Potentially inappropriate medications according to PRISCUS list and FORTA (Fit fOR The Aged) classification in geriatric psychiatry: a cross-sectional study

Westhoff, Martin Schulze; Groh, Adrian; Schröder, Sebastian; Proskynitopoulos, Phileas Johannes; Jahn, Kirsten; Klietz, Martin; Krichevsky, Benjamin; Stichtenoth, Dirk O.; Wedegärtner, Felix; Bleich, Stefan; Frieling, Helge; Heck, Johannes

doi:10.1007/s00702-022-02541-1

Cited by 4 publications

(17 citation statements)

References 37 publications

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“…Patients' medications comprised a median of eight drugs (IQR 6–11 drugs; range 1–21 drugs). Disease characteristics of the study population have been reported elsewhere 11 . In brief, the three most frequent psychiatric diagnoses in the study population (on the level of n = 92 individual patients) were dementia (39.1%; 36/92), depression (37.0%; 34/92), and schizophrenia/schizophreniform disorder (18.5%; 17/92).…”

Section: Resultsmentioning

confidence: 97%

“…Thus, the study populations of Ref. 11 and the present study are essentially the same. Analogous to Ref.…”

Section: Methodsmentioning

confidence: 89%

“…The present study was designed as a retrospective monocentric cross‐sectional pilot study and as a satellite project to Ref. 11. Thus, the study populations of Ref.…”

Section: Methodsmentioning

confidence: 99%

“…Analogous to Ref. 11, patients were eligible for enrolment (i) if they were at least 65 years of age; (ii) if they were treated on the gerontopsychiatric ward of the Department of Psychiatry, Social Psychiatry and Psychotherapy of Hannover Medical School between April 2021 and February 2022; and (iii) if they or their legal guardian had provided written informed consent that patient data be used for research purposes. Hannover Medical School is a university hospital and tertiary care centre in northern Germany; the gerontopsychiatric ward is a 27‐bed facility specialised in the treatment and care of elderly psychiatric inpatients.…”

Section: Methodsmentioning

confidence: 99%

“…In contrast to Ref. 11, patients taking drugs regularly and/or on an as‐needed basis (i.e., pro re nata (PRN) drugs) were eligible for enrolment (Ref. 11: only patients with regularly taken medication).…”

Section: Methodsmentioning

confidence: 99%

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Sedatives and analgesics are major contributors to potentially inappropriate duplicate prescriptions in geriatric psychiatry*

et al. 2023

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Background This study sought to investigate the frequency and characteristics of duplicate prescriptions (DPs) in elderly psychiatric inpatients using a novel categorisation of DPs that differentiates between appropriate duplicate prescriptions (ADPs) and potentially inappropriate duplicate prescriptions (PIDPs). Methods The study was conducted as a monocentric retrospective cross‐sectional pilot study on the gerontopsychiatric ward of the Department of Psychiatry, Social Psychiatry and Psychotherapy of Hannover Medical School, a large university hospital in northern Germany. The outcome measures were the nature and frequency of PIDPs compared with the frequency of ADPs. Results For 92 individual patients a total of 339 medication chart reviews were conducted between April 2021 and February 2022. The median age of the study population was 73 years (interquartile range (IQR) 68–82 years); 64.6% were female. Patients' medications comprised a median of eight drugs (IQR 6–11 drugs) and 43.1% of the study population were exposed to at least one PIDP (at least one grade‐1 PIDP: 39.5%; at least one grade‐2 PIDP: 5.0%; at least one grade‐3 PIDP: 1.5%). Sedatives were most frequently responsible for grade‐1 and grade‐2 PIDPs, while grade‐3 PIDPs were elicited exclusively by analgesics. Nearly half of the study population (49.0%) displayed at least one ADP. Conclusion Even though the clinical implications of PIDPs are not fully established to date, we recommend that physicians who treat elderly psychiatric patients pay special attention to PIDPs, especially PIDPs elicited by sedatives. Termination of PIDPs may prevent adverse drug reactions and save healthcare expenditures.

