Potentially Inappropriate Medications by Beers Criteria in Older Outpatients: Prevalence and Risk Factors

Lim, Yeon Jung; Kim, Ha Yeon; Choi, Jaekyung; Lee, Ji Sun; Ahn, Ah Leum; Oh, Eun Jung; Cho, Dong Yung; Kweon, Hyuk-Jung

doi:10.4082/kjfm.2016.37.6.329

Cited by 44 publications

(68 citation statements)

References 22 publications

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“…These statistics indicate that the rate of polypharmacy is also high in older Korean people. There are two studies related to PIM use in older Korean people without cancer and the results are conflicting: one study demonstrated that 81% of the subjects were prescribed at least one PIM [28], whereas the other showed that 27.6% of older outpatients were taking at least one PIM [29]. The main reason for this difference could be attributed to the difference in population.…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

et al. 2019

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Background Polypharmacy is an important issue in the care of older patients with cancer, as it increases the risk of unfavorable outcomes. We estimated the prevalence of polypharmacy, potentially inappropriate medication (PIM) use, and drug–drug interactions (DDIs) in older patients with cancer in Korea and their associations with clinical outcomes. Subjects, Materials, and Methods This was a secondary analysis of a prospective observational study of geriatric patients with cancer undergoing first‐line palliative chemotherapy. Eligible patients were older adults (≥70 years) with histologically diagnosed solid cancer who were candidates for first‐line palliative chemotherapy. All patients enrolled in this study received a geriatric assessment (GA) at baseline. We reviewed the daily medications taken by patients at the time of GA before starting chemotherapy. PIMs were assessed according to the 2015 Beers criteria, and DDIs were assessed by a clinical pharmacist using Lexi‐comp Drug Interactions. We evaluated the association between polypharmacy and clinical outcomes including treatment‐related toxicity, and hospitalization using logistic regression and Cox regression analyses. Results In total, 301 patients (median age 75 years; range, 70–93) were enrolled; the most common cancer types were colorectal cancer (28.9%) and lung cancer (24.6%). Mean number of daily medications was 4.7 (±3.1; range, 0–14). The prevalence of polypharmacy (≥5 medications) was 45.2% and that of excessive polypharmacy (≥10 medications) was 8.6%. PIM use was detected in 137 (45.5%) patients. Clinically significant DDIs were detected in 92 (30.6%) patients. Polypharmacy was significantly associated with hospitalization or emergency room (ER) visits (odds ratio: 1.73 [1.18–2.55], p < .01). Neither polypharmacy nor PIM use showed association with treatment‐related toxicity. Conclusion Polypharmacy, PIM use, and potential major DDIs were prevalent in Korean geriatric patients with cancer. Polypharmacy was associated with a higher risk of hospitalization or ER visits during the chemotherapy period. Implications for Practice This study, which included 301 older Korean patients with cancer, highlights the increased prevalence of polypharmacy in this population planning to receive palliative chemotherapy. The prevalence of polypharmacy and excessive polypharmacy was 45.2% and 8.6%, respectively. The prescription of potentially inappropriate medications (PIMs) was detected in 45.5% and clinically significant drug–drug interaction in 30.6% of patients. Given the association of polypharmacy with increased hospitalization or emergency room visits, this study points to the need for increased awareness and intervention to minimize polypharmacy in the geriatric cancer population undergoing chemotherapy. Moreover, specific criteria for establishing PIMs should be adopted for the treatment of older adults with cancer.

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Section: Introductionmentioning

confidence: 99%

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

et al. 2019

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“…3,4 Causation of drugrelated adverse events in older patients is multifactorial, including complex medication regimens, ageing, and changes in medicine pharmacokinetics and pharmacodynamics. 5 It has been reported that the adverse drug events related to PIMs are associated with the rate of hospitalisation. 6 The use of inappropriate medications in this population has been shown to cause approximately 5% of hospital admissions.…”

