Potentially Inappropriate Medication Usage in Older Adults in a Tertiary Academic Medical Center Emergency Department

Background: The Beers Criteria® medications are potentially inappropriate medications (PIMs) recommended by the American Geriatric Society to be avoided or used with caution in adults 65 years and older. The usage of PIMs in the emergency department (ED) setting is not well characterized. Objectives: The purpose of this study is to evaluate the usage of PIMS in the ED. Methods: This is a single center retrospective observational study of a random sample of patients aged 65 and older who presented to the ED during a 6-month timeframe. The primary outcome was the incidence of ED readmissions in patients administered or prescribed a PIM compared with patients who were not prescribed or administered a PIM. Secondary outcomes included ED length of stay (LOS) and hospital admission. Results: Out of 192 patients, there was a total of 58 patients (30.2%) in the PIM group and 134 patients (69.8%) in the No PIM group. ED re-presentation within 30 days occurred in 10 patients (17%) in the PIM group vs 26 patients (19%) in the No PIM group (p = 0.88). The median ED LOS was 227 minutes vs 208 minutes (p = 0.1679). Hospital admission within 30 days occurred in 4 patients (7%) in the PIM group and 13 patients (10%) in the No PIM group (p = 0.725). Conclusions: This analysis did not show statistically significant differences between patients who received a PIM compared to those who received an alternative medication with regard to re-presentation, admission, and ED LOS. ED LOS trended towards being longer in the PIM group.

Potentially Inappropriate Prescribing and Potential Prescribing Omissions in 82,935 Older Hospitalised Adults: Association with Hospital Readmission and Mortality within Six Months

Polypharmacy with “potentially inappropriate medications” (PIMs) and “potential prescribing omissions” (PPOs) are frequent among those 65 and older. We assessed PIMs and PPOs in a retrospective study of 82,935 patients ≥ 65 during their first admission in the period March 2013 through February 2018 to the four acute-care Calgary hospitals. We used the American Geriatric Society (AGS) and STOPP/START criteria to assess PIMs and PPOs. We computed odds ratios (ORs) for key outcomes of concern to patients, their families, and physicians, namely readmission and/or mortality within six months of discharge, and controlled for age, sex, numbers of medications, PIMs, and PPOs. For readmission, the adjusted OR for number of medications was 1.09 (1.09–1.09), for AGS PIMs 1.14 (1.13–1.14), for STOPP PIMs 1.15 (1.14–1.15), for START PPOs 1.04 (1.02–1.06), and for START PPOs correctly prescribed 1.16 (1.14–1.17). For mortality within 6 months of discharge, the adjusted OR for the number of medications was 1.02 (1.01–1.02), for STOPP PIMs 1.07 (1.06–1.08), for AGS PIMs 1.11 (1.10–1.12), for START PPOs 1.31 (1.27–1.34), and for START PPOs correctly prescribed 0.97 (0.94–0.99). Algorithm rule mining identified an 8.772 higher likelihood of mortality with the combination of STOPP medications of duplicate drugs from the same class, neuroleptics, and strong opioids compared to a random relationship, and a 2.358 higher likelihood of readmission for this same set of medications. Detailed discussions between patients, physicians, and pharmacists are needed to improve these outcomes.

Uso de medicamentos potencialmente inapropriados em idosos institucionalizados: prevalência e fatores associados

Resumo Este trabalho teve como objetivo verificar a prevalência do uso de medicamento potencialmente inapropriado (MPI) para idosos residentes em Instituições de Longa Permanência para Idosos (ILPI), assim como os tipos de medicamentos e seus fatores associados. Trata-se de estudo transversal realizado em 10 ILPI da cidade do Natal, entre outubro e dezembro de 2013. Os medicamentos inapropriados foram classificados de acordo com os Critérios de Beers da American Geriatric Society 2015. Foram analisadas variáveis sociodemográficas, relacionadas à ILPI e às condições de saúde. Para as análises univariada e multivariada entre a variável principal (uso de MPI) e as demais foi utilizada a regressão de Poisson. A amostra foi composta por 321 idosos e, destes, 304 utilizavam medicamentos. A prevalência de uso de MPI foi de 54,6% (IC 95%: 48,9-60,2) e no modelo final esteve associada à polifarmácia e à demência. As classes terapêuticas de MPI mais identificadas foram antipsicóticos e benzodiazepínicos. O estudo revelou alta prevalência de MPI entre os idosos das ILPI, configurando a necessidade de adoção de indicadores do uso destes medicamentos e a implantação de estratégias que tornem a farmacoterapia mais segura e adequada aos idosos.

Potentially Inappropriate Medications Use among Older Adults with Comorbid Diabetes and Hypertension

Background Potentially inappropriate medications (PIMs) are medications that should be avoided among older adults due to their risk which offsets their benefit. The objective of this study is to estimate the prevalence of PIMs use and to evaluate its associated factors among older adults with comorbid diabetes and hypertension using the 2019 Beers criteria.Methods A cross-sectional retrospective study design was used. This study included 1,853 older adults (age ≥ 65 years) with comorbid diabetes and hypertension visited an ambulatory care setting in a large hospital in the central region of Saudi Arabia. The primary outcome was the prevalence of PIMs use based on the updated 2019 American Geriatric Society (AGS) Beers Criteria. The secondary outcome was the factors associated with the presence of PIMs use (use of one or more PIMs) by referencing the Beers Criteria list.Results Almost one out of two individuals had PIMs use with the average number of medication taken was seven; where 40.3% of the older adults taken one PIMs, and about 16% were using two or more PIMs. The most commonly prescribed PIMs were the use of gastrointestinal and endocrine medications. High risk of PIMs use was among those with ischemic heart disease and anxiety comorbidities and those using multiple medications (i.e., polypharmacy).Conclusions Given higher PIMs use among older adults with diabetes and hypertension comorbidities, tailored strategies and interventions to minimize the PIMs use in this population are warranted. There is a need for greater vigilance when managing patients with comorbid conditions to avoid the use of inappropriate medications.

Geriatric Interprofessional Education

Older persons commonly experience complex health needs that are best met by a multifaceted healthcare team. Most healthcare disciplines provide geriatric competencies specific to their professions which support the development of IPE curricula. The American Geriatric Society provided a list of formal geriatric competencies that are useful to curriculum designers and health professions educators. The chapter provides ideas for imbedding commonly occurring geriatric concepts and clinical assessment tools that are relevant to all disciplines for the creation of interprofessional learning activities.