Outcomes of adverse drug events reported with potentially inappropriate medications in older adults, 2004–2017

2021 ◽  
Vol 51 (2) ◽  
pp. 137-144
Author(s):  
Sharon K. Park ◽  
Bao Tran Luu
Keyword(s):  
Older Adults ◽  
Adverse Drug Events ◽  
Potentially Inappropriate Medications ◽  
Inappropriate Medications

Potentially inappropriate medications in older adults: A review of the 2012 Beers Criteria and the implications in persons with dementia

2014 ◽  
Vol 4 (4) ◽  
pp. 166-169 ◽  
Author(s):  
Nicole J. Brandt ◽  
Traci Turner
Keyword(s):  
Older Adults ◽  
Adverse Drug Events ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Clinical Tool ◽  
Drug Classes ◽  
Information Set ◽  
Sliding Scale ◽  
Institutionalized Patients ◽  
Inappropriate Medications

In 2012, the American Geriatrics Society (AGS), along with a panel of 11 experts, updated the Beers Criteria which has evolved significantly since its inception in 1991. The Beers Criteria, in general, classifies medications/medication classes as: (1) potentially inappropriate for use in all older adults, (2) potentially inappropriate for older adults with certain diseases or symptoms and (3) requiring extra caution when used in older adults. Although each patient must be evaluated individually, the Beers Criteria is a useful clinical tool that can be used when initiating pharmacologic agents in both ambulatory and institutionalized patients. The concept behind use of the Beers Criteria is that it allows prescribers to readily identify, and avoid, medications associated with negative outcomes in older adults therefore decreasing the risk of adverse drug events (ADEs). Within this review article, there will be a highlight of potentially inappropriate medications (PIMs) commonly seen in clinical practice settings such as antipsychotics, benzodiazepines, non-benzodiazepine sedative-hypnotics, anticholinergics and sliding scale insulin. The focus will be to outline the risk-benefits of these drug classes within the context of persons with dementia. Furthermore, the use of PIMs has both clinical and financial implications in Medicare Star ratings and Healthcare Effectiveness Data and Information Set (HEDIS) measures.

scholarly journals Intervention Design With Cognitively Impaired Populations: The Optimize Deprescribing Intervention

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 403-403
Author(s):  
Orla Sheehan ◽  
Elizabeth Bayliss ◽  
Ariel Green ◽  
Melanie Drace ◽  
Jonathan Norton ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Chronic Conditions ◽  
Adverse Drug Events ◽  
Multiple Chronic Conditions ◽  
Cognitively Impaired ◽  
Potentially Inappropriate Medications ◽  
Intervention Delivery ◽  
Time Required ◽  
Inappropriate Medications

Abstract Older adults with cognitive impairment and multiple other chronic conditions often have polypharmacy which increases their risks of medication related cognitive effects, adverse drug events, hospitalization and death and leads to higher health care costs. Deprescribing, the process of reducing or stopping potentially inappropriate medications may improve outcomes for those older adults with cognitive impairment and multiple chronic conditions. The OPTIMIZE trial examined whether a primary care-based, patient- and family-centered intervention educating and activating patients, family members, and clinicians about deprescribing reduces numbers of chronic medications and potentially inappropriate medications for older adults with dementia or mild cognitive impairment and multiple chronic conditions. We explored the mechanisms of intervention effectiveness through post hoc qualitative stakeholder interviews and surveys with 15 patients, 7 family caregivers, and 28 clinicians. All stakeholder groups endorsed the acceptability of the intervention. Success of the intervention was affected by contextual factors including prior knowledge and openness to deprescribing, cognition and prognosis. Positive outcomes included patients and care partners scheduling specific appointments to discuss deprescribing and providers remembering to consider deprescribing in cognitively impaired older adults. Recollection of intervention materials was inconsistent over time but highest shortly after intervention delivery. The time required to mail intervention materials to patients prior to a scheduled appointment limited the reach of the intervention by excluding persons with rapidly scheduled appointments. Our work identifies key learnings in intervention roll out which can guide future translation of our intervention to other settings and other pragmatic intervention studies in this vulnerable population.

scholarly journals Inappropriate medications and physical function: a systematic review

