Potentially inappropriate medication use in older adults: prevalence and physician knowledge

Abstract

OBJECTIVE: To analyze the frequency, profile, and additional variables associated with the prescription of potentially inappropriate medications (PIM) to older adults in primary care, and evaluate physicians’ knowledge about these medications. METHODS: A cross-sectional study was conducted based on data from patient records for the period of January 2014 to December 2017 in a city located in the state of Minas Gerais. The frequency of PIM use was evaluated based on the 2019 Beers-Fick criteria. Physician knowledge was evaluated using a validated questionnaire as a primary data source. RESULTS: In a sample of 423 older adults, 75.89% (n = 321) used at least one PIM, the most common of which were medications used to treat central nervous system disorders (48.00%; n = 203). Most participants were female (62.41%; n = 264) and 70 years or older (69.50%; n = 294). When presented with clinical cases illustrating common situations in the management of older patients, 53.33% of physicians (n = 8) answered four or five questions correctly out of a possible seven; 13.33% (n = 2) answered six questions correctly; and 33.33% (n = 5) obtained three correct answers or fewer. CONCLUSIONS: These findings showed a high frequency of PIM use among older adults treated in Primary Health Care settings, with medications used in the treatment of central nervous system disorders. Our results highlight the importance of continuing education for health professionals and improved assessments of the medication available in the Unified Health System (Sistema Único de Saúde; SUS) for use in older adults, especially those taking multiple medications

Comparing AGS Beers 2019, STOPP version 2, and EU(7)-PIM list in Portuguese older adults in primary health care

“…A poor concordance between criteria was found which means there was minimal overlap between the criteria. Several studies have also shown a high PIM prevalence in older adult primary care users, ranging from 23.6 to 75.9% [33][34][35][36][37][38][39]. The Beers criteria are usually the tool that identifies most PIMs in older population when several screening tools are compared to each other [33,[36][37][38].…”

“…According to a recent systematic review, the worldwide overall pooled prevalence of PIM use was 36.7%, varying between 47.0% in Africa, 46.9% in South America, 37.2% in Asia, 35.0% in Europe, 29.0% in North America, and 23.6% in Oceania [21]. Moreover, high PIM prevalence could impose a high economic burden on the older population and society [2].…”