Number of medications or number of diseases: what influences underprescribing?

Gorup, Eva Cedilnik; Šter, Marija Petek

doi:10.1007/s00228-017-2336-x

Cited by 14 publications

(31 citation statements)

References 40 publications

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“… 14 This prescription pattern is surprisingly prevalent among older adults receiving polypharmacy (22%–77%) based on data from previously published studies. 14 , 15 , 16 Under‐prescription of medications is associated with ADRs (such as a greater risk of cardiovascular events, disability, and mortality). 16 , 17 It is worth mentioning that under‐prescription of medications does not take into account that some patients may truly have a good reason not to initiate the treatment, which limits the reliability of its definition.…”

Section: Introductionmentioning

confidence: 99%

“… 14 , 15 , 16 Under‐prescription of medications is associated with ADRs (such as a greater risk of cardiovascular events, disability, and mortality). 16 , 17 It is worth mentioning that under‐prescription of medications does not take into account that some patients may truly have a good reason not to initiate the treatment, which limits the reliability of its definition. Previously, under‐prescribing of medications focused on the treatment of specific diseases (e.g., heart failure, diabetes, dementia, depression, and osteoporosis) or symptoms (e.g., pain).…”

Section: Introductionmentioning

confidence: 99%

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Under‐prescription of medications in older adults according to START criteria: A cross‐sectional study in Lebanon

Hanna

Chahine

Souheil

2022

Health Science Reports

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Background and Aims Under‐prescription is defined as the exclusion of medications indicated for the treatment of certain conditions without any rationale for not prescribing them. The under‐prescription of medications is highly prevalent among older adults (≥65 years) receiving polypharmacy. This study aimed to assess the prevalence of the under‐prescription of medications using the Screening Tool to Alert to Right Treatment (START) criteria version 2 and to identify the predictors of having potential prescribing omissions (PPOs). Methods This cross‐sectional, face‐to‐face interview study was carried out between September 2021 and February 2022. The study comprised community‐dwelling older adults taking at least one medication on a regular basis. The study questionnaire included the patients' demographics, clinical data, and comorbidities. PPOs were identified using the START criteria. The χ 2 test was used to assess the association between under‐prescription of medication and the demographic/clinical variables. Multivariable logistic regression was performed to explore factors associated with under‐prescription of medications as the dependent variable and taking all variables that showed a p < 0.05 in the bivariate analysis as independent. Results A total of 444 older adults agreed to participate in this study. The mean age of participants was 71 ± 8.6; the majority of them, 305 (68.7%), were men. Polypharmacy was present in 261 patients (58.8%) and underprescribing of medications in 260 patients (58.6%). The highest percentage of under‐prescribing of medications was reported with statins in 115 patients (44.2%) followed by aspirin in 93 (35.7%), and angiotensin‐converting enzyme inhibitors in 61 (23.4%). The results of the multivariable analysis showed that patients with underprescribed medications had higher odds of polypharmacy (odds ratio [OR]: 2.015, confidence interval [CI] 95% 1.362–2.980, p < 0.001) and higher Charlson Comorbidity Index (OR 2.807, CI 95% 1.463–5.85, p = 0.02). Conclusion The present findings highlight that PPOs are highly prevalent among community‐dwelling older adults in Lebanon. Multimorbidity and polypharmacy were the identified predictors for under‐prescription of medications in this population.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Under‐prescription of medications in older adults according to START criteria: A cross‐sectional study in Lebanon

Hanna

Chahine

Souheil

2022

Health Science Reports

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“…Our findings are not surprising, considering research chronology of PIM in the elderly in our country and consequent growing awareness of MDs after this researches. On the other hand, there is a large pool of biomedical evidence in conflicting reports on polypharmacy effect on PIM and further cross-sectional national study will further clarify this topic in detail in different geographic areas in Serbia [26][27][28] .…”

Section: Discussionmentioning

confidence: 98%

“…Multivariable logistic regression showed strong influence of this factor and present significant risk factor through adjusted OR value of 3.99. This can be explained by large number of medical specialist examination at patients with comorbidity and consequently and consequently the simultaneous prescribing of drugs that enter into potential interactions according to Beers criteria [24][25][26][27][28][29] .…”

