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      Comparison of the extent and prevalence of prescription of potentially inappropriate medications prescribed to geriatric age group residing in old-age homes versus those receiving care from tertiary care hospital using Beers criteria

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          Abstract

          Context:

          Certain medications have higher chances of causing adverse effects in geriatric age group. Evidence is against prescribing these medications to the elderly. A list of such medications is called Beers criteria, which was revised by the American Geriatrics Society in 2015.

          Aims:

          Using the Beer's list as reference, the researchers intend to find the extent and prevalence of potentially inappropriate medication (PIM) in geriatric population residing in different settings.

          Settings and Design:

          The researchers analyzed prescription pattern of 200 individuals with age ≥65 years, 100 individuals from old-age homes (OAHs) and 100 individuals from a tertiary care hospital. After collecting data, the researchers tallied each prescription with list of drugs in Beers criteria to find all the possible PIMs in both the groups.

          Results:

          It was found that the average age of residents of OAHs was significantly higher ( P < 0.002) than the corresponding group from a tertiary care hospital. The residents of OAHs were also a receiving significantly higher ( P < 0.0001) number of PIM than their counterparts from the tertiary care hospital. The average number of PIMs prescribed to females in OAHs was also significantly higher than those in the other group. About 55% of residents of OAHs received at least one PIM, compared to just 26% in the other group. At least 27% of individuals of OAHs received two or more PIMs, compared to just 2% in a tertiary care hospital. Lorazepam was the most commonly prescribed PIM in OAHs, whereas ranitidine was the most common PIM in a tertiary care hospital. Ibuprofen was the second most common PIM, with 15% of OAHs residents receiving this drug, while none of the patients from a tertiary care hospital received ibuprofen.

          Conclusion:

          All the results point toward a poor prescription pattern in the residents of OAHs compared to those receiving care from a tertiary care hospital.

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          Most cited references20

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          Meta-analysis of the impact of 9 medication classes on falls in elderly persons.

          John Woolcott, Kathryn Richardson, Matthew Wiens … (2009)
          There is increasing recognition that the use of certain medications contributes to falls in seniors. Our objective was to update a previously completed meta-analysis looking at the association of medication use and falling to include relevant drug classes and new studies that have been completed since a previous meta-analysis. Studies were identified through a systematic search of English-language articles published from 1996 to 2007. We identified studies that were completed on patients older than 60 years, looking at the association between medication use and falling. Bayesian methods allowed us to combine the results of a previous meta-analysis with new information to estimate updated Bayesian odds ratios (ORs) and 95% credible intervals (95% CrIs) Of 11 118 identified articles, 22 met our inclusion criteria. Meta-analyses were completed on 9 unique drug classes, including 79 081 participants, with the following Bayesian unadjusted OR estimates: antihypertensive agents, OR, 1.24 (95% CrI, 1.01-1.50); diuretics, OR, 1.07 (95% CrI, 1.01-1.14); beta-blockers, OR, 1.01 (95% CrI, 0.86-1.17); sedatives and hypnotics, OR, 1.47 (95% CrI, 1.35-1.62); neuroleptics and antipsychotics, OR, 1.59 (95% CrI, 1.37-1.83); antidepressants, OR, 1.68 (95% CrI, 1.47-1.91); benzodiazepines, OR, 1.57 (95% CrI, 1.43-1.72); narcotics, OR, 0.96 (95% CrI, 0.78-1.18); and nonsteroidal anti-inflammatory drugs, OR, 1.21 (95% CrI, 1.01-1.44). The updated Bayesian adjusted OR estimates for diuretics, neuroleptics and antipsychotics, antidepressants, and benzodiazepines were 0.99 (95% CrI, 0.78-1.25), 1.39 (95% CrI, 0.94-2.00), 1.36 (95% CrI, 1.13-1.76), and 1.41 (95% CrI, 1.20-1.71), respectively. Stratification of studies had little effect on Bayesian OR estimates, with only small differences in the stratified ORs observed across population (for beta-blockers and neuroleptics and antipsychotics) and study type (for sedatives and hypnotics, benzodiazepines, and narcotics). An increased likelihood of falling was estimated for the use of sedatives and hypnotics, neuroleptics and antipsychotics, antidepressants, benzodiazepines, and nonsteroidal anti-inflammatory drugs in studies considered to have "good" medication and falls ascertainment. The use of sedatives and hypnotics, antidepressants, and benzodiazepines demonstrated a significant association with falls in elderly individuals.
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            American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

