scholarly journals Polypharmacy and potentially inappropriate medications (PIMS) in older adults referred to a liaison psychiatry service

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S306-S307
Author(s):  
Anietie Akpan ◽  
Omolade Longe
Keyword(s):  
Cognitive Impairment ◽  
Older Adult ◽  
Adverse Drug Events ◽  
Adult Population ◽  
Inappropriate Medication ◽  
Inappropriate Prescribing ◽  
Potentially Inappropriate Medications ◽  
Liaison Psychiatry ◽  
Anticholinergic Burden ◽  
Inappropriate Medications

AimsThe older adult is more likely to be prescribed a lot of medications (polypharmacy) on account of multi-morbidity and being under the care of several specialists. Adverse drug events and reactions account for a significant number of acute hospital presentations in this population group with increased risks of delirium, lasting cognitive impairment, falls and death.Medications are not routinely reviewed or rationalised in the elderly, often contributing to preventable harm.We sought to estimate the prevalence of polypharmacy and potentially inappropriate medications, anticholinergics in particular, in patients (65 years and older) referred to the St Mary's Hospital Liaison Psychiatry Department over a 3-month period.MethodBetween 01/06/2019 and 31/08/2019 all referral forms (from in-patient wards and A&E) for patients aged 65+ years were screened for medications currently prescribed and administered. The medications were confirmed via the St. Mary's Hospital electronic records, pharmacists’ completed Medicines Reconciliation and GP Summary Care Records. Polypharmacy was defined as patients prescribed 5 or more medications. Drugs with anticholinergic properties were considered as an example of Potentially Inappropriate Medication (PIMs) using the Anticholinergic Burden Scale. 77 patients were referred in the time period. 9 were excluded due to incomplete/unreconciled medication information.Result77.94% (n = 53) were prescribed 5 or more medications.38.24% (n = 26) were prescribed over 10 medications.10.29% (n = 7) prescribed over 15 medications.69% of (n = 47) prescribed an anticholinergic.42.65% (n = 29) prescribed more than 1 anticholinergic.ConclusionPolypharmacy and potentially inappropriate prescribing remain widespread within the older adult population.Increased anticholinergic burden further compounds risks of cognitive impairment, delirium and death.Other categories of Potentially Inappropriate Medications, including those no longer needed, ought to be identified and reviewed. Over-the-counter medications also need to be screened for.Elimination or reduction of anticholinergic burden may improve quality of life for patients, as well as cost burden on services.Pharmacovigilance, collaborative working, regular and systematic medication reviews, and on-going training are needed across services providing care for the older adult.

scholarly journals Polypharmacy and potentially inappropriate medications (PIMs) in older adults referred to a memory clinic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S306-S306
Author(s):  
Anietie Akpan ◽  
Bruno De Blaquiere ◽  
Issadevi Nellaya ◽  
Cornelia Termure ◽  
Sujoy Mukherjee
Keyword(s):  
Cognitive Impairment ◽  
Older Adult ◽  
Elderly Care ◽  
Anticholinergic Effect ◽  
Potentially Inappropriate Medications ◽  
List Type ◽  
Number Of Patients ◽  
Burden Scale ◽  
Anticholinergic Burden ◽  
Inappropriate Medications