Section: Discussionmentioning

confidence: 99%

Potentially inappropriate medication prescribing among elderly patients with cardiovascular diseases

Stojanović¹,

Djurić

Jakovljevic³

et al. 2022

VOJNOSANIT PREGL

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Background/Aim: The purpose of the conducted study was to show the frequencies of PIM in the elderly population with cardiovascular diseases and to describe factors with significant impact on PIM present in the elderly population. Methods: The study was performed as a retrospective, cross-sectional study. The research was performed during 2018 , the relevant data collected during the period from January 2016 to December 2017. Study sample included 1500 patients over 65 years with cardiovasculares disease who had medical records at the Institute for Gerontology and Palliative Care, Belgrade. Assessment of PIM was done by standard international criteria American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. Results: PIM frequency in elderly population was 70, 3%. In relation to gender, it was more frequent in female elders. Mean number of prescribed drugs was similar for 2016 and 2017, respectively 7, 2 and 7, 3. The most common were: medium acting benzodiazepines (70, 9%), central ? blockers (23, 98%), and antipsychotics (typical and atypical) (20,94%). The most common comorbidity was noted in a group labelled with the international disease classification I00-I99 which inlcudes heart and blood vessel diseases (n=2658; 36.9%). The most common diagnoses belonged to the subgroup I10-I15 hypertensive diseases (n=1298; 18%), I20-I25 ischemic heart diseases (n= 542; 7.5%), I30-I52, other forms of heart disease (n=705; 9.8%), I60-I69 cerebrovascular diseases (n =94; 1.3%), and I80- I89 diseases of veins, lymph vessels and lymph nodes (n=12; 0.17%). Predictor for PIM were numerous: polypharmacy, gender, nicotine use, cognitive status, nutrition state and number of diseases registered at study sample. Conclusion: Cardiovascular diseases in the elderly population are associated with a high prevalence of potentially inappropriate drug prescribing. Creating health recommendations for prescribing drugs in the elderly that would emphasize these factors could reduce the prevalence of PIM in this population

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“…In some instances, multimorbidity may result in under-prescribing of appropriate drugs in older adults who may benefit. Several observational studies show that medication under-use occurs in 40-60% of older adults, and significantly more often in those with multimorbidity 82223. Such omissions can be detrimental, especially given the high prognostic risks of cardiovascular disease in older adults.…”

Section: Geriatric Conditions In Older Adults With Cardiovascular Diseasementioning

confidence: 99%

Cardiovascular care of older adults

Oneill

Forman

2021

BMJ

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Age is an independent risk factor for cardiovascular disease. With the accelerated growth of the population of older adults, geriatric and cardiac care are becoming increasingly entwined. Although cardiovascular disease in younger adults often occurs as an isolated problem, it is more likely to occur in combination with clinical challenges related to age in older patients. Management of cardiovascular disease is transmuted by the context of multimorbidity, frailty, polypharmacy, cognitive dysfunction, functional decline, and other complexities of age. This means that additional insight and skills are needed to manage a broader range of relevant problems in older patients with cardiovascular disease. This review covers geriatric conditions that are relevant when treating older adults with cardiovascular disease, particularly management considerations. Traditional practice guidelines are generally well suited for robust older adults, but many others benefit from a relatively more personalized therapeutic approach that allows for a range of medical circumstances and idiosyncratic goals of care. This requires weighing of risks and benefits amidst the patient’s aggregate clinical status and the ability to communicate effectively about this with patients and, where appropriate, their care givers in a process of shared decision making. Such a personalized approach can be particularly gratifying, as it provides opportunities to optimize an older patient’s function and quality of life at a time in life when these often become foremost therapeutic priorities.

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Number of medications or number of diseases: what influences underprescribing?

Cited by 14 publications

References 40 publications

Under‐prescription of medications in older adults according to START criteria: A cross‐sectional study in Lebanon

Under‐prescription of medications in older adults according to START criteria: A cross‐sectional study in Lebanon

Potentially inappropriate medication prescribing among elderly patients with cardiovascular diseases

Cardiovascular care of older adults

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