Patterns of Potentially Inappropriate Medication Use Across Three Cohorts of Older Medicaid Recipients

2005 ◽  
Vol 39 (7-8) ◽  
pp. 1175-1181 ◽  
Author(s):  
Sally K Rigler ◽  
Carolyn M Jachna ◽  
Subashan Perera ◽  
Theresa I Shireman ◽  
Marty L Eng
Keyword(s):  
Muscle Relaxant ◽  
Inappropriate Medication ◽  
Inappropriate Prescribing ◽  
Medication Use ◽  
Potentially Inappropriate Medication ◽  
Inappropriate Drug ◽  
Short Term ◽  
Community Based ◽  
Inappropriate Medication Use ◽  
Disease Associations

BACKGROUND Potentially inappropriate medication use is a serious quality concern, especially when it occurs in more vulnerable older adults or for extended durations. OBJECTIVE To characterize patterns of inappropriate medication use and duration among 3 cohorts with differing health status. METHODS We identified unconditionally inappropriate drug use, using Beers 1997 criteria, among 3185 older Kansas Medicaid beneficiaries. Claims from May 2000 to April 2001 provided data for 3 cohorts: nursing facility (NF) residents, recipients of home- and community-based services through the Frail Elderly (FE) program, and persons with neither NF/FE care (Ambulatory). Duration, categorized as short-term (≤1 month's supply), extended (>1–9 mo), or chronic (>9–12 mo), was determined for each drug and cohort. Drug–disease associations were explored. RESULTS Any inappropriate medication use occurred in 21%, 48%, and 38% of Ambulatory, FE, and NF cohorts, respectively. Inappropriate analgesics, antihistamines, antidepressants, muscle relaxants, and oxybutynin were most common, but prevalence and duration varied by cohort. Short-term analgesic and antihistamine use was common. FE cohort members had the highest use rates for all drugs. The NF cohort had less antidepressant and muscle relaxant use. Drug–disease associations were noted for amitriptyline use in diabetes mellitus, propoxyphene use in musculoskeletal and upper gastrointestinal conditions, and muscle relaxant use in musculoskeletal conditions. CONCLUSIONS Cross-sectional, one-year prevalence figures are comprised of both short- and long-term use that varies by drug and cohort. NF residence is associated with reduced use of drugs scrutinized during mandated medication review. Relevant diseases are associated with specific inappropriate prescribing. Future efforts should target extended and chronic duration of use and persons at highest risk for adverse effects, including recipients of home- and community-based care.

scholarly journals Polypharmacy among Underserved Older African American Adults

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Mohsen Bazargan ◽  
James Smith ◽  
Masoud Movassaghi ◽  
David Martins ◽  
Hamed Yazdanshenas ◽  
...  
Keyword(s):  
African American ◽  
Inappropriate Medication ◽  
Medication Use ◽  
Community Dwelling ◽  
Potentially Inappropriate Medication ◽  
Inappropriate Drug ◽  
Potentially Inappropriate Medications ◽  
African American Adults ◽  
Inappropriate Medication Use ◽  
Inappropriate Medications

The purpose of the present study was to examine correlates of polypharmacy among underserved community-dwelling older African American adults. Methods. This study recruited 400 underserved older African Americans adults living in South Los Angeles. The structured face-to-face interviews collected data on participants’ characteristics and elicited data pertaining to the type, frequency, dosage, and indications of all medications used by participants. Results. Seventy-five and thirty percent of participants take at least five and ten medications per day, respectively. Thirty-eight percent of participants received prescription medications from at least three providers. Inappropriate drug use occurred among seventy percent of the participants. Multivariate analysis showed that number of providers was the strongest correlate of polypharmacy. Moreover, data show that gender, comorbidity, and potentially inappropriate medication use are other major correlates of polypharmacy. Conclusions. This study shows a high rate of polypharmacy and potentially inappropriate medication use among underserved older African American adults. We documented strong associations between polypharmacy and use of potentially inappropriate medications, comorbidities, and having multiple providers. Polypharmacy and potentially inappropriate medications may be attributed to poor coordination and management of medications among providers and pharmacists. There is an urgent need to develop innovative and effective strategies to reduce inappropriate polypharmacy and potentially inappropriate medication in underserved elderly minority populations.

Inappropriate Prescribing for the Elderly: Beers Criteria-Based Review

2000 ◽  
Vol 34 (3) ◽  
pp. 338-346 ◽  
Author(s):  
Rajender R Aparasu ◽  
Jane R Mort
Keyword(s):  
Inappropriate Medication ◽  
Inappropriate Prescribing ◽  
Medication Use ◽  
The Elderly ◽  
Inappropriate Drug ◽  
Beers Criteria ◽  
Prescribing Practices ◽  
Healthcare Settings ◽  
Inappropriate Medication Use ◽  
Inappropriate Medications