AimsThe older adult is more likely to be prescribed a lot of medications (polypharmacy) on account of multi-morbidity and consequently being under the care of several specialists. Adverse drug events and reactions account for significant morbidity and mortality in this population group. Common sequelae include confusional episodes, dementia syndromes, falls, and higher rates of acute hospital admissions.Medications are not routinely reviewed in elderly care. We sought to estimate the prevalence of polypharmacy, and potentially inappropriate medications (e.g. anticholinergics or medications with central anticholinergic effects) in those referred to the Cognitive Impairment and Dementia Service (Elm Lodge), Older Persons Mental Health, West London NHS Trust.MethodAll referrals between 01/10/2020 and 30/11/2020 were screened for medications prescribed. Polypharmacy was defined as prescription of 5 or more medications. Medications with anticholinergic properties were considered examples of Potentially Inappropriate Medications (PIMs). The Anticholinergic Effect on Cognition (AEC) Tool, ‘Medichec’, was used to identify and rate anticholinergic burden. Anticholinergic load was also compared using the Anticholinergic Burden Scale (ABS).ResultTotal number of patients referred – 19311 patients excluded due to unavailable/incomplete medication records.Study number: 182Polypharmacy: 79.67% (n = 145) were prescribed 5 or more medications.44.51% (n = 81) prescribed 5–9 medications.23.08% (n = 42) prescribed 10–14 medications.8.79% (n = 16) prescribed 15–19 medications.1.67% (n = 3) prescribed more than 20 medications.Anticholinergics prescribed (AEC Tool): 37.36% (n = 68) prescribed an anticholinergic.6.59% (n = 12) prescribed more than 1 anticholinergic.Anticholinergics (ABS): 29.67% (n = 54) prescribed an anticholinergic.7.699% (n = 14) prescribed more than 1 anticholinergic.ConclusionPolypharmacy and potentially inappropriate prescribing (e.g. anticholinergics) remain widespread within the older adult population. Anticholinergic load was broadly similar with the Anticholinergic Effect on Cognition tool and the Anticholinergic Burden Scale. Increased anticholinergic burden further compounds risks of cognitive impairment, delirium and death.Other categories of Potentially Inappropriate Medications, including those no longer needed, ought to be identified and reviewed. Over-the-counter medications also need to be screened for.Elimination or reduction of anticholinergic burden may improve quality of life for patients, as well as cost burden on services.Pharmacovigilance, collaborative working, and regular training are needed across services providing care for the older adult.

scholarly journals Use of potentially inappropriate medication and polypharmacy in older adults: a repeated cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kristine Thorell ◽  
Patrik Midlöv ◽  
Johan Fastbom ◽  
Anders Halling
Keyword(s):  
Chronic Conditions ◽  
Adverse Drug Events ◽  
Adult Population ◽  
Inappropriate Medication ◽  
Cross Sectional Study ◽  
Potentially Inappropriate Medications ◽  
Sectional Study ◽  
Cross Sectional ◽  
Increased Risk ◽  
Inappropriate Medications

Abstract Background With age, the number of chronic conditions increases along with the use of medications. For several years, polypharmacy has been found to be on the increase in western societies. Polypharmacy is associated with an increased risk of adverse drug events (ADE). Medications called potentially inappropriate medications (PIM) have also been found to increase the risk of ADEs in an older population. In this study, which we conducted during a national information campaign to reduce PIM, we analysed the prevalence of PIM in an older adult population and in different strata of the variables age, gender, number of chronic conditions and polypharmacy and how that prevalence changed over time. Methods This is a registry-based repeated cross-sectional study including two cohorts. Individuals aged 75 or older listed at a primary care centre in Blekinge on the 31st March 2011 (cohort 1, 15,361 individuals) or on the 31st December 2013 (cohort 2, 15,945 individuals) were included in the respective cohorts. Using a chi2 test, the two cohorts were compared on the variables age, gender, number of chronic conditions and polypharmacy. Use of five or more medications at the same time was the definition for polypharmacy. Results Use of PIM decreased from 10.60 to 7.04% (p-value < 0.001) between 2011 and 2013, while prevalence of five to seven chronic conditions increased from 20.55 to 23.66% (p-value < 0.001). Use of PIM decreased in all strata of the variables age, gender number of chronic conditions and polypharmacy. Except for age 80–84 and males, where it increased, prevalence of polypharmacy was stable in all strata of the variables. Conclusions Use of potentially inappropriate medications had decreased in all variables between 2011 and 2013; this shows the possibility to reduce PIM with a focused effort. Polypharmacy does not increase significantly compared to the rest of the population.