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Section: Resultsmentioning

confidence: 97%

“…Thus, the study populations of Ref. 11 and the present study are essentially the same. Analogous to Ref.…”

Section: Methodsmentioning

confidence: 89%

“…The present study was designed as a retrospective monocentric cross‐sectional pilot study and as a satellite project to Ref. 11. Thus, the study populations of Ref.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Sedatives and analgesics are major contributors to potentially inappropriate duplicate prescriptions in geriatric psychiatry*

et al. 2023

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Prevalence and predictors of inappropriate prescribing in outpatients with severe mental illness

Koomen,

van de Meent,

Elferink

et al. 2023

Therapeutic Advances in Psychopharmacology

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Background: Potentially inappropriate prescribing (PIP) is frequent in geriatrics and results in an increased risk for adverse effects, morbidity, mortality and reduced quality of life. Research on PIP in psychiatry has mainly focused on elderly patients and inpatients. Objectives: To determine the prevalence and the predictors of PIP of psychotropic medication in outpatients with severe mental illness. Design: This study is part of the Muva study, a pragmatic open Stepped Wedge Cluster Randomized Trial of a physical activity intervention for patients (age ⩾ 16 years) with severe mental illness. Methods: A structured medication interview, questionnaires on social functioning, quality of life and psychiatric symptoms, and BMI and waist circumference measurements were performed followed by a structured medication review. Patients were divided into groups: PIP versus no PIP. Between-group differences were calculated and a multivariate binary logistic regression was performed to examine predictors for PIP. A receiver operating characteristics analysis was performed to determine the area under the curve (AUC). Results: In 75 patients, an average of 5.2 medications of which 2.5 psychotropic medication was used. 35 (46.7%) patients were identified with PIP. Unindicated long-term benzodiazepine use was the most frequently occurring PIP (34.1%). Predictors of PIP were female gender [odds ratio (OR) = 4.88, confidence interval (CI) = 1.16–20.58, p = 0.03], number of medications (OR = 1.41, CI = 1.07–1.86, p = 0.02) and lower social functioning (OR = 1.42, CI = 1.01–2.00, p = 0.05). The AUC was 0.88 for the combined prediction model. Conclusion: The prevalence of PIP of psychotropic medication in outpatients with severe mental illness is high. It is therefore important to identify, and where possible, resolve PIP by frequently performing a medication review with specific attention to females, patients with a higher number of medications and patients with lower social functioning. Trial registration: This trial was registered in The Netherlands Trial Register (NTR) as NTR NL9163 on 20 December 2020 ( https://trialsearch.who.int/Trial2.aspx?TrialID=NL9163 ).

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Drug safety in older patients with alcohol use disorder: a retrospective cohort study

Schröder,

Westhoff,

Pfister

et al. 2024

Therapeutic Advances in Psychopharmacology

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Background: Older patients with alcohol use disorder are at particular risk of developing adverse drug reactions due to multimorbidity, polypharmacy, and altered organ function. Objectives: In this study, we investigated the frequency and characteristics of potentially serious alcohol–medication interactions, potentially inappropriate medications (PIMs) for older adults, and potential drug–drug interactions (pDDIs) in a population of older patients with alcohol use disorder over a 10-year period. Design: Retrospective monocentric cohort study. Methods: Prescribed medications were screened for potentially serious alcohol–medication interactions, PIMs, and pDDIs using the POSAMINO (POtentially Serious Alcohol–Medication INteractions in Older adults) criteria, the PRISCUS 2.0 list, the FORTA (Fit fOR The Aged) classification, and the drug interaction program AiD Klinik®. Results: We enrolled 114 patients aged ⩾65 years with alcohol use disorder, who were treated in an addiction unit of a university hospital in Germany. About 80.7% of the study population had at least one potentially serious alcohol–medication interaction. Potentially serious alcohol–medication interactions most commonly affected the cardiovascular (57.7%) and the central nervous system (32.3%). A total of 71.1% of the study population received at least one prescription of a FORTA C or D drug, compared with 42.1% who received at least one PIM prescription according to the PRISCUS 2.0 list. A total of 113 moderate and 72 severe pDDIs were identified in the study population. Conclusion: Older patients with alcohol use disorders are frequently exposed to potentially serious alcohol–medication interactions, PIMs, and pDDIs. Improvements in the quality of prescribing should primarily target the use of cardiovascular and psychotropic drugs.

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Potentially inappropriate medications according to PRISCUS list and FORTA (Fit fOR The Aged) classification in geriatric psychiatry: a cross-sectional study

Cited by 4 publications

References 37 publications

Sedatives and analgesics are major contributors to potentially inappropriate duplicate prescriptions in geriatric psychiatry*

Sedatives and analgesics are major contributors to potentially inappropriate duplicate prescriptions in geriatric psychiatry*

Prevalence and predictors of inappropriate prescribing in outpatients with severe mental illness

Drug safety in older patients with alcohol use disorder: a retrospective cohort study

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