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      Prevalence of Potentially Inappropriate Medication use in older drivers

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          Abstract

          Background

          Potentially Inappropriate Medication (PIM) use has been studied in a variety of older adult populations across the world. We sought to examine the prevalence and correlates of PIM use in older drivers.

          Methods

          We applied the American Geriatrics Society 2015 Beers Criteria to baseline data collected from the “brown-bag” review of medications for participants of the Longitudinal Research on Aging Drivers (LongROAD) study to examine the prevalence and correlates of PIM use in a geographically diverse, community-dwelling sample of older drivers ( n = 2949). Proportions of participants who used one or more PIMs according to the American Geriatrics Society 2015 Beers Criteria, and estimated odds ratios (ORs) and 95% confidence intervals (CIs) of PIM use associated with participant characteristics were calculated.

          Results

          Overall, 18.5% of the older drivers studied used one or more PIM. The most commonly used therapeutic category of PIM was benzodiazepines (accounting for 16.6% of the total PIMs identified), followed by nonbenzodiazepine hypnotics (15.2%), antidepressants (15.2%), and first-generation antihistamines (10.5%). Compared to older drivers on four or fewer medications, the adjusted ORs of PIM use were 2.43 (95% CI 1.68–3.51) for those on 5–7 medications, 4.19 (95% CI 2.95–5.93) for those on 8–11 medications, and 8.01 (95% CI 5.71–11.23) for those on ≥12 medications. Older drivers who were female, white, or living in urban areas were at significantly heightened risk of PIM use.

          Conclusion

          About one in five older drivers uses PIMs. Commonly used PIMs are medications known to impair driving ability and increase crash risk. Implementation of evidence-based interventions to reduce PIM use in older drivers may confer both health and safety benefits.

          Trial registration

          Not applicable.

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          Most cited references27

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          Explicit Criteria for Determining Inappropriate Medication Use in Nursing Home Residents

          Mark Beers (1991)
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            Health outcomes associated with potentially inappropriate medication use in older adults.

            The purpose of this study was to examine the prevalence of potentially inappropriate medication use (PIMs) among community-dwelling older adults and the association between PIMs and health care outcomes. Participants were 17,971 individuals age 65 years and older. PIM use was defined by the Beers criteria. Drug-related problems (DRPs) were defined using ICD-9 codes. Forty percent of the 17,971 individuals filled at least 1 PIM prescription, and 13% filled 2 or more PIM prescriptions. Overall DRP prevalence among those with at least 1 PIM prescription was 14.3% compared to 4.7% in the non-PIM group (p < .001). In conclusion, preventing PIM use may be important for decreasing medication-related problems, which are increasingly being recognized as requiring an integrated interdisciplinary approach. (c) 2007 Wiley Periodicals, Inc.
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              Healthcare outcomes associated with beers' criteria: a systematic review.

              To examine healthcare outcomes associated with Beers' criteria of inappropriate medication use based on a literature review. A search of MEDLINE, International Pharmaceutical Abstracts, and Cumulative Index to Nursing and Allied Health Literature was conducted to identify articles published from October 1991 to October 2006. The following key words were used: Beers, inappropriate, medication, drug, use, prescribing, and elderly. A manual search was also conducted using the references listed in the articles identified through the database search. Studies that examined the impact or outcomes of Beers' criteria of inappropriate medication use (1991, 1997, and 2003 critera) were selected. Each article was examined for study setting, data source, study sample, study design, criteria, analysis and covariates, type of healthcare outcome, and study findings. Of 235 articles retrieved, 18 presented studies that examined healthcare outcomes associated with inappropriate medication use based on Beers' criteria. Specifically, setting-specific evidence as well as overall evidence was examined from the selected studies. The review considered evidence of association if more than 50% of the findings were statistically significant. Most of the 18 studies evaluated were retrospective cohort studies involving patients 65 years of age or older from diverse healthcare settings. In community settings, there was no evidence of association with respect to mortality and other healthcare use, and evidence regarding quality of life and costs was inconclusive. However, inappropriate medication use was associated with hospitalization measures in community elderly. In nursing homes, there was no evidence of association with mortality and the association with hospitalization measures was inconclusive. In hospitals, there was inconclusive evidence to make any generalizations. Across healthcare settings, inappropriate medication use was associated with adverse drug reactions and costs but not with other outcome measures. There is evidence that Beers' criteria of inappropriate medication use is associated with adverse healthcare impact in the community-dwelling elderly. With increasing use of Beers' criteria as quality-of-care measures, there is a need to strengthen the predictive validity of these criteria in all healthcare settings.
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                Author and article information