OBJECTIVE: To review currently available literature applying the Beers criteria for inappropriate medication use in the elderly to prescribing practices in various settings. DATA SOURCE: Key words including inappropriate, Beers, medication, prescribing, elderly, geriatric, and criteria were used to search MEDLINE records from January 1992 to June 1999. DATA EXTRACTION: Eight relevant studies were found that applied the Beers criteria in various healthcare settings. DATA SYNTHESIS: Each study was examined for methodologic issues, criteria used, prevalence, nature and extent of inappropriate medication use, and factors associated with their use. Despite the methodologic differences, the review revealed some consistent patterns across healthcare settings. This review has shown that: (1) most of the researchers modified the Beers criteria to examine inappropriate medication use in the elderly; (2) studies using patient-based prevalence showed that between nearly one in four (23.5%) and one in seven (14.0%) elderly patients received an inappropriate medication as defined by either the Beers list of 20 inappropriate medications or the Modified Beers list; (3) the majority of these patients received one inappropriate agent; and (4) long-acting benzodiazepines, dipyridamole, propoxyphene, and amitriptyline were among the most frequently prescribed inappropriate medications. Univariate analyses indicated that women, patients >80 years old, and Medicaid patients appeared to receive more inappropriate medications than others; however, multivariate analyses found that only a higher number of medications was consistently associated with inappropriate medication use. CONCLUSIONS: Inappropriate prescribing or use trends are noteworthy because they were observed despite methodologic differences. The findings can be instrumental in developing targeted interventions to influence future prescribing practices. More research is needed to address the national trends and healthcare impact of inappropriate drug use in the elderly.

Prevalence And Predictors Of Potentially Inappropriate Medication Use Among Elderly Patients Using Updated Beers Criteria 2019: A Single Centered Retrospective Analysis

2021 ◽  
Vol 16 ◽  
Author(s):  
Sreedharan Nair ◽  
Syam Sundar ◽  
Srilakshmi Cheeti ◽  
Aditi Bajpai ◽  
S Deepika ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Inappropriate Medication ◽  
Medication Use ◽  
Potentially Inappropriate Medication ◽  
Inappropriate Drug ◽  
Control Group ◽  
Beers Criteria ◽  
Care Hospital ◽  
Medication History ◽  
Inappropriate Medication Use

Background: Inappropriate medication use poses a sizable health safety hazard in the elderly owing to aging-associated physiological and anatomic changes. Inappropriate drug prescribing and polypharmacy in this population elevates the risk of adverse drug reactions (ADR). To assess the prevalence and predictors of Potentially Inappropriate Medication (PIM) use in elderly patients according to updated Beers Criteria 2019. Method: Medical Records of 402 patients aged ≥65 years admitted a tertiary care hospital from June 2018 to May 2019 were analyzed. The patients who experienced at least one PIM based on the 2019 Updated Beers Criteria were considered as cases and others as control. Data were presented as descriptive statistics and logistic regression was performed to assess the factors affecting the outcomes. Result: The mean age was found to be 73.7 ± 6.4 years in the test and 70.5± 5.5 years in the control group. The prevalence of PIMs to be used with caution was found to be 54%. Whereas the prevalence of PIMs to be avoided and to be used with reduced dose was found to be 45% and 1% respectively. The most prescribed PIMs were aspirin, diuretics, long-acting sulfonylureas, and proton pump inhibitors (PPIs). Increasing age, polypharmacy, and the number of drugs in medication history were significantly (P<0.05) correlated with a substantial risk of PIM use. The risk of developing serious and moderate drug-drug interactions (DDIs) was significantly high in the test group (P<0.05) when compared to the control group. Conclusion: A high prevalence of PIMs was observed in this study. Age, polypharmacy and ≥3 drugs in medication history were identified as risk factors for PIM use and were at a higher risk of developing DDIs. Continuous medication review by clinical pharmacists can aid in reducing the occurrence of PIMs amongst geriatrics.

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.

Polypharmacy and Potentially Inappropriate Medication Use in Older Blacks with Diabetes Mellitus Presenting to the Emergency Department

2021 ◽  
pp. 089826432110455
Author(s):  
Ginah Nightingale ◽  
Emily M. Scopelliti ◽  
Robin Casten ◽  
Monica Woloshin ◽  
Shu Xiao ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Controlled Trial ◽  
Inappropriate Medication ◽  
Medication Use ◽  
Potentially Inappropriate Medication ◽  
Cross Sectional ◽  
Randomized Controlled ◽  
Inappropriate Medication Use ◽  
Sectional Analysis

Background: Medication-related problems in older Blacks with diabetes mellitus (DM) are not well established. Objectives: To describe the frequency of medication-related problems in older Blacks with DM presenting to the emergency department (ED). Methods: The study was a cross-sectional analysis of baseline data from a randomized controlled trial evaluating Blacks aged ≥60 years of age presenting to the ED. Polypharmacy, potentially inappropriate medication (PIM) use, and anticholinergic score were evaluated. Results: Of 168 patients (median age = 68, range 60–92), most ( n = 164, 98%) were taking ≥5 medications, and 67 (39.9%) were taking a PIM. A majority ( n = 124, 74%) were taking a medication with an anticholinergic score ≥1. Number of medications was correlated with number of PIMs ( r = .22, p = .004) and anticholinergic score ( r = .50, p < .001). Conclusion: Polypharmacy and PIM use was common in older Blacks with DM.

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