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 Inappropriate Medication Use in Hospitalized Patients Diagnosed with Parkinson’s Disease

Pharmacy ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 100 ◽  
Author(s):  
Nicholas Cox ◽  
Jessica Louie ◽  
Benson Sederholm
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Inappropriate Medication ◽  
Academic Medical Center ◽  
Inappropriate Prescribing ◽  
Admission Diagnosis ◽  
P Value ◽  
Potentially Inappropriate Medications ◽  
Duration Of Stay ◽  
Inappropriate Medications

The purpose of this study was to evaluate the rate at which potentially inappropriate medications were administered for patients diagnosed with Parkinson’s disease (PD). This is a single-center, retrospective, case cohort study with data collected at an academic medical center between January 2010 and December 2013. Participants included all adult patients with admission diagnosis codes for PD. Included patients were screened for administrations of 27 potentially inappropriate medications and two potentially appropriate medications to be used for comparison. There were 1736 patients who met inclusion criteria with 175 documented administrations of potentially inappropriate medications to 77 patients. Patients who received potentially inappropriate medications had a longer mean duration of stay than the baseline population of PD patients (3.3 days vs. 1.9 days, p-value < 0.001). Despite recommendations to avoid certain medications in PD patients, a substantial number of administrations still occurred. The use of these medications can have clinical implications and our findings demonstrate increases in duration of stay. The findings from this study can assist in developing technological alerts to reduce inappropriate prescribing to PD patients. Larger prospective studies are warranted to further investigate the administration of inappropriate medications to patients diagnosed with PD.

scholarly journals Use of potentially inappropriate medication and polypharmacy in older adults: a repeated cross-sectional study

2020 ◽  
Author(s):  
Kristine Thorell ◽  
Patrik Midlöv ◽  
Johan Fastbom ◽  
Anders Halling
Keyword(s):  
Chronic Conditions ◽  
Adverse Drug Events ◽  
Inappropriate Medication ◽  
Cross Sectional Study ◽  
P Value ◽  
Potentially Inappropriate Medications ◽  
Sectional Study ◽  
Cross Sectional ◽  
Increased Risk ◽  
Inappropriate Medications

Abstract Background: With age, the number of chronic conditions increases along with the use of medications. For several years, polypharmacy has been found to be on the increase in western societies. Polypharmacy is associated with an increased risk of adverse drug events (ADE). Medications called potentially inappropriate medications (PIM) have also been found to increase the risk of ADEs in an older population. In this study, which we conducted during a national information campaign to reduce PIM, we analysed the prevalence of PIM in an older adult population and in different strata of the variables age, gender, number of chronic conditions and polypharmacy and how that prevalence changed over time. Methods: This is a registry-based repeated cross-sectional study including two cohorts. Individuals aged 75 or older listed at a primary care centre in Blekinge on the 31st March 2011 (cohort 1, 15 361 individuals) or on the 31st December 2013 (cohort 2, 15 945 individuals) were included in the respective cohorts. Using a chi2 test, the two cohorts were compared on the variables age, gender, number of chronic conditions and polypharmacy. Use of five or more medications at the same time was the definition for polypharmacy. Results: Use of PIM decreased from 10.60% to 7.04% (p-value <0.001) between 2011 and 2013, while prevalence of five to seven chronic conditions increased from 20.55% to 23.66% (p-value <0.001). Use of PIM decreased in all strata of the variables age, gender number of chronic conditions and polypharmacy. Except for age 80-84 and males, where it increased, prevalence of polypharmacy was stable in all strata of the variables. Conclusions: Use of potentially inappropriate medications had decreased in all variables between 2011 and 2013; this shows the possibility to reduce PIM with a focused effort. Polypharmacy does not increase significantly compared to the rest of the population.

scholarly journals Use of potentially inappropriate medication and polypharmacy in older adults: a repeated cross-sectional study

2020 ◽  
Author(s):  
Kristine Thorell ◽  
Patrik Midlöv ◽  
Johan Fastbom ◽  
Anders Halling
Keyword(s):  
Chronic Conditions ◽  
Adverse Drug Events ◽  
Inappropriate Medication ◽  
Cross Sectional Study ◽  
P Value ◽  
Potentially Inappropriate Medications ◽  
Sectional Study ◽  
Cross Sectional ◽  
Increased Risk ◽  
Inappropriate Medications