2021 ◽  
Vol 12 ◽  
pp. 204209862110303
Author(s):  
Elizabeth Manias ◽  
Md Zunayed Kabir ◽  
Andrea B. Maier
Keyword(s):  
Older Adults ◽  
Physical Function ◽  
Physical Performance ◽  
Inappropriate Medication ◽  
Functional Independence ◽  
Potentially Inappropriate Medications ◽  
Timed Up And Go ◽  
Risk Of Falls ◽  
Prescribing Omissions ◽  
Inappropriate Medications

Background and aims: Inappropriate medication prescription is highly prevalent in older adults and is associated with adverse health outcomes. The aim of this study was to examine the associations between potentially inappropriate medications (PIMS) and potential prescribing omissions with physical function in older adults situated in diverse environments. Methods: A systematic search was completed using the following databases: MEDLINE, CINAHL, PsycINFO, EMBASE and COCHRANE. Results were extracted from the included studies. Results: In total, 55 studies reported on 2,767,594 participants with a mean age of 77.1 years (63.5% women). Study designs comprised 26 retrospective cohort studies, 21 prospective cohort studies and 8 cross-sectional studies. Inappropriate medications in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), impaired activities of daily living (ADL; 8 out of 10 studies) and impaired instrumental ADL (IADL) score (4 out of 6 studies). Five out of seven studies also showed that PIMs were associated with poorer physical performance comprising the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many medication classes were implicated as PIMs in falls, fractures and impairment in physical performance including antipsychotic, sedative, anti-anxiety, anticholinergic, antidiabetic, opioid and antihypertensive medications. For patients not receiving musculoskeletal medications, such as calcium, vitamin D and bisphosphonates, older adults were found to be at risk of a hospital admission for a fall or fracture. Conclusion: Inappropriate medication prescriptions are associated with impaired physical function across longitudinal and cross-sectional studies in older adults situated in diverse settings. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions. Plain language summary Inappropriate medications and physical function Background and aims: The use of inappropriate medications is very common in older adults and is associated with harmful health problems. The aim was to examine associations between potentially inappropriate medications and potential prescribing omissions with physical function in older adults situated in diverse environments. Methods: Library databases were examined for possible studies to include and a systematic search was completed. Relevant information was obtained from the included studies. Results: In total, 55 studies reported on 2,767,594 participants who were an average age of 77.1 years and about 6 out of 10 were women. A variety of different study designs were used. Inappropriate medication prescriptions in community and hospital settings were significantly associated with higher risk of falls (21 out of 30 studies), higher risk of fractures (7 out of 9 studies), problems with activities of daily living (ADL), such as eating, bathing, dressing, grooming, walking and toileting (8 out of 10 studies) and problems with instrumental ADL such as managing medications, house cleaning and shopping (4 out of 6 studies). Five out of seven studies also showed that inappropriate medications were associated with poorer physical performance involving the Timed Up and Go test, walking speed, grip strength, time to functional recovery, functional independence and scale of functioning. Many types of medication classes were shown to be associated with a risk of falls, fractures and problems with physical performance. Omitted medications were also associated with falls and fractures. Conclusion: Inappropriate medication prescriptions are associated with problems relating to physical function. It is important to support older people to reduce their use of inappropriate medications and prevent prescribing omissions.

scholarly journals Use of potentially inappropriate medications among ambulatory home-dwelling elderly patients with dementia: A review of the literature

2017 ◽  
Vol 150 (3) ◽  
pp. 169-183 ◽  
Author(s):  
Tejal Patel ◽  
Karen Slonim ◽  
Linda Lee
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Adverse Events ◽  
Inappropriate Medication ◽  
Medication Use ◽  
Adverse Outcomes ◽  
Potentially Inappropriate Medication ◽  
Potentially Inappropriate Medications ◽  
Inappropriate Medication Use ◽  
Inappropriate Medications

