Title: Potentially Inappropriate Medication Use among Elderly Inpatients at a Teaching Hospital in South India

Authors: Dr Steve Paul Manjaly, Dr Geetha Francis, Dr Betsy Mathew

 DOI:  https://dx.doi.org/10.18535/jmscr/v4i11.85

Abstract

 BACKGROUND: Use of inappropriate medications among elderly is common. An association between potentially inappropriate medication (PIM) use in elderly and adverse outcomes such as impaired muscle strength, functional status, increased healthcare expenditure, and increased risk of hospitalization and death has been demonstrated.  Yet there are few studies addressing this issue.

OBJECTIVE: This study focuses on the prevalence of the use of potentially inappropriate medications in hospitalized elderly.

DESIGN: A retrospective observational study was done between June and December 2012 involving 150 patients. Patient data including period of hospital stay, medical illnesses and medication list at discharge were obtained from the in-patient records. The chi-squared test for categorical variables was used to compare the characteristics of participants receiving and not receiving inappropriate medications.

SETTING: The study collected data from 150 patients admitted to a teaching hospital at Bangalore, Karnataka.

PATIENTS: The sample was composed of 150 patients aged > 60 years admitted with multiple co morbidities.

MEASUREMENTS: The percentage of patients prescribed PIMs as defined using a modified Beers list was measured. Multivariable-adjusted odds ratios for PIM use were computed.

RESULTS: Of the 150 patients, 17.3% received at least 1 PIM, and 7% received 3 or more. Most common category of PIM  use were Prazosin, followed by benzodiazepines 

 PIM use was directly associated with no: of comorbidities and Polypharmacy

CONCLUSION:  There is a widespread use of potentially inappropriate medications among elderly patients in the population studied. Physicians should be more aware of the Beer’s criteria when treating the elderly.

KEYWORDS: Potentially inappropriate medications (PIM), Beers criteria (BC), Polypharmacy, geriatric, elderly.

References

1.      Campanelli CM. American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults: The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. J Am Geriatr Soc. 2012; 60(4):616-631.

2.      John et al ,  A study on polypharmacy in senior Indian population, ijpcbs 2013, 3(1), 168-171.

3.      Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med. 2005;165:68–74.

4.      Landi F, Russo A, Liperoti R, et al. Impact of inappropriate drug use on physical performance among a frail elderly population living in the community. Eur J Clin Pharmacol. 2007;63:791–799

5.      Fu AZ, Liu GG, Christensen DB. Inappropriate medication use and health outcomes in the elderly. J Am Geriatr Soc. 2004;52:1934–1939.

6.      Aparasu RR, Fliginger SE. Inappropriate medication prescribing for the elderly by office-based physicians. Ann Pharmacother 1997;31:823-9.

7.      Goulding, Inappropriate Medication Prescribing for Elderly Ambulatory Care Patients , Arch Intern Med. 2004;164(3):305-312

8.      Barry PJ, O’Keefe N, O’Connor KA et al. Inappropriate prescribing in the elderly: a comparison of the Beers  criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalised patients. J Clin Pharm Ther 2006; 31: 617–26.

9.      Laroche ML, Charmes JP, Nouaille Y, Fourrier A, Merle L. Impact of hospitalisation in an acute medical geriatric unit on potentially inappropriate medication use. Drugs Aging 2006;23:49-59.

10.  Egger SS, Bachmann A, Hubmann N, Schlienger RG, Krδhenbόhl S. Prevalence of potentially inappropriate medication use in elderly patients: Comparison between general medical and geriatric wards. Drugs Aging 2006;23:823-37.

11.  Lin HY, Liao CC, Cheng SH, Wang PC, Hsueh YS. Association of potentially inappropriate medication use with adverse outcomes in ambulatory elderly patients with chronic diseases: Experience in a Taiwanese medical setting. Drugs Aging 2008;25:49-59

12.  Veena D.R, Padma L, Sapna Patil. Drug prescribing pattern in elderly patients in a teaching hospital. IOSR Journal of Dental and Medical Sciences (JDMS). Volume 1, Issue 5 (Sep-Oct. 2012), PP 39-42

13.  Harugeri A, Joseph J, Parthasarathi G, Ramesh M, Guido S. Potentially inappropriate medication use in elderly patients: A study of prevalence and predictors in two teaching hospitals. J Postgrad Med 2010;56:186-91.

