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

Abstract

ObjectivesA nationwide large-scale survey was conducted to identify the prevalence and causal medications of adverse drug events (ADEs) that are caused by potentially inappropriate medications (PIMs) given to homebound elderly patients, factors associated with ADEs, and measures taken by pharmacists to manage ADEs and their effects on ADEs.SettingsA questionnaire was mailed to 3321 pharmacies nationwide. It asked about the details of PIMs and ADEs of up to 5 patients for whom home visits were provided by a pharmacist. Questionnaire forms were filled in by pharmacists who visited the patients.Design and participantsBetween 23 January and 13 February 2013, comprehensive assessment forms were sent to 3321 pharmacies. Data collected from 1890 pharmacies including data of 4815 patients were analysed and 28 patients of unknown sex were excluded. Their average age was 82.7 years. PIMs were identified based on the 2003 Beers Criteria Japan.ResultsThere were 600 patients who did not provide valid answers regarding the medications. In the remaining 4243 patients, one or more medications that were considered to be PIMs had been prescribed to 48.4% of patients. PIM-induced ADEs were found in 8% of these patients by pharmacists during home visits. The top ADE-inducing medications were strong anticholinergic antihistamines, benzodiazepines, sulpiride and digoxin. The most common ADEs associated with benzodiazepines were frequent lightheadedness, somnolence and sleepiness, which increase the risk of falls and subsequent fractures in elderly patients. The following factors associated with ADEs were identified: sex, pharmacist awareness of prescription issues, frequency of visits and time spent at patients’ homes, and the frequency of detailed checks for patient adverse reactions by pharmacists.ConclusionsThe PIM prevalence associated with home healthcare in Japan was relatively high, as reported in previous studies. The present study suggests that pharmacists could reduce the incidence of PIMs and consequent ADEs.

Efficacy of pharmacists' assessment and intervention based on Screening Tool for Older Persons' Appropriate Prescriptions for Japanese compared with Screening Tool for Older Persons' Appropriate Prescriptions for Japanese criteria version 2 in older patients with cardiovascular disease

“…PIM are often prescribed to the Japanese older adults, and become a problem that needs to be resolved. A nationwide survey carried out in Japan reported that 48.4% of study patients were prescribed PIM based on the 2003 Beers Criteria Japan . To enhance the safety of geriatric pharmacotherapy in Japan, the Japan Geriatrics Society published the “Guidelines for medical treatment and its safety in the elderly 2005.” The guidelines were completely revised in 2016 based on a systematic review and were renamed the “Screening Tool for Older Persons' Appropriate Prescriptions for Japanese (STOPP‐J).” STOPP‐J includes two lists: “List of drugs to be prescribed with special caution” and “List of drugs to consider starting.” The “List of drugs to be prescribed with special caution” shows the drug classes that are likely to cause serious adverse effects in older patients, along with their indications and recommended usage .…”

Factors associated with polypharmacy in elderly home‐care patients

“…The OR for PIM was also significant at 4.992. It has been reported that increasing the number of prescribed medications induces an increase in the number of PIM, and that polypharmacy is associated with PIM . In addition, it has been suggested that polypharmacy is triggered by so‐called prescribing cascades, and several drug classes (e.g.…”

Factors associated with potentially harmful drug–drug interactions in older Korean people: A population‐based study

“…The resultant side‐effects increase healthcare costs, as well as the rates of both morbidity and mortality . Polypharmacy and inappropriate drug use in older adults occur around the world . A cohort study carried out in Brazil showed that inappropriate drug use in older adults increased the mortality rate by 44% .…”