The Burden of Potentially Inappropriate Medications in Chronic Polypharmacy

Guillot, Jordan; Maumus-Robert, Sandy; Marceron, Alexandre; Noïze, Pernelle; Pariente, Alexandre; Bezin, Julien

doi:10.3390/jcm9113728

Cited by 29 publications

(27 citation statements)

References 41 publications

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“…Most previous PIMs research was focused on people of 65 years of age and older even though some included information on younger people. 15,16,22,23 In our study we observed that PIMs were as prevalent in people aged <65 as in older people. The prevalence of PIMs observed in younger individuals should raise concern.…”

Section: Ofsupporting

confidence: 50%

“…14 These criteria overlap and commonalities and differences can help paint a more comprehensive picture of PIMs. [14][15][16] PIMs lists have been applied in health care databases mainly in Europe and among those over 65 years with few consideration of sex or race. 17 Very little work has been done among those under 65 years of age or according to sex and race/ethnicity.…”

Section: Introductionmentioning

confidence: 99%

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Potentially inappropriate medication use by level of polypharmacy among US Veterans 49–64 and 65–70 years old

Guillot

Rentsch

Gordon

et al. 2022

Pharmacoepidemiology and Drug

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Background Potentially inappropriate medications (PIMs) are medications contra‐indicated in particular circumstances. We sought to characterize PIMs by level of polypharmacy by age, sex, and race/ethnicity. Methods We performed a cross‐sectional drug dispensing study using electronic health records available through the US Department of Veterans Affairs. We extracted pharmacy fill and refill records during fiscal year 2016 (i.e., October 1, 2015–September 30, 2016) for all patients aged 49–70 who accessed care in the preceding fiscal year. PIMs were defined by the combined Beers and Laroche (henceforth Beers Laroche) criteria used for older patients and the PROMPT criteria used for middle‐aged. Results In the 1 499 586 patients aged 49–64, PIMs prevalence by PROMPT in patients with 0–4, 5–9, and ≥10 medications was 14.0%, 62.2%, and 86.1%, respectively, and by Beers Laroche was 14.3%, 63.4%, and 85.7%, respectively. In the 1 249 119 patients aged 65–70, PIMs prevalence by Beers Laroche was 14.8%, 59.9%, and 83.3%, and by PROMPT was 13.9%, 57.4%, and 82.0%, respectively. Meaningful differences in prevalence were shown by sex and race/ethnicity according to both set of criteria (e.g. PROMPT in patients with 5–9 medications: 66.1% women vs. 59.3% men; standardized‐mean‐differences [SMD] = 0.14; 61.7% of White vs. 54.5% of non‐White; SMD = 0.15). The most common PIMs were digestive, analgesic, antidiabetic, and psychotropic medications. Conclusion Prevalence of PIMs was high and increased with polypharmacy. Beers Laroche and PROMPT provided similar estimations inside and outside their target age, suggesting that PIMs are common among those with polypharmacy regardless of age.

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Section: Ofsupporting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Potentially inappropriate medication use by level of polypharmacy among US Veterans 49–64 and 65–70 years old

Guillot

Rentsch

Gordon

et al. 2022

Pharmacoepidemiology and Drug

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“…Polypharmacy is implemented before discharge in order to reduce the risk of readmission. Polypharmacy, which is common among older patients, can affect the physiology of older patients [ 51 ] and cause femoral and compression fractures as well as cognitive dysfunction [ 26 , 29 , 52 ]. In this study, one of the frequent causes of readmission was fracture, which can be caused by the effects of polypharmacy.…”

Section: Discussionmentioning

confidence: 99%

Risk of Hospital Readmission among Older Patients Discharged from the Rehabilitation Unit in a Rural Community Hospital: A Retrospective Cohort Study

Ohta¹,

Sano

2021

JCM

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Rehabilitation for hospitalized older people can improve their independence for performing activities of daily living (ADL), but determining its appropriateness can be challenging because of inherent limitations in their ADL and short life expectancy. Thus, we aimed to clarify the benefit of rehabilitation among older Japanese patients. We retrospectively evaluated consecutive older patients (age > 65 years) admitted to the rehabilitation unit of a rural community hospital between 1 April 2016 and 31 March 2020. The primary outcome measure was readmission for acute conditions. Of the 732 patients evaluated, 311 patients (42.5%) were readmitted. Readmission was significantly associated with body mass index (BMI) (p < 0.001), dependent condition (p < 0.001), higher cognitive domain scores in the functional independence measure (FIM) (p = 0.019), and polypharmacy (p = 0.026). The most frequent cause of readmission was pyelonephritis (11.9%), followed by pneumonia (10.9%), compression fracture (10.6%), heat stroke (8.4%), and cerebral stroke (8.0%). In conclusion, older Japanese patients discharged from rehabilitation units have lower readmission rates than those previously reported. Thus, better nutritional control, a multidisciplinary approach to the management of cognitive dysfunction, and a decrease in polypharmacy could be associated with improved outcomes among discharged older patients.

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“…The burden of PIMs appears high in older adults with chronic polypharmacy and multimorbidity. 16 Frailty syndrome is manifested as a marked vulnerability for more intensive medication intake, multi-morbidities and decreased resistance to PIMs. 17 Tools for cardiac capacity stratification such as the New York Heart Association (NYHA) class, serve as a good prognostic factor in heart failure, lung disease, prescription pattern and quality of life.…”

Section: Introductionmentioning

confidence: 99%

Potentially Inappropriate Medication and Associated Factors Among Older Patients with Chronic Coronary Syndrome at Hospital Discharge in Beijing, China

Zhao¹,

Song²,

Zheng³

et al. 2021

CIA

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Medication therapy is crucial in the management of chronic coronary syndrome (CCS). The use of potentially inappropriate medications (PIMs) contributes to poor outcomes in older patients, making it a major public health concern. However, few studies are available on PIMs use in older Chinese CCS patients. To investigate the frequency of prescribed PIMs at discharge and explore risk factors in older adults with CCS. Patients and Methods: The cross-sectional study was conducted in a tertiary hospital in China over three months, from 1st October to 31st December, 2019. CCS patients aged over 60 years who were discharged alive were recruited. Information on demographics and medications at discharge was collected. Clinical data including diagnoses, frailty status, New York Heart Association (NYHA) class and age-adjusted Charlson Comorbidity Index (ACCI) were evaluated in each patient. PIMs were identified using the 2019 Beers criteria. Binary logistic regression was performed to recognize variables related to PIMs. Results: A total of 447 eligible patients with 2947 medications were included. The prevalence of PIMs use was 38%. Medications to be avoided, to be used with caution, and with drug-drug interactions were 38.4%, 48.9% and 12.7% of the PIMs, respectively. Medications with drug-disease/syndrome interactions and those adjusted for kidney function were not identified. The common PIMs were diuretics (37.1%), benzodiazepines and benzodiazepine receptor agonist hypnotics (15.2%), glimepiride (13.1%), and co-prescription of potassiumsparing diuretics and renin-angiotensin system (RAS) inhibitors (9.7%). Individuals with frailty syndrome, polypharmacy, multiple comorbidities, atrial fibrillation, psychiatric disorders and greater NYHA class severity were more likely to receive PIMs. Conclusion: Prescription of PIMs was a common burden in older adults. A CCS multidisciplinary team is needed to control PIMs, especially in vulnerable older patients.

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The Burden of Potentially Inappropriate Medications in Chronic Polypharmacy

Cited by 29 publications

References 41 publications

Potentially inappropriate medication use by level of polypharmacy among US Veterans 49–64 and 65–70 years old

Potentially inappropriate medication use by level of polypharmacy among US Veterans 49–64 and 65–70 years old

Risk of Hospital Readmission among Older Patients Discharged from the Rehabilitation Unit in a Rural Community Hospital: A Retrospective Cohort Study

Potentially Inappropriate Medication and Associated Factors Among Older Patients with Chronic Coronary Syndrome at Hospital Discharge in Beijing, China

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