            (2015)
            The 2015 American Geriatrics Society (AGS) Beers Criteria are presented. Like the 2012 AGS Beers Criteria, they include lists of potentially inappropriate medications to be avoided in older adults. New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual's kidney function and select drug-drug interactions documented to be associated with harms in older adults. The specific aim was to have a 13-member interdisciplinary panel of experts in geriatric care and pharmacotherapy update the 2012 AGS Beers Criteria using a modified Delphi method to systematically review and grade the evidence and reach a consensus on each existing and new criterion. The process followed an evidence-based approach using Institute of Medicine standards. The 2015 AGS Beers Criteria are applicable to all older adults with the exclusion of those in palliative and hospice care. Careful application of the criteria by health professionals, consumers, payors, and health systems should lead to closer monitoring of drug use in older adults.
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              Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents.

              Andrew M Fouts, Sharon Kotabe, K Nguyen … (2006)
              Polypharmacy is a well-known risk factor for adverse drug reactions (ADRs). The objective of this study was to determine the relationship between the use of > or = 9 different scheduled medications and the occurrence of ADRs in geriatric nursing home residents. This was a retrospective cohort study conducted in a 1200-bed, county-owned and -operated, longterm care skilled nursing facility Participants were 335 subjects aged > or = 65 years who were present at the facility during the index month of October 1998. Hospice, respite care, and rehabilitation patients were excluded. Use of > or = 9 different scheduled medications was defined a priori as routinely administered medications, excluding as-needed agents, topical agents, 1-time administration, and vaccinations. ADRs were identified by voluntary reporting and by chart review during a 12-month period. ADRs were assessed individually by 2 clinical pharmacists applying the Naranjo ADR probability scale. A total of 207 ADRs were identified. The cohort receiving > or = 9 scheduled medications (n = 43) experienced 53 ADRs, compared with 154 ADRs in the control group receiving or = 9 scheduled medications. The sex distribution was also similar, with women outnumbering men in both cohorts: 60% and 81% were women in the control and cohort groups, respectively. The mean age was 72 years (range, 65-100 years). After the data were adjusted for the number of days each subject was at risk for experiencing an ADR, subjects using > or = 9 different scheduled medications were 2.33 times more likely than controls to experience an ADR (95% CI, 1.54-3.52; P /=9 different scheduled medications and ADRs was found among these geriatric nursing home residents.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Perspect Clin Res
                Journal ID (iso-abbrev): Perspect Clin Res
                Journal ID (publisher-id): PCR
                Title: Perspectives in Clinical Research
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 2229-3485
                ISSN (Electronic): 2229-5488
                Publication date (Print): Oct-Dec 2020
                Publication date (Electronic): 26 April 2019
                Volume: 11
                Issue: 4
                Pages: 144-149
                Affiliations
                [1]Department of Internal Medicine, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
                [1 ]Department of Internal Medicine, Sheth VS General Hospital, Ahmedabad, Gujarat, India
                [2 ]Department of Pharmacology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
                Author notes
                Address for correspondence: Dr. Aakash Rajendra Sheth, Sheth Hospital, Shalimar Complex, Station Road, Bharuch, Ahmedabad - 392 001, Gujarat, India. E-mail: akashsheth2011@ 123456gmail.com
                Article
                Publisher ID: PCR-11-144
                DOI: 10.4103/picr.PICR_144_18
                PMC ID: 7819371
                PubMed ID: 33489831
                SO-VID: ebc3f5e6-e18a-4507-9545-e37b70c5d1eb
                Copyright © Copyright: © 2019 Perspectives in Clinical Research
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 09 October 2018
                Date revision received : 18 October 2018
                Date accepted : 25 February 2019
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Medicine
                Keywords: beers criteria,elderly,geriatric,old-age homes,potentially inappropriate medication,tertiary care hospital
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: beers criteria, elderly, geriatric, old-age homes, potentially inappropriate medication, tertiary care hospital

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