Abstract Background: With age, the number of chronic conditions increases along with the use of medications. For several years, polypharmacy has been found to be on the increase in western societies. Polypharmacy is associated with an increased risk of adverse drug events (ADE). Medications called potentially inappropriate medications (PIM) have also been found to increase the risk of ADEs in an older population. In this study, which we conducted during a national information campaign to reduce PIM, we analysed the prevalence of PIM in an older adult population and in different strata of the variables age, gender, number of chronic conditions and polypharmacy and how that prevalence changed over time. Methods: This is a registry-based repeated cross-sectional study including two cohorts. Individuals aged 75 or older listed at a primary care centre in Blekinge on the 31st March 2011 (cohort 1, 15 361 individuals) or on the 31st December 2013 (cohort 2, 15 945 individuals) were included in the respective cohorts. Using a chi2 test, the two cohorts were compared on the variables age, gender, number of chronic conditions and polypharmacy. Use of five or more medications at the same time was the definition for polypharmacy. Results: Use of PIM decreased from 10.60% to 7.04% (p-value <0.001) between 2011 and 2013, while prevalence of five to seven chronic conditions increased from 20.55% to 23.66% (p-value <0.001). Use of PIM decreased in all strata of the variables age, gender number of chronic conditions and polypharmacy. Except for age 80-84 and males, where it increased, prevalence of polypharmacy was stable in all strata of the variables. Conclusions: Use of potentially inappropriate medications had decreased in all variables between 2011 and 2013; this shows the possibility to reduce PIM with a focused effort. Polypharmacy does not increase significantly compared to the rest of the population.

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.

Highlights From the 2019 AGS Beers Criteria® Updates

2020 ◽  
Vol 35 (2) ◽  
pp. 68-74
Author(s):  
Creaque V. Charles ◽  
Angie Eaton
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Data Extraction ◽  
Inappropriate Medication ◽  
The Elderly ◽  
The United States ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Geriatric Population ◽  
Inappropriate Medications

OBJECTIVE: To compare the 2015 and 2019 AGS Beers Criteria® of potentially inappropriate medications in the elderly.<br/> DATA SOURCES: American Geriatrics Society 2015 and 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication (PIM) Use in Older Adults published literature.<br/> STUDY SELECTION/DATA EXTRACTION: The literature was reviewed, compared, and summarized to identify pertinent changes and updates to the AGS Beers Criteria of PIMs in the elderly.<br/> DATA SYNTHESIS: The AGS Beers Criteria® contains a list of potentially inappropriate medications that should be used with caution, avoided, notable drug-drug interactions, and drugs that should be dose-adjusted based on kidney function in the older adult. The updated AGS Beers Criteria® also includes removal of medications that are no longer sold in the United States, have a low usage rate, provide low evidence of harm, and/or the potential harm is not unique to the older adult.<br/> CONCLUSION: The AGS Beers Criteria® is intended to improve and optimize the care of the geriatric population. It serves as a guide to minimize older adults' exposure to PIMs whenever possible. As with previously published updates to the AGS Beers Criteria®, the 2019 update outlines the following: recommendations, rationale, and quality of the recommendations, as well as the strength of the recommendations.

scholarly journals Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department

2017 ◽  
Vol 13 (1) ◽  
pp. 197-202 ◽  
Author(s):  
Ajit Kumar Sah ◽  
Rajesh Kumar Jha ◽  
Phoolgen Sah ◽  
Sangharshila Basnet
Keyword(s):  
Inappropriate Medication ◽  
Inappropriate Prescribing ◽  
The Elderly ◽  
Tertiary Hospital ◽  
Medical Problem ◽  
Potentially Inappropriate Medications ◽  
Older Individuals ◽  
The Impact ◽  
Inappropriate Medications ◽  
Patient Department

Background & Objectives: Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The study was conducted with objectives to determine the prevalence of potentially inappropriate medicine (PIM) prescribing in older Nepalese patients in a medicine outpatient department.Materials & Methods: A prospective observational analysis of drugs prescribed in medicine out-patient department (OPD) of a tertiary hospital of central Nepal was conducted during November 2012 to October 2013 among 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM) in elderly patients was analysed using Beer’s Criteria updated to 2013. Results: In the 869 patients included, the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%), amlodipine (23.16%), paracetamol (17.6%), salbutamol (15.72%) and vitamin B complex (13.26%). The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Conclusion: Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with number of medications prescribed. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly.

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