                Contributors
                GL2240@cumc.columbia.edu , gl2240@cumc.columbia.edu
                Howard.Andrews@nyspi.columbia.edu
                STC2126@cumc.columbia.edu
                BL2309@cumc.coumbia.edu
                cl94@cumc.columbia.edu
                merleda@nyspi.columbia.edu
                abigailgordon98@gmail.com
                TJM2141@cumc.columbia.edu
                David.Strogatz@bassett.org
                eby@umich.edu
                MARIAN.BETZ@ucdenver.edu
                Carolyn.DiGuiseppi@ucdenver.edu
                vjones@jhu.edu
                ljmolnar@umich.edu
                llhill@ucsd.edu
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                10 October 2019
                10 October 2019
                2019
                : 19
                : 260
                Affiliations
                [1 ]ISNI 0000000419368729, GRID grid.21729.3f, Department of Anesthesiology, , Columbia University College of Physicians and Surgeons, ; New York, NY USA
                [2 ]ISNI 0000000419368729, GRID grid.21729.3f, Department of Epidemiology, , Columbia University Mailman School of Public Health, ; New York, NY USA
                [3 ]ISNI 0000000419368729, GRID grid.21729.3f, Center for Injury Epidemiology and Prevention, , Columbia University Irving Medical Center, ; 622 West 168th St, PH5-505, New York, NY 10032 USA
                [4 ]ISNI 0000000419368729, GRID grid.21729.3f, Department of Psychiatry, , Columbia University College of Physicians and Surgeons, ; New York, NY USA
                [5 ]ISNI 0000000419368729, GRID grid.21729.3f, Department of Biostatistics, , Columbia University Mailman School of Public Health, ; New York, NY USA
                [6 ]GRID grid.414265.0, Bassett Research Institute, ; Cooperstown, NY USA
                [7 ]ISNI 0000000086837370, GRID grid.214458.e, University of Michigan Transportation Research Institute, ; Ann Arbor, MI USA
                [8 ]The Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI USA
                [9 ]ISNI 0000 0001 0703 675X, GRID grid.430503.1, Department of Emergency Medicine, , University of Colorado School of Medicine, ; Aurora, CO USA
                [10 ]ISNI 0000 0001 0703 675X, GRID grid.430503.1, Department of Epidemiology, Colorado School of Public Health, , University of Colorado Anschutz Medical Campus, ; Aurora, CO USA
                [11 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Department of Health, Behavior, and Society, , Johns Hopkins University Bloomberg School of Public Health, ; Baltimore, MD USA
                [12 ]ISNI 0000 0001 2107 4242, GRID grid.266100.3, Department of Family and Preventive Medicine, , University of California San Diego, ; La Jolla, CA USA
                Author information
                http://orcid.org/0000-0003-4732-2448
                Article
                1287
                10.1186/s12877-019-1287-8
                6785868
                31601189
                f6183235-d982-4c69-b361-651fc709b122
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 10 December 2018
                : 20 September 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100003550, AAA Foundation for Traffic Safety;
                Award ID: N/A
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Geriatric medicine
                aging,beers criteria,driving safety,older adults,potentially inappropriate medications

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