Section: Introductionmentioning

confidence: 99%

Potentially inappropriate medications in older patients based on Beers criteria: a cross-sectional study of a family medicine practice in Saudi Arabia

et al. 2020

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BackgroundThe use of potentially inappropriate medications (PIMs) is an important issue in older patients who are at risk of adverse drug events.AimTo determine the prevalence of PIM use, according to Beers criteria, among an older population (aged ≥65 years) in a large family medicine setting, and to identify the associated risks.Design & settingA prospective cross-sectional study of patients aged ≥65 years was conducted from June 2017 to June 2018 at the Family and Community Medicine (FCM) clinics of King Saud Medical City (KSMC) in Riyadh, Saudi Arabia.MethodThis cross-sectional study included patients aged ≥65 years who were seen at new appointments or followed-up at the FCM clinics of KSMC in Riyadh, Saudi Arabia. Data were collected by extensive face-to-face interviews and from the patients’ medical records.ResultsA total of 270 older patients aged 72.41 ±6.23 years (mean ±standard deviation [SD]) were included in the present study. The prevalence of PIMs was 60.7% (n = 164). Multivariate analyses identified three independent variables associated with PIMs: incremental age per 5 years (odds ratio [OR] 1.47, 95% confidence intervals [CI] = 1.15 to 1.88; P = 0.002), female sex (OR 1.95, 95% CI = 1.10 to 3.42; P = 0.021), and polypharmacy (OR 8.21, 95% CI = 4.58 to 14.7; P<0.001). The most common PIMs used were 39.4% related to proton pump inhibitors (PPI), 25.2% to diuretics (other than spironolactone), 10.6% to non-steroidal anti-inflammatory drugs (NSAIDs), and 8.7% to aspirin use.ConclusionThis study showed high prevalence of PIMs. Increasing age, female sex, and polypharmacy were found to be significant risk factors for PIM use. The frequency of morbidities was not significantly different among patients with PIMs compared to those without PIMs, except for hypertension and osteoarthritis, which were more common in the PIMs group. The present study reinforces the importance of comprehensive medication management and reviews.

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“…4) In this setting, elderly individuals sometimes receive life-sustaining therapies or unnecessary treat-ments, including potentially inappropriate medications with questionable benefits on the quality of life of this population. 5) In developed countries, such as the United States, the United Kingdom, and Japan, the concept of subacute care and long-term care had fulfilled the health care needs of patients discharged from acute hospitals, facilitating them to return to the community. 6) However, the LTCH model in Korea focused on assisting elderly individuals with activities of daily living (ADL), chronic nursing care, and palliative care with no specified admission or discharge criteria, giving them only little difference in function with nursing homes in general.…”

Section: Introductionmentioning

confidence: 99%

Use of the Frailty Index and FRAIL-NH Scale for the Assessment of the Frailty Status of Elderly Individuals Admitted in a Long-term Care Hospital in Korea

Won

2018

Ann Geriatr Med Res

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Background Numerous elderly individuals with multimorbidity and impaired function are admitted in long-term care hospitals (LTCHs) in Korea. In this study, we aimed to describe the frailty status of elderly patients admitted in a LTCH using the FRAIL-NH scale and to identify the clinical relevance of frailty status on clinical outcomes, including death. Methods We retrospectively reviewed the medical records of 100 elderly patients who were hospitalized and died in an LTCH from March 2011 to February 2017. The monthly assessment results obtained from the inpatients’ data set (IDS) were used as main data sources for the 6-item FRAIL-NH scale and frailty index that was composed of 22 newly established items. Results The mean frailty index of the patients included in the analysis (mean age, 81.5±7.2 years; men, 53%) was 0.60 (standard deviation [SD], 0.10; range, 0.28-0.80). The distribution of the FRAIL-NH score in this population was in accordance with the 22-item frailty index, which shows a standardized beta of 0.571 (p<0.001, R=0.572). When the patients were categorized based on the FRAIL-NH score, the mean survival durations of the more fail group (FRAIL-NH >10, n=49) and less frail group (FRAIL-NH ≤10, n=51) were 529.3 days (SD, 453.4) and 888 days (SD, 679.9), respectively. Similarly, the frailty index was associated with earlier mortality. Conclusion Frailty is extremely common in elderly patients admitted in an LTCH and can be easily measured using the FRAIL-NH scale that utilizes the IDS of LTCHs in Korea. Since frailty is associated with earlier mortality, the assessment of frailty status in patients admitted in LTCHs may be helpful in clinical decision-making.

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Potentially Inappropriate Medications by Beers Criteria in Older Outpatients: Prevalence and Risk Factors

Cited by 44 publications

References 22 publications

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

Potentially inappropriate medications in older patients based on Beers criteria: a cross-sectional study of a family medicine practice in Saudi Arabia

Use of the Frailty Index and FRAIL-NH Scale for the Assessment of the Frailty Status of Elderly Individuals Admitted in a Long-term Care Hospital in Korea

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