Potentially inappropriate medications in elderly ambulatory and institutionalized patients: an observational study

Abstract

BackgroundThe elderly are frequently exposed to drug related problems causing hospitalizations and increased costs of care. Information about Romanian prescribing practices among the elderly and potential medication associated- risks is lacking. The objective of this study was to identify and compare the most frequent potentially inappropriate medications (PIM) recommended to ambulatory and institutionalized Romanian elderly, through an observational retrospective design.MethodsAll reimbursed medications prescribed to a sample of ambulatory elderly accessing two community pharmacies and all medications recommended to a group of institutionalized elderly (urban facilities, Romania, same month) were analyzed. The STOPP/START criteria and the PRISCUS list were used for PIM identification and for classification as misprescribed, underprescribed or overprescribed -subtypes.ResultsThe analysis involved 345 prescriptions recommended to ambulatory elderly and 91 medical files available for the institutionalized patients. The ambulatory elderly had a mean age of 74.8 years old and were daily exposed to a median number of 3 prescribed medications. The institutionalized elderly were older (mean age 80.77) received 8 medications daily and 69 % of them were functionally dependent. Cardiovascular and neuropsychiatric indications were the most frequent: 64.34 % and 18.55 % of the ambulatory prescriptions, 93.40 % and 41.75 % of the institutionalized patients’ medical files. 159 PIM were identified on 34.49 % of the ambulatory prescriptions. 82.41 % of the institutionalized patients’ medical files contained 140 PIM. The potential underprescribing of cardiovascular therapies was the most frequent PIM category on the ambulatory prescriptions (55.34 % of all PIM), while for the institutionalized patients’ medical files, the misprescribed and overprescribed PIM were those predominantly represented (62.14 % and 27.14 % of all PIM). In both subgroups of data, NSAIDs (56.66 % of ambulatory prescriptions and 35.63 % of institutionalized patients’ data) and benzodiazepines (26.66 % of ambulatory prescriptions and 24.13 % of institutionalized patient’s data) were predominantly misprescribed. Anticholinergics were rarely used (0.62 % of total PIM from ambulatory prescriptions, 2.14 % of total PIM from institutionalized patients’ data).ConclusionsThe PIM identified in both elderly groups suggested potential risks for the occurrence of adverse events specific to the elderly population. Larger studies, both observational and interventional, are needed to ensure a safer therapeutic approach.

<p>Potentially Inappropriate Prescriptions in Ambulatory Elderly Patients Living in Rural Areas of Romania Using STOPP/START (Version 2) Criteria</p>

“…That study did not assess PPOs. 11 In our study, NSAIDs were the most prevalent drugs prescribed for >2 weeks. NSAIDs are recommended for use with caution in elderly patients for a short period of time and at a minimal therapeutic dose due to: (i) their side effects; (ii) an increased risk of falls and stroke.…”

“…Compared with the study undertaken by Primejdie et al in 2016, we found a lower prevalence of PIMs in these two rural areas compared with 34.49% reported for urban areas. 11 In 2018, O'Riordan et al looked at PIMs in elderly people living in urban and rural settings in Ireland, Switzerland, and the Netherlands. They found that the highest percentage of PIMs was in elderly patients in Switzerland (16.7%), the Netherlands (12.5%), and Ireland (8.7%).…”

“…They showed disparities between communitydwelling and institutionalized patients regarding the prevalence of inappropriate prescribing in urban settings. 11 Differences in the prevalence of inappropriate prescribing are also expected between urban and rural settings. 12 Indeed, patients from rural areas have little access to specialist physicians for several reasons: high costs, infrastructure problems, patients' level of education and awareness of the importance of being evaluated by a specialist.…”

Potentially inappropriate medication use among older patients attending a geriatric centre in south-west Nigeria

“…In contrast, the NSAIDs used in some studies in Europe were described to be lower, as acetaminophen or opoids signified the chosen analgesic pathway. 19 , 20 This might be suggestive of the necessity for reevaluation of the implemented pain management strategies. Benzodiazepines use in the older persons has been identified in many studies as a common potential problem.…”

Impact of medication use on quality of life of institutionalized elderly in Northeast Brazil

“…Although the mean number of medications used in our sample was lower than that observed in other studies 19 , there was a correlation with worse quality of life. More medications used by elderly increases the risk of toxicity, mainly due to pharmacokinetic and pharmacodynamic changes associated with aging 20 . The manifestations of adverse reactions are moderate to severe, commonly related to hepatic, renal and gastrointestinal function 21 , and may be confused with new health problems 22 .…”