Polypharmacy and potential inappropriateness of pharmaco-logical treatment among community-dwelling elderly patients

In this study, we describe the phenomenon of polypharmacy and the frequency of the potential inappropriate medication use, according to the criteria of Beers (Beers, M.H. (1997): Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch. Intern. Med. 157. 1531-153 C) among elderly subjects in Poland. The study involved 680 individuals (including 438 women and 242 men) aged 65 years and more (mean age: 72.6+/-6.5 years) residing in Poznań (P) and 320 (216 women and 104 men (mean age: 72.5+/-6.0 years) residing in Glogow (G). The average number of all drugs taken by the analyzed patients was more than 6 (P: 6.9+/-3.2, range: 0-17 drugs, and in G: 6.6+/-3.1, 0-16), of prescribed drugs, more than 5 (P: 5.3+/-2.8, range: 0-15 drugs, G: 5.2+/-2.8, ranging 0-16) and of non-prescribed drugs, more than 1 (P: 1.6+/-1.5, range: 0-11 drugs, G: 1.4+/-1.4, range 0-8). As far as the frequency of the potential inappropriate medication use is concerned, almost one third of all persons, (285 persons, 28.2% of all), in P: 195 persons (28.6% of the subjects), in G: 90 (27.2%) used at least one of the potential inappropriate medications. Polypharmacy and the potential inappropriateness of pharmacological treatment are common in community-dwelling elderly subjects in Poland. There is a great need to improve the quality of medication use in this group of patients. In order to do it we have elaborated and nowadays we introduce the project of pharmaceutical care in Poland.     

Die PRISCUS-Liste im klinischen Test

Background

Certain drugs are classified as potentially inappropriate medications (PIM) for the elderly. In 2010, the PRISCUS list was published, specifically designed for its applicability in the German pharmaceutical market. The aim of this study was to evaluate the PRISCUS list compared to international PIM lists.

Methods

Based on selected PIM lists (PRISCUS, STOPP/START, Beers), the medications of 308 patients at a clinic of geriatric rehabilitation were screened for PIMs. Applying START criteria, omission of indicated drug therapies was detected.

Results

Regarding the rate of PIM detection, the PRISCUS list was less sensitive than the application of STOPP criteria. While hospitalized, the mean number of administered PIMs per patient was 1.2 based on STOPP criteria and 0.5 based on the PRISCUS list. The lowest number of PIMs per patient was detected by applying the Beers list (0.4 PIMs).

Conclusion

The Beers list should not be used in the German pharmaceutical market. The amendment of diagnosis-related STOPP criteria to the PRISCUS list would be useful to significantly advance therapeutic success and drug safety in the elderly.     

Inappropriate medication prescribing for elderly ambulatory care patients

BACKGROUND: Inappropriate medication use in elderly patients has been linked to a large share of adverse drug reactions and to excess health care utilization. METHODS: Trends in the prevalence of potentially inappropriate drug prescribing at ambulatory care visits by elderly persons from 1995 to 2000 were examined with data from office-based physicians in the National Ambulatory Medical Care Survey and from hospital outpatient departments in the National Hospital Ambulatory Medical Care Survey. Explicit criteria were used to identify potentially inappropriate prescribing. Multivariate regression was used to identify related factors. RESULTS: In 1995 and 2000, at least 1 drug considered inappropriate by the Beers expert panel was prescribed at 7.8% of ambulatory care visits by elderly patients. At least 1 drug classified as never or rarely appropriate by the Zhan expert panel was prescribed at 3.7% and 3.8% of these visits in 1995 and 2000, respectively. Pain relievers and central nervous system drugs were a large share of the problem. The odds of potentially inappropriate prescribing were higher for visits with multiple drugs and double for female visits. The latter was due to more prescribing of potentially inappropriate pain relievers and central nervous system drugs. CONCLUSIONS: Potentially inappropriate prescribing at ambulatory care visits by elderly patients, particularly women, remains a substantial problem. Interventions could target more appropriate drug selection by physicians when prescribing pain relievers, antianxiety agents, sedatives, and antidepressants to elderly patients. Such behavior could eliminate a large portion of inappropriate prescribing for elderly patients and reduce its higher risk for women.     

Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly

PURPOSE: To determine if inpatient or outpatient geriatric evaluation and management, as compared with usual care, reduces adverse drug reactions and suboptimal prescribing in frail elderly patients. METHODS: The study employed a randomized 2 x 2 factorial controlled design. Subjects were patients in 11 Veterans Affairs (VA) hospitals who were > or =65 years old and met criteria for frailty (n = 834). Inpatient geriatric unit and outpatient geriatric clinic teams evaluated and managed patients according to published guidelines and VA standards. Patients were followed for 12 months. Blinded physician-pharmacist pairs rated adverse drug reactions for causality (using Naranjo's algorithm) and seriousness. Suboptimal prescribing measures included unnecessary and inappropriate drug use (Medication Appropriateness Index), inappropriate drug use (Beers criteria), and underuse. RESULTS: For serious adverse drug reactions, there were no inpatient geriatric unit effects during the inpatient or outpatient follow-up periods. Outpatient geriatric clinic care resulted in a 35% reduction in the risk of a serious adverse drug reaction compared with usual care (adjusted relative risk = 0.65; 95% confidence interval: 0.45 to 0.93). Inpatient geriatric unit care reduced unnecessary and inappropriate drug use and underuse significantly during the inpatient period (P <0.05). Outpatient geriatric clinic care reduced the number of conditions with omitted drugs significantly during the outpatient period (P <0.05). CONCLUSION: Compared with usual care, outpatient geriatric evaluation and management reduces serious adverse drug reactions, and inpatient and outpatient geriatric evaluation and management reduces suboptimal prescribing, in frail elderly patients.