africa (Fadare et al, 2013; Fadare et al, 2015; Van Heerden et al, 2016; Akande-Sholabi et al, 2018; Saka et al, 2018). With improvement in the management of communicable diseases, such as HIV/AIDS, malaria, and tuberculosis, people are living longer in many developing countries and as such the proportion of elderly patients is expected to rise significantly in the next decade.…”

Expert consensus on clinical applicability of the American Geriatrics Society‐Beers Criteria to older persons in Africa: An exploratory validation study

“…First, the 2015 AGS‐Beers Criteria original recommendations with the caveats were included in the survey, with special consideration for the medicines reported to be commonly inappropriately prescribed among Africans . Secondly, some of the parent recommendations were modified based on the observation of a previous study by the research team that showed associations between certain AGS‐Beers potential inappropriate medications (PIMs) and adverse drug reactions (ADRs) among older inpatients in Nigeria and South Africa . For instance, the 2015 AGS‐Beers Criteria recommend spironolactone to be avoided in renal impairment (Crcl < 30 mL/min), but based on the finding of the above study, the threshold for renal impairment was increased to <60 mL/min in this present study.…”

“…For instance, the 2015 AGS‐Beers Criteria recommend spironolactone to be avoided in renal impairment (Crcl < 30 mL/min), but based on the finding of the above study, the threshold for renal impairment was increased to <60 mL/min in this present study. Tramadol was also recommended to be “avoided” against cautious use stipulated in the 2015 AGS‐Beers Criteria based on the finding of the above‐cited study …”

“…Many explicit criteria including the American Geriatrics‐Beers (AGS‐Beers) Criteria, the Screening Tool of Older People's Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) Criteria, developed in Ireland, and the Fit for the Aged (FORTA) in Germany have been developed to improve the quality of prescribing to older persons . Despite evidence suggesting that potential inappropriate prescribing (PIP) is rife in Africa and is associated with adverse effects among the continent's older persons, there is a lack of locally available explicit criteria to guide prescribing to this group of patients. It is, therefore, imperative that relevant criteria to guide prescribing of medications to this population are contextualized.…”

“…The AGS‐Beers Criteria appear to enjoy wider acceptance among African researchers than any other explicit criteria judging from literature . However, there is a dearth of knowledge on the applicability of the criteria recommendations to older persons on the continent.…”