Comparison of prescribing criteria in hospitalised Australian elderly

Abstract

The Beers criteria (2003) and McLeod criteria (1997) have been applied internationally to quantify inappropriate prescribing in elderly populations. Similarly, guidelines have been published locally by the National Prescribing Service (NPS). Objective This study aimed to adapt, evaluate and compare the utility of these three established criteria in measuring prescribing appropriateness in a sample of hospitalised elderly patients. Methods Initial refinement of the criteria produced versions applicable to Australian practice. Inpatient records of 202 patients aged 65 years or older in six wards of the Princess Alexandra Hospital, Brisbane, Australia, were reviewed using the adapted criteria. ‘Potentially inappropriate’ prescribing was descriptively analysed using relevant denominators. Results The adapted criteria collectively listed 70 ‘potentially inappropriate’ medicines or drug groups and 116 ‘potentially inappropriate’ prescribing practices. Patients (mean age 80.0; SD=8.3 years) were prescribed, a median of eight medicines (SD=4.0). At least one ‘potentially inappropriate’ medicine was identified in 110 (55%) patients. ‘Potentially inappropriate’ prescribing practices averaged 1.1 per patient (range 1-6). The adapted Beers criteria identified more ‘potentially inappropriate’ medicines/practices (44%, 101/232) than the McLeod criteria (41%) and NPS criteria (16%). Aspirin, benzodiazepines, beta-blockers and dipyridamole were most commonly identified. Conclusion The Beers and McLeod criteria, developed internationally, required considerable modification for local prescribing. The three criteria differed in their focus and approaches, such that development and validation of national criteria, using the key features of these models, is recommended. There is potential to apply validated guidelines in clinical practice and review of prescribing, but only to supplement clinical judgement.

Potentially inappropriate prescribing in institutionalised older patients in Spain: the STOPP-START criteria compared with the Beers criteria

“…The prevalence of using inadequate psychotropic drugs in the Spanish institutionalised population was 12.5%, with diazepam as one of the most often prescribed drugs 32. Benzodiazepines use in older people was also one of the most common potential problems identified in many studies 19,25,33,34. Psychotropic medication is extensively used in Australian nursing homes for indications other than schizophrenia 35.…”

Potentially inappropriate medication use in older people with cancer: Prevalence and correlates

“…However, differences in medication availability may mean the results in Australia are not directly comparable to those of US studies. 54 Furthermore, the Beers Criteria were designed for general samples of older people and, therefore, may not be fully applicable for cancerspecific indications. Nevertheless, our data were collected at each patient's initial consultation and only 12.7% of our sample had a previous cancer diagnosis.…”

Análisis de la prescripción de medicamentos en una comunidad geriátrica Argentina

“…Aproximadamente la mitad de las personas que residían en el Hospital Geriátrico consumía regularmente seis o más fármacos por día, este hallazgo es consistente con el reportado en estudios epidemiológicos de otros países [8][9][10][11] , así como también los grupos de drogas más utilizados 12,13 . Contrariamente a lo esperado, no se encontró relación significativa entre la utilización de fárma-cos del grupo A02 y los AINEs.…”

“…Al igual que en otros estudios, se encontró una fuerte asociación entre polimedicación y consumo de MPI 8,28,29 . En cambio, la prevalencia de MPI resultó más elevada que la reportada 8,9,11,28,29 . Puesto que se utilizaron los Criterios de Beers actualizados en 2012 y que al momento de la presentación de este trabajo no se publicaron estudios similares basados en ellos, las comparaciones no resultan adecuadas.…”