Background: Older adults with dementia are at high risk for drug-related adverse outcomes. While much is known about potentially inappropriate medication use in older adults, its prevalence and characteristics among those with dementia are not as well elucidated. We conducted a literature review to examine the prevalence of potentially inappropriate medication use among home-dwelling older adults with dementia. Our secondary aim was to determine the most frequently implicated medications and factors associated with potentially inappropriate medication use. Methods: MEDLINE, EMBASE, CINAHL, and International Pharmaceutical Abstracts were searched between 1946 and 2014 for articles that referenced potentially inappropriate medication use and types of dementia. One reviewer screened all titles and abstracts from the initial search and full-text articles after the initial screen for eligibility, then 2 reviewers independently abstracted data from included studies. Results: Searches yielded 81 articles, of which 7 met inclusion criteria. Prevalence of potentially inappropriate medication use varied from 15% to 46.8%. No single drug or drug class was reported consistently across all studies as the most frequent potentially inappropriate medication, but anticholinergics and benzodiazepines, drugs that affect cognition, were among the most common medications or pharmacological classes listed. Discussion: Older adults with dementia may be particularly vulnerable to potentially inappropriate medications because of cognitive impairment from their condition and the greater likelihood of experiencing adverse events from medications. Given this population’s greater susceptibility to adverse events, more intense medication and patient monitoring may be warranted, especially among those taking anticholinergics and benzodiazepines, as these drugs can contribute to cognitive impairment.

scholarly journals Older adults using multi-dose dispensing exposed to risks of potentially inappropriate medications

2019 ◽  
Vol 15 (9) ◽  
pp. 1102-1106 ◽  
Author(s):  
Veera Bobrova ◽  
Jyrki Heinämäki ◽  
Outi Honkanen ◽  
Shane Desselle ◽  
Marja Airaksinen ◽  
...  
Keyword(s):  
Older Adults ◽  
Potentially Inappropriate Medications ◽  
Inappropriate Medications

scholarly journals Inappropriate Medication Use In Older Adults According To Beers Criteria In A Tertiary Referral Hospital, In Bolu, Turkey

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Burcin M. Atak ◽  
Gulali Aktas ◽  
Tuba T. Duman ◽  
Ozge Kurtkulagi ◽  
Satilmis Bilgin ◽  
...  
Keyword(s):  
Older Adults ◽  
Inappropriate Medication ◽  
Bleeding Risk ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Tertiary Referral Hospital ◽  
Inappropriate Use ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Inappropriate Medications

Aims — We aimed to study the medications used by older adults for any potentially inappropriate medications. Material and Methods — A hundred and four consecutive subjects over 65 years of age who visited our clinic were enrolled in the study. Possible inappropriate medications were defined according to Beers Criteria. Results — A total of 57 women and 49 men were enrolled in the study. Mean ages of the women and men were 78.6±6.1 years and 77.4±5.4 years, respectively (p=0.30). While 18 subjects (17%) had no increased risk due to inappropriate use of medications, 30 were on inappropriate medications that increased renal failure risk, 5 were on inappropriate medication that amplified neurological side effects, 12 were on inappropriate medications that augmented bleeding risk, 20 were on inappropriate medication that lack safety and efficacy data, and 30 were on inappropriate medication that amplified the risk of falls. The number of increased risks according to Beers Criteria was significantly and positively correlated with number of medications used (r=0.366, p<0.001) and the number of comorbidities (r=0.312, p=0.001). Conclusion — The number of increased risks due to inappropriate use of medicines in older adults is positively correlated with the number of medicines used and the number of accompanied diseases. Therefore we suggest that the medicines used by older people should be reviewed in all settings, and unnecessary drugs should be avoided to be prescribed.

Optimizing pharmacotherapy for older patients

2017 ◽  
pp. 183-188 ◽  
Author(s):  
Denis O’Mahony
Keyword(s):  
Older People ◽  
Adverse Drug Events ◽  
Economic Consequences ◽  
High Risk Population ◽  
Potentially Inappropriate Medications ◽  
Inappropriate Drugs ◽  
Prescribing Omissions ◽  
The Relationship ◽  
Global Population ◽  
Inappropriate Medications

The prevalence of complex multimorbidity is increasing steadily in tandem with global population ageing. Complex multimorbidity is in turn intimately associated with polypharmacy, the relationship being one of cause-and-effect. Polypharmacy commonly leads to prescription of inappropriate drugs, resulting in a substantially higher risk of drug-related problems, principally adverse drug–drug and drug–disease interactions. These problems become manifest in the form of common geriatric symptoms such as falls, acute confusion, and incontinence and commonly result in increased healthcare utilization, including hospitalization, with obvious economic consequences. In addition, adverse drug reactions and adverse drug events lead to death in older people. The challenge of optimization of pharmacotherapy in older people with complex multimorbidity is a major one. There is increasing evidence that avoidance of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) using validated PIM and PPO criteria lists leads to better and safer pharmacotherapy in this high-risk population.

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