Potentially inappropriate medication use: the Beers’ Criteria used among older adults with depressive symptoms

Abstract

INTRODUCTION: The ageing population means prescribing for chronic illnesses in older people is expected to rise. Comorbidities and compromised organ function may complicate prescribing and increase medication-related risks. Comorbid depression in older people is highly prevalent and complicates medication prescribing decisions. AIM: To determine the prevalence of potentially inappropriate medication use in a community-dwelling population of older adults with depressive symptoms. METHODS: The medications of 191 community-dwelling older people selected because of depressive symptoms for a randomised trial were reviewed and assessed using the modified version of the Beers’ Criteria. The association between inappropriate medication use and various population characteristics was assessed using Chi-square statistics and logistic regression analyses. RESULTS: The mean age was 81 (±4.3) years and 59% were women. The median number of medications used was 6 (range 1–21 medications). The most commonly prescribed potentially inappropriate medications were amitriptyline, dextropropoxyphene, quinine and benzodiazepines. Almost half (49%) of the participants were prescribed at least one potentially inappropriate medication; 29% were considered to suffer significant depressive symptoms (Geriatric Depression Scale =5) and no differences were found in the number of inappropriate medications used between those with and without significant depressive symptoms (Chi-square 0.005 p=0.54). DISCUSSION: Potentially inappropriate medication use, as per the modified Beers’ Criteria, is very common among community-dwelling older people with depressive symptoms. However, the utility of the Beers’ Criteria is lessened by lack of clinical correlation. Ongoing research to examine outcomes related to apparent inappropriate medication use is needed. KEYWORDS: Depression; depressive symptoms; inappropriate prescribing; older adults

Evaluation of the heterogeneity of studies estimating the association between risk factors and the use of potentially inappropriate drug therapy for the elderly: a systematic review with meta-analysis

“…The characteristics of the hospitalized older adults, diseases, and drugs used are different from those of nonhospitalized individuals [60]. Different studies that evaluated PIDT worldwide indicate that the use of PIDT in hospitals is higher than in other environments [61][62][63][64][65][66][67]. In addition to studies conducted in hospitals, there were a greater number of relevant articles found in the databases.…”

The Association Between Benzodiazepine Use and Depression Outcomes in Older Veterans

“…Despite concerns about the potential for side effects and toxicity, benzodiazepines (BZDs) are commonly used in the elderly 1–3 . Overall estimates of BZD use in the elderly range from approximately 9 to 25% of the community dwelling population 4–7 .…”

Guest Editorial: Potentially inappropriate prescribing — moving from process to outcome

“…Lee et al 3 have highlighted that these types of prescribing indicators can act as a 'red flag' to prompt discussions around prescribing, rather than being simply used as a final judgment on the quality of prescribing. Increasingly, there is recognition that polypharmacy is not an inherently bad thing.…”

“…These criteria have been applied in the study by Lee et al 3 whose paper is published in this issue of the journal. These authors determined the Based on the application of the Beers' Criteria, almost half of the entire sample was receiving at least one potentially inappropriate medication, but there was no difference in the numbers of inappropriate medicines being prescribed in those patients with significant depressive symptoms compared to those without significant symptoms.…”

“…This is reflected in the literature, in that the more drugs a patient receives, the greater the likelihood of receiving a potentially inappropriate drug. 5 Importantly, Lee et al 3 highlight that the Beers' criteria do not allow for any measurement of outcome as a result of using potentially inap-…”