14.  Mandavi, Pramil Tiwari, Vinay Kapur. Inappropriate drug prescribing identified among Indian elderly hospitalized patients, Int J Risk Saf Med 2007; 19: 111-116

15.  Klarin I,Wimo A, Fastbom J. The association of inappropriate drug use with hospitalisation and mortality: a population based study of the very old. Drugs Aging 2005; 22: 69–82.

16.  Jano E, Aparasu RR. Healthcare outcomes associated with Beers criteria: A systematic review. Ann Pharmacother. 2007;41:438–447.

17.  Rothberg et al. Potentially Inappropriate Medication Use in Hospitalized Elders, J Hosp Med 2008 3 :2 91-102

18.  Viktil et al. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems, Br J Clin Pharmacol 63 :2 187–195

19.  E.R. Hajjar et al. Polypharamcy in elderly patients. Am J Geriatr Pharmacother. 2007 Dec; 5(4):345-51

20.  Shalini, Joshi MC et al. Study of polypharmacy and associated problems among elderly patients http://www.akspublication.com/ijmu 2012 January;7(1):35-9. Accessed Feb 19,  2014.

21.  Cooney D, Pascuzzi K. Polypharmacy in the elderly: focus on drug interactions and adherence in hypertension. Clin Geriatr Med 2009;25:221–33.

22.  Espino DV, Bazaldua OV, Palmer RF, et al. Suboptimal medication use and mortality in an older adult  communitybased cohort: Results from the Hispanic EPESE Study. J Gerontol A Biol Sci Med Sci. 2006;61:170-175.

23.  Berdot et al, Inappropriate medication use and risk of falls – A prospective study in a large community-dwelling elderly cohort, BMC Geriatr. 2009; 9: 30.

24.  Magaziner J, Cadigan DA, Fedder DO, Hebel JR. Medication use and functional decline among community dwelling older women. J  Aging Health. 1989;1: 470- 484.

25.  Marcum and Gellad. Medication Adherence to Multidrug Regimens. Clin Geriatr Med 28 (2012) 287–300

26.  Sehgal, Bajwa SJS, Vishal et al. Polypharmacy and Potentially Inappropriate Medication Use as the Precipitating Factor in Readmissions to the Hospital. J Family Med Prim Care. 2013 Apr-Jun; 2(2): 194–199.

27.  Stacy et al, Potentially Inappropriate Prescribing of Benzodiazepines for Older Adults and Risk of Falls During a Hospital Stay: A Descriptive Study .Can J Hosp Pharm. 2009 Jul-Aug; 62(4): 276–283.

28.  Tsai R, Potentially Inappropriate Medication Use in Mild Cognitive Impairment (MCI) Patients: Results from the Kerala Einstein Study. J Am Geriatr Soc. 2012 July; 60(7): 1369–1370.

29.  Barry et al, START (screening tool to alert doctors to the right treatment)—an evidence-based screening  tool to detect prescribing omissions in elderly patients Age and Ageing 2007; 36: 632–638.

30.  Hamilton et al, Inappropriate prescribing and adverse drug events in older people. BMC Geriatrics 2009, 9:5

31.  Naugler CT, Brymer C, Stolee P, Arcese ZA (2000) Development and validation of an improved prescribing for the elderly tool. The Canadian Journal of Clinical Pharmacology, 7, 103–107

32.  M. Crotty,  J Halbert, D Rowett et al. An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing. Age Ageing 2004; 33: 612–617. 

Corresponding Author

Dr Steve Paul Manjaly

MBBS. DNB (Medicine), DGM (Geriatric Medicine),

Assistant Professor, Department of Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala