Associations Between Potentially Inappropriate Medications and Adverse Health Outcomes in the Elderly: A Systematic Review and Meta-analysis

Abstract

Background: Adverse drug outcomes in the elderly have led to the development of lists of potentially inappropriate medications (PIMs), such as the Beers criteria, and these PIMs have been studied widely; however, it is still unclear whether PIM use is predictive of adverse outcomes in older people. Objective: To qualitatively examine the associations between exposure to PIMs from the general Beers criteria and the Screening Tool of Older Persons’ Prescriptions list and adverse outcomes, such as adverse drug reactions (ADRs)/adverse drug events (ADEs), hospitalization, and mortality. Methods: Specified databases were searched from inception to February 1, 2018. Two reviewers independently selected studies that met the inclusion criteria, assessed study quality, and extracted data. Data were pooled using Stata 12.0. The outcomes were ADRs/ADEs, hospitalization, and mortality. Results: A total of 33 studies met the inclusion criteria. The combined analysis revealed a statistically significant association between ADRs/hospitalizations and PIMs (odds ratio [OR] = 1.44, 95% CI = 1.33-1.56; OR = 1.27, 95% CI = 1.20-1.35), but no statistically significant association was found between mortality and PIMs (OR = 1.04; 95% CI = 0.75-1.45). It is interesting to note that the results changed when different continents/criteria were used for the analysis. Compared with the elderly individuals exposed to 1 PIM, the risk of adverse health outcomes was much higher for those who took ≥2 PIMs. Conclusion and Relevance: We recommend that clinicians avoid prescribing PIMs for older adults whenever feasible. In addition, the observed associations should be generalized to other countries with different PIM criteria with caution.

Potentially inappropriate medication and attitudes of older adults towards deprescribing

“…Due to associated negative health consequences (e.g. reduced adherence and quality of life and increased risk of adverse drug reactions and hospitalizations), PIMs are an unnecessary burden to the older population [ 10 – 12 ].…”

The impact of hospitalisation to geriatric wards on the use of medications and potentially inappropriate medications - a health register study

“…Consequently, we may not consider all PIMs identified by the EU(7)-PIM list to represent inappropriate prescribing in our population. Unlike the START/STOPPlist [6], the relationship between the EU(7)-PIM list and the NORGEP-NH list and adverse health outcomes in older adults is yet to be established. Research is needed to validate the ability of these newly developed PIM lists Admittance to a geriatric ward is an opportunity to improve the quality of medication use in older patients.…”

“…Identification of PIMs is particularly relevant when safer or more effective treatment alternatives exist [5]. In older adults, PIMs are associated with an increased risk of ADEs and hospitalisations and is a public health concern [6].…”

Aplicação dos Critérios de Beers de 2015 Operacionalizados para Portugal em Pessoas Idosas Institucionalizadas: Um Estudo Transversal

“…15,[19][20][21][22][23][24] Além disso, as alterações fisiológicas do envelhecimento nos processos de farmacocinética e farmacodinâmica tornam as pessoas idosas mais suscetíveis a interações medicamentosas, efeitos tóxicos e adversos das drogas. 25 Todos estes fatores em sinergia propiciam a ocorrência de eventos adversos aos medicamentos (EAMs) 26,27 e, consecutivamente, da potencial cascata iatrogénica (prescrição em cascata ou cascata medicamentosa).…”