The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review

Lee, Georgie; Etherton‐Beer, Christopher; Hosking, Sarah; Pasco, Julie A.; Page, Amy

doi:10.1177/20420986221100117

Cited by 25 publications

(7 citation statements)

References 158 publications

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“…Under-prescribing is another reason for a potentially suboptimal medication regime [ 32 ]. We observed a higher number of patients with PAD in the post-intervention group were discharged on antiplatelet agent and lipid-lowering therapy following implementation of the geriatric co-management model.…”

Section: Discussionmentioning

confidence: 99%

Optimising Medications in Older Vascular Surgery Patients Through Geriatric Co-management

Wang

James²,

Hilmer³

et al. 2023

Drugs Aging

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Background Prescribing of potentially inappropriate medications and under-prescribing of guideline-recommended medications for cardiovascular risk modification have both been associated with negative outcomes in older adults. Hospitalisation represents an important opportunity to optimise medication use and may be achieved through geriatrician-led interventions. Objective We aimed to evaluate whether implementation of a novel model of care called Geriatric Comanagement of older Vascular (GeriCO-V) surgery patients is associated with improvements in medication prescribing. Methods We used a prospective pre-post study design. The intervention was a geriatric co-management model, where a geriatrician delivered comprehensive geriatric assessment-based interventions including a routine medication review. We included consecutively admitted patients to the vascular surgery unit at a tertiary academic centre aged ≥ 65 years with an expected length of stay of ≥ 2 days and who were discharged from hospital. Outcomes of interest were the prevalence of at least one potentially inappropriate medication as defined by the Beers Criteria at admission and discharge, and rates of cessation of at least one potentially inappropriate medication present on admission. In the subgroup of patients with peripheral arterial disease, the prevalence of guideline-recommended medications on discharge was determined. Results There were 137 patients in the pre-intervention group (median [interquartile range] age: 80.0 [74.0–85.0] years, 83 [60.6%] with peripheral arterial disease) and 132 patients in the post-intervention group (median [interquartile range] age: 79.0 (73.0–84.0) years, 75 [56.8%] with peripheral arterial disease). There was no change in the prevalence of potentially inappropriate medication use from admission to discharge in either group (pre-intervention: 74.5% on admission vs 75.2% on discharge; post-intervention: 72.0% vs 72.7%, p = 0.65). Forty-five percent of pre-intervention group patients had at least one potentially inappropriate medication present on admission ceased, compared with 36% of post-intervention group patients ( p = 0.11). A higher number of patients with peripheral arterial disease in the post-intervention group were discharged on antiplatelet agent therapy (63 [84.0%] vs 53 [63.9%], p = 0.004) and lipid-lowering therapy (58 [77.3%] vs 55 [66.3%], p = 0.12). Conclusions Geriatric co-management was associated with an improvement in guideline-recommended antiplatelet agent prescribing aimed at cardiovascular risk modification for older vascular surgery patients. The prevalence of potentially inappropriate medications was high in this population, and was not reduced with geriatric co-management. Supplementary Information The online version contain...

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Section: Discussionmentioning

confidence: 99%

Optimising Medications in Older Vascular Surgery Patients Through Geriatric Co-management

Wang

James²,

Hilmer³

et al. 2023

Drugs Aging

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“…with poorer clinical outcomes [2]. Socioeconomic disadvantage, beliefs, and health literacy can contribute to nonadherence or suboptimal prescribing.…”

Section: Suboptimal Prescribing Of Medicines Has Been Associatedmentioning

confidence: 99%

“…Polypharmacy and hyperpolypharmacy were defined as the use of five or more; and ten or more medicines, respectively [2]. PIMs were assessed using the Beers 2015…”

Section: Definitionsmentioning

confidence: 99%

The Influence of Social and Individual Factors on Medicine Use in Older Adults

Rafhi,

Stupans,

Park

et al. 2023

APJHM

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Objective: To quantitatively explore the social and individual factors (including beliefs, experiences, and health literacy) that may affect medicine use in older adults. Design: A descriptive research approach with quantitative-based methods was used. Individual structured interviews were completed for each participant where they were questioned on any health conditions, medicines, and healthcare utilisation. The following validated questionnaires were implemented in the interview; Beliefs about Medicines Questionnaire, Health Literacy Questionnaire, EQ-5D-5L scale, Barthel Activities of Daily Living Index, Perceived Sensitivity to Medicines Scale, Patients Attitudes Towards Deprescribing, Medication Related Burden Quality of Life, and Adherence to Refills and Medication Scale. Descriptive statistics were calculated using SPSS software. Setting: People ≥65 years living in the community in Australia. Main Outcome Measures: Suboptimal prescribing, including polypharmacy, potentially inappropriate medicines use, and adherence. Results: Twenty-four participants completed the study and reported a mean BMQ necessity score of 11/25, mean specific concerns score of 19/25, mean general overuse score of 12/20 and suggest general harm score of 16/20. Most participants believed that medicines do more harm than good and physicians are overprescribing medicines. The highest scoring HLQ domain was ‘Navigating the healthcare system’, while the lowest scoring domains were ‘social support’ and ‘having sufficient information to manage my health’. Additionally, individual experience was found to be an important factor in participants’ medication attitudes and participants who trusted their prescriber were more likely to adhere to their medication regimen. Conclusion: The influence of beliefs, experiences, and health literacy on medicine use in older adults remains unclear, and future studies will investigate the effects of these factors on a larger sample size.

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“…Numerous previous studies have used several of the PIM and PPO tools used in this study to examine the PIM and/or PPO prevalence in different settings. According to a recent review of PIM prevalence studies [6], the proportions of study participants affected by PIMs was 44.3% for FORTA (vs. 76.5% in this study) and ranged from 26.7% to 67.3% for STOPP (vs. 65.9% in this study), from 37.5% to 90.6% for EU(7) PIM (vs. 61.9% in this study) and from 13.7% to 68.5% for PRISCUS (vs. 12.8% in this study). Campbell et al (2010) found that 10.8% of a sample of African American adults aged ≥ 70 years were exposed to at least one drug with strong anticholinergic properties (vs. 6.6% in this study) [29,30].…”

Section: Comparison To Literaturementioning

confidence: 99%

“…As a guidance for clinicians, a number of consensus-based instruments have been developed listing potentially inappropriate medication (PIM) to be avoided or used with caution in older people. Instruments alerting physicians to potential prescribing omissions (PPO) have also been developed [6][7][8]. Internationally prominent examples include START/STOPP criteria, and EU(7)-PIM, while the PRISCUS and FORTA lists are German developments [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Detecting Medication Risks among People in Need of Care: Performance of Six Instruments

Dreischulte

Sanftenberg

Hennigs

et al. 2023

IJERPH

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Introduction: Numerous tools exist to detect potentially inappropriate medication (PIM) and potential prescribing omissions (PPO) in older people, but it remains unclear which tools may be most relevant in which setting. Objectives: This cross sectional study compares six validated tools in terms of PIM and PPO detection. Methods: We examined the PIM/PPO prevalence for all tools combined and the sensitivity of each tool. The pairwise agreement between tools was determined using Cohen’s Kappa. Results: We included 226 patients in need of care (median (IQR age 84 (80–89)). The overall PIM prevalence was 91.6 (95% CI, 87.2–94.9)% and the overall PPO prevalence was 63.7 (57.1–69.9%)%. The detected PIM prevalence ranged from 76.5%, for FORTA-C/D, to 6.6% for anticholinergic drugs (German-ACB). The PPO prevalences for START (63.7%) and FORTA-A (62.8%) were similar. The pairwise agreement between tools was poor to moderate. The sensitivity of PIM detection was highest for FORTA-C/D (55.1%), and increased to 79.2% when distinct items from STOPP were added. Conclusion: Using a single screening tool may not have sufficient sensitivity to detect PIMs and PPOs. Further research is required to optimize the composition of PIM and PPO tools in different settings.

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The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review

Cited by 25 publications

References 158 publications

Optimising Medications in Older Vascular Surgery Patients Through Geriatric Co-management

Optimising Medications in Older Vascular Surgery Patients Through Geriatric Co-management

The Influence of Social and Individual Factors on Medicine Use in Older Adults

Detecting Medication Risks among People in Need of Care: Performance of Six Instruments

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