Potentially inappropriate medication use among older outpatients—prevalence and contributing factors: a retrospective study
Keywords:
Potentially Inappropriate Medication List, STOPP START Criteria, Aged, Potentially Inappropriate Medication Use, STOPP/START 3, Older AdultsAbstract
BACKGROUND: Adverse outcomes associated with potentially inappropriate medication (PIM) use are prevalent among older adults.
OBJECTIVES: This study aimed to determine the frequency of PIM use older outpatients and assess its association with chronic comorbidities and geriatric syndromes using the screening tool of older persons’ prescriptions (STOPP) and screening tool to alert to right treatment (START) version 3 criteria.
DESIGN AND SETTING: This retrospective study included patients aged 65 years or older who attended geriatric outpatient clinics between January and June 2024.
METHODS: PIM use was evaluated using the STOPP/START version 3 criteria. Polypharmacy was defined as the use of five or more medications.
RESULTS: Among the 107 patients (median age, 77 years; range, 65–91), 71% (n = 76) used PIM, with a median of two PIMs per patient (range, 0–6). PIM use was significantly more prevalent among patients with polypharmacy (odds ratio [OR] = 3.986; 95% CI: 1.493–10.639; p = 0.006). Analyses based on the STOPP criteria also revealed significant associations of PIM use with dementia (OR = 13.240; 95% CI: 1.504–116.529; p = 0.02), polypharmacy (OR = 4.352; 95% CI: 1.476–12.827; p = 0.008), and a history of falls (OR = 3.131; 95% CI: 1.017–9.634; p = 0.047).
CONCLUSION: Polypharmacy was significantly associated with greater odds of PIM use among older adults. Based on the STOPP version 3 criteria, dementia and a history of falls were also associated with increased PIM use in this population.
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1. Tian F, Chen Z, Zeng Y, Feng Q, Chen X. Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2023 Aug 2;6(8):e2326910. https://doi.org/10.1001/jamanetworkopen.2023.26910.
2. Araújo NC, Silveira EA, Mota BG, Guimarães RA, Modesto ACF, Pagotto V. Risk factors for potentially inappropriate medication use in older adults: a cohort study. Int J Clin Pharm. 2022 Oct;44(5):1132–9. https://doi.org/10.1007/s11096-022-01433-4.
3. Drusch S, Le Tri T, Ankri J, Zureik M, Herr M. Decreasing trends in potentially inappropriate medications in older people: a nationwide repeated cross-sectional study. BMC Geriatr. 2021 Dec;21(1):621. https://doi.org/10.1186/s12877-021-02568-1.
4. Amrouch C, Amrouch S, Dai L, et al. Applicability of STOPP/START prescribing criteria in integrated Swedish administrative health registries and a Swedish population-based cohort. Eur Geriatr Med. 2024 May 16;15(4):1149–58. https://doi.org/10.1007/s41999-024-00990-3.
5. By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriat Soc. 2019 Apr;67(4):674–94. https://doi.org/10.1111/jgs.15767.
6. By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriat Soc. 2023 Jul;71(7):2052–81. https://doi.org/10.1111/jgs.18372.
7. Von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. Ann Intern Med. 2007 Oct 16;147(8):573–7. https://doi.org/10.7326/0003-4819-147-8-200710160-00010.
8. Baré M, Herranz S, Jordana R, et al. Multimorbidity patterns in chronic older patients, potentially inappropriate prescribing and adverse drug reactions: protocol of the multicentre prospective cohort study MoPIM. BMJ Open. 2020 Jan;10(1):