Dataset Information

Prevalence and determinants of potentially inappropriate medications in elderly inpatients in Thailand: a retrospective observational study based on the 2019 Beers criteria.

ABSTRACT:

Background

The prevalence of potentially inappropriate medications (PIMs), including NSAIDs, first-generation antihistamines, tricyclic antidepressants (TCAs), and benzodiazepines among elderly inpatients in Thailand, based on the 2019 Beers criteria, is insufficiently investigated.

Methods

This study retrospectively examined 300 elderly patients in a Thai tertiary hospital, assessing four PIM classes based on the 2019 Beers criteria and exploring factors and variations in PIM prescription patterns across different phases of hospitalisation.

Results

The study found an overall PIM prescription rate of 28%, consisting of: benzodiazepines (14%), first-generation antihistamines (9%), NSAIDs (3%), and TCAs (2%). Patients taking at least 5 medications prior to admission were more likely to receive PIMs (OR 3.77, 95% CI 1.15-12.35). Furthermore, PIM prescription was significantly associated with age, showing a 4.8% yearly increase (p = 0.01), and the number of comorbidities increased by 16.2% per unit (p = 0.021). Additionally, PIM use during admission was significantly linked to a longer hospital stay (OR 3.32, 95% CI 1.50-7.33).

Conclusions

These findings emphasise the need for continued monitoring and optimisation of medication management, and collaboration between pharmacists and physicians to review and adjust prescriptions, especially in elderly inpatients experiencing polypharmacy and multiple comorbidities.

SUBMITTER: Sriboonruang T

PROVIDER: S-EPMC10775711 | biostudies-literature | 2024

REPOSITORIES: biostudies-literature

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Publications

Prevalence and determinants of potentially inappropriate medications in elderly inpatients in Thailand: a retrospective observational study based on the 2019 Beers criteria.

Sriboonruang Tatta T Chusiri Sirichai S Ritsamdang Jiraphan J

Journal of pharmaceutical policy and practice 20231214 1

<h4>Background</h4>The prevalence of potentially inappropriate medications (PIMs), including NSAIDs, first-generation antihistamines, tricyclic antidepressants (TCAs), and benzodiazepines among elderly inpatients in Thailand, based on the 2019 Beers criteria, is insufficiently investigated.<h4>Methods</h4>This study retrospectively examined 300 elderly patients in a Thai tertiary hospital, assessing four PIM classes based on the 2019 Beers criteria and exploring factors and variations in PIM pre ...[more]

PMID: 38205194

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Project description:Background and aimsA potentially inappropriate medication (PIM) is defined as a drug-carrying risks outweighing the expected clinical benefits. Elderly patients with chronic kidney disease (CKD) are particularly at higher risk of drug-related toxicities. In Lebanon, no studies have been conducted regarding the prescribing of PIMs in hospitalized CKD patients. This study aimed to check the prevalence of PIMs using the American Geriatrics Society (AGS) Beers criteria in elderly patients with advanced CKD stages including dialysis and to identify possible risk factors that may be associated with prescribing PIMs in this population.MethodsA retrospective cross-sectional study was conducted on patients with advanced CKD above the age of 65 years and admitted between January 2019 and June 2019 to two University Hospitals in Beirut, Lebanon. We used multiple logistic regression analysis to determine which factors were associated with prescription of PIMs according to AGS Beers criteria-2019.ResultsThe study sample included 199 patients with renal dysfunction, 75.9% were aged 70 years or more, 53.8% were females, and 61.8% were prescribed five drugs or more. Eighty-two patients were receiving hemodialysis (41.2%). PIMs prevalence was 34.1% (68/199 patients) according to Beers criteria in elderly patients with advanced CKD stages.The most frequently prescribed PIMs were ranitidine (39.1%), enoxaparin (25%), tramadol (9.8%), and ciprofloxacin (5.4%). Polypharmacy (OR 2.1, CI 95% 1.58-2.79), a higher number of comorbidities (OR 3.01, CI 95% 1.43-6.30), and coronary artery diseases (OR 3.14 CI 95% 1.44-6.85) were the factors associated with an increased risk of at least one PIM prescription.ConclusionOur study found that one out of three patients with advanced CKD had at least one PIM according to the latest Beers criteria. A large proportion of inappropriate prescribing is preventable by increasing awareness of prescribing physicians to the explicit lists of PIMs.

Project description:Background: Potentially inappropriate medications (PIMs) are associated with adverse outcomes and higher healthcare costs in older adults. Explicit screening criteria like the Beers Criteria, STOPP criteria, and the Malaysian Potentially Inappropriate Prescribing (MALPIP) criteria served to identify PIMs, but comparative data are scarce. Aim: To evaluate the prevalence of PIMs identified by Beers 2019, STOPP version 2 and MALPIP criteria in Malaysian older adults and examine their predictive ability for adverse outcomes and cost-saving potential. Methods: A historical cohort study was conducted among older adults aged ≥ 60 years on five or more medications in four Malaysian tertiary hospitals. PIMs were identified using Beers, STOPP, and MALPIP criteria. Sensitivity, specificity and predictive abilities of these criteria were analysed against clinical outcomes. Monthly cost savings were calculated based on hypothetical deprescribing scenarios. Results: Among 1069 patients, the prevalence of PIMs was 89.1% using MALPIP, 51.3% with Beers, and 37.0% with STOPP criteria. A moderate concordance was seen between Beers and STOPP criteria (κ = 0.437), and the lowest agreement was observed between the STOPP and MALPIP (κ = 0.131). STOPP criteria significantly predicted hospital readmissions (p = 0.003), while Beers and MALPIP did not show significant predictive abilities across all outcomes. The most common PIMs identified were proton pump inhibitors (PPIs) and nonsteroidal anti-inflammatory drugs (NSAIDs). Deprescribing scenarios based on these criteria indicated potential monthly cost savings of MYR 4.83 to MYR 44.84 per patient, with the greatest savings associated with MALPIP criteria. Conclusion: MALPIP demonstrated the highest potential for cost savings, the highest sensitivity but the lowest specificity in PIM detection. Context-specific assessments and clinical judgment are crucial in optimising medication safety and efficacy in geriatric pharmacotherapy. Further research is needed to refine PIM criteria to better predict clinical outcomes and balance the benefits and risks of deprescribing in diverse healthcare settings.

Project description:Background: Age-related comorbidities prone older adults to polypharmacy and to an increased risk of potentially inappropriate medication (PIM) use. This work aims to analyze the concordance and overlap among the EU(7)-PIM list, 2019 Beers criteria, and Screening Tool of Older Person's Prescriptions (STOPP) version 2 criteria and also to analyze the prevalence of PIM. Methods: A retrospective cohort study was conducted on older inpatients of an internal medicine ward. Demographic, clinical, and pharmacological data were collected, during March 2020. After PIM identification by the EU(7)-PIM list, Beers criteria, and STOPP v2 criteria, the concordance and overlap between criteria were analyzed. A descriptive analysis was performed, and all the results with a p-value lower than 0.05 were considered statistically significant. Results: A total of 616 older patients were included in the study whose median age was 85 (Q1-Q3) (78-89) years. Most of the older patients were male (51.6%), and the median (Q1-Q3) number of days of hospitalization was 17 (13-22) days. According to the EU(7)-PIM list, Beers criteria, and STOPP criteria, 79.7, 92.0, and 76.5% of older adults, respectively, used at least one PIM. A poor concordance (<63.4%) among criteria was observed. An association between PIM and the number of prescribed medicines was found in all applied criteria. Moreover, an association between the number of PIMs and diagnoses of endocrine, nutritional, and metabolic diseases, mental, behavioral, and neurodevelopmental disorders, and circulatory system diseases and days of hospitalization was observed according to Beers criteria, and that with diseases of the circulatory system and musculoskeletal system and connective tissue was observed according to STOPP criteria. Conclusion: Despite the poor concordance between the EU(7)-PIM list, 2019 Beers, and STOPP v2 criteria, this work highlights the need for more studies in inpatients to develop strategies to facilitate the identification of PIM to decrease the high prevalence of PIM in hospitalized patients. The poor concordance among criteria also highlights the need to develop new tools adapting the existing criteria to medical ward inpatients.

Dataset Information

Prevalence and determinants of potentially inappropriate medications in elderly inpatients in Thailand: a retrospective observational study based on the 2019 Beers criteria.

Background

Methods

Results

Conclusions

Publications

Prevalence and determinants of potentially inappropriate medications in elderly inpatients in Thailand: a retrospective observational study based on the 2019 Beers criteria.

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