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

Abstract

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.

Characterization of potentially inappropriate medication prescriptions for the elderly in primary care and hospital settings

“…This finding is consistent with a regional study conducted in Qatar in 2019, which found an average of 8 medications per patient, along with other local studies by Alsuwaidan and Alturki in 2019 and 2020 on chronic disease patients with an average of 6.4 and 4.2 medications per patient, respectively. [ 16 17 18 ] Another recent local study considered PIMs and polypharmacy and found cases of patients that were prescribed ten or 12 PIMs at once, with more than 25% of their study population having more than five PIMs at once. [ 19 ] The number of medications can be correlated to the increased number of chronic conditions in geriatrics, along with an increased number of surgeries.…”

“…[ 19 ] The number of medications can be correlated to the increased number of chronic conditions in geriatrics, along with an increased number of surgeries. [ 16 17 19 ] In addition, an Indonesian study found that the rate of PIM exposure reached 52.2% of their geriatric patients in primary care facilities was only statistically significant to polypharmacy. [ 20 ] In addition to the increased number of medications, we found increased statistical significance across all medications administered in hospital settings when compared to primary care centers, as shown in Table 2 .…”

“…[ 13 ] which found 35.6% and Alturki et al . [ 17 ] with 39.4% PPI exposure among their patients. PPI studies are not new to medical attention, with many studies focusing on how they are related to several adverse effects, especially in geriatric age groups.…”

Sleep Disturbance, Sleep Disorders and Co-Morbidities in the Care of the Older Person

“…Commonly prescribed medications in the context of co-morbidity may also negatively impact sleep. Antihypertensives, antidepressants, antiepileptics, corticosteroids, decongestants and diuretics are among many medications that have been associated with insomnia, and may represent potentially inappropriate medications in the older patient [251][252][253][254]. The number of potentially inappropriate prescribed medications has also been associated with reduced sleep efficiency and sleep quality [255].…”

Identifying key prescribing cascades in older people (iKASCADE): a transnational initiative on drug safety through a sex and gender lens—rationale and design

“…Older age, female sex, and comorbidities have all been associated with adverse drug events [23]. A number of studies have reported that women experience both increased and decreased effects from medications as well as more adverse drug events than men [24][25][26][27].…”