The “iatrogenic triad”: polypharmacy, drug–drug interactions, and potentially inappropriate medications in older adults

Novaes, Priscila Horta; Cruz, Danielle Teles da; Lucchetti, Alessandra Lamas Granero; Leite, Isabel Cristina Gonçalves; Lucchetti, Giancarlo

doi:10.1007/s11096-017-0470-2

Cited by 64 publications

(76 citation statements)

References 37 publications

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“…The present findings regarding the association of PIM use and female gender agree with those reported for subjects from Pelotas (RS) ( p < 0.001) (Lutz et al, ) and São Paulo (SP) ( p < 0.001) (Cassoni et al, ). This association may be explained by the greater proportion of women among older people (Novaes et al, ) and the fact that women more often look for health care, receive a diagnosis, have a longer life expectancy, live with more morbidities (Baldoni et al, ), and are more likely to use medications (Neves et al, ).…”

Section: Discussionmentioning

confidence: 99%

Potentially inappropriate medication use and frailty phenotype among community‐dwelling older adults: A population‐based study

Bolina

Gomes

Marchiori

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To investigate the association between potentially inappropriate medication use and frailty phenotype among community‐dwelling older adults and to identify factors associated with the use of these drugs according to frailty condition. Background There is insufficient evidence about the association between inappropriate medication use and the condition of frailty, particularly among community‐dwelling older adults. Therefore, data obtained from population surveys should be made available in order to support the development of clinical guidelines about the prevention of frailty. Design This was a cross‐sectional study conducted according to the STROBE Checklist. Methods This population‐based study was conducted on 1,607 older adults. Potentially inappropriate medication use was assessed according to Beers criteria and frailty syndrome was determined according to the phenotype proposed by Fried and colleagues. Data were analysed statistically using multinomial or binary logistic regression models. Results About 13.6% of the subjects were frail, and 36.8% used at least one inappropriate medication. The adjusted model indicated that, the more potentially inappropriate medication use, the higher the prevalence of frailty, prefrailty and the walking slowness component. Female gender, one or more years of schooling, five or more reported morbidities, and instrumental dependence regarding daily life activities were factors associated with potentially inappropriate medication use in the nonfrail group. Conclusion Inappropriate medication use was prevalent among community‐living older adults, and its presence was associated with the occurrence of frailty. Relevance to clinical practice Primary care nurses are the professionals with the greatest contact with the older adults in the community. Thus, the results support the inclusion of the assessment of potentially inappropriate medication use in the routine of nursing consultation. In case of a positive screening, the older person should be referred to geriatric evaluation in order to optimise drug treatment for the prevention of frailty.

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Section: Discussionmentioning

confidence: 99%

Potentially inappropriate medication use and frailty phenotype among community‐dwelling older adults: A population‐based study

Bolina

Gomes

Marchiori

et al. 2019

Journal of Clinical Nursing

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“…Analysis of potential drug interactions should be part of therapeutic planning for CAPS users, especially those at greater risk of polytherapy, 3 children and the elderly. 5 A study in Australia showed that the identification of drug interactions by pharmacists was one of the most common interventions in psychiatric hospitals, 14 in contrast to the situation of the CAPS in this region. 15 Moreover, in mental health, identifying severe interactions that pose a health risk should be only one of the aspects investigated, since establishing the clinical relevance of interactions for these users may also be crucial.…”

Section: Discussionmentioning

confidence: 99%

“…3 Furthermore, polypharmacy is frequently observed in mental health treatment 4 and is a significant risk factor for the occurrence of drug interactions, 3 demonstrating the need to monitor these occurrences. 5 Drug interactions that involve psychotropic primarily compromise the metabolization process. Interactions may considerably raise the risk of intoxication, due to the inhibition of some cytochrome P450 isoenzymes, and exacerbate adverse reactions, 6 as occurs in several antipsychotic drugs.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Potential Drug Interactions in Brazilian Mental Health Services: Prevalence and Associated Factors

Silva¹,

Lima²,

Ruas³

2018

JYP

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Background: In the mental health field, the psychotropic polypharmacy is frequently observed, a significant risk factor for the occurrence of drug interactions. Objective: Identify potential drug interactions on the prescriptions of mental health services users and describe the associated factors. Methods: A cross-sectional study was conducted in 11 services. Sociodemographic data and information about the use of drug were obtained through interviews of users, analysis of prescriptions and medical charts, using a semi-structured questionnaire. Potential drug interactions were identified using the Micromedex® database, the association with sociodemographic characteristics and aspects related to the medicines prescribed were analyzed using the prevalence ratio. Results: The number of medicines prescribed ranged from 0 to 9, with an average of 3.38 (SD=1.76) per user, the most prescribed being haloperidol (12.3%), clonazepam (8.2%) and biperiden (7.9%). The proportion of interactions considering the number of users interviewed was 35.1%. The most frequent between potential interactions were haloperidol and fluoxetine (9.1%); haloperidol and carbamazepine (8.8%); and carbamazepine and chlorpromazine (5.9%). The highest prevalence ratio (PR) for the occurrence of potential interactions was in women (PR=1.36; 95% CI 1.08:1.71), users who had reported improper medicine use (PR=1.36; 95% CI: 1.07:1.72) and those with more than 5 prescribed medicines (PR=1.87; 95% CI: 1.49:2.33). Conclusion: Potential drug interactions were observed in more than one-third of the user's Brazilian mental health services. The profile of interactions detected could guide the pharmacotherapeutic follow-up of priority users, and help the multidisciplinary team identify signs and symptoms that can influence the treatment of users.

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“…Many of the explicit measures of PIP incorporate a large range of criteria, and a comparative analysis of different measures of PIP may help identify common prevalent inappropriate medication classes or criteria associated with adverse health outcomes that can be applied in clinical practice. For instance, a recent study comparing the 2015 revised version of STOPP and AGS Beers Criteria® 2012 found the five most common instances of PIP were the same for both measures …”

mentioning

confidence: 99%

Comparing Potentially Inappropriate Prescribing Tools and Their Association With Patient Outcomes

Moriarty

Bennett

Kenny

et al. 2019

J American Geriatrics Society

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OBJECTIVE To assess the agreement of several different measures of potentially inappropriate prescribing (PIP) in older people and compare their relationship with patient‐reported outcomes. DESIGN Prospective cohort study including participants in The Irish Longitudinal Study on Ageing (TILDA). SETTING Waves 1 and 2 of TILDA, a nationally representative aging cohort study. PARTICIPANTS A total of 1753 community‐dwelling TILDA participants with linked administrative pharmacy claims data on medications. MEASUREMENTS Potentially inappropriate medications were assessed using the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) v1, American Geriatrics Society (AGS) Beers Criteria® 2012, and relevant Assessing Care of Vulnerable Elders (ACOVE) v3 indicators. Potential prescribing omissions were assessed using the Screening Tool to Alert Doctors to the Right Treatment (START) v1 and ACOVE v3 indicators. Their agreement was assessed via κ statistics, and multivariate regression was used to assess relationships with emergency department visits, general practitioner (GP) visits, quality of life, and functional decline (increased assistance needed for activities of daily living). RESULTS There was slight agreement between STOPP and AGS Beers Criteria® (κ = 0.20) and ACOVE indicators (κ = 0.15), while agreement between AGS Beers Criteria® and ACOVE indicators was fair (κ = 0.31). Agreement was fair between START and ACOVE indicators (κ = 0.34). All measures of inappropriate medications were significantly associated with increased GP visits. Only exposure to two or more START indicators was associated with reduced quality of life (adjusted mean difference = −1.12; 95% confidence interval [CI] = −1.92 to −0.33), and only two or more AGS Beers Criteria® were associated with functional decline (adjusted odds ratio = 2.11; 95% CI = 1.37‐3.28). For omissions, both measures were associated with functional decline, but only ACOVE indicators were associated with increased GP visits. CONCLUSION Prevalence of PIP and relationships with outcomes can differ substantially between tools with little agreement. Choice of PIP measure for research or practice should be considered in light of the circumstances and requirements in each case. J Am Geriatr Soc 68:526–534, 2020

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The “iatrogenic triad”: polypharmacy, drug–drug interactions, and potentially inappropriate medications in older adults

Cited by 64 publications

References 37 publications

Potentially inappropriate medication use and frailty phenotype among community‐dwelling older adults: A population‐based study

Potentially inappropriate medication use and frailty phenotype among community‐dwelling older adults: A population‐based study

Analysis of Potential Drug Interactions in Brazilian Mental Health Services: Prevalence and Associated Factors

Comparing Potentially Inappropriate Prescribing Tools and Their Association With Patient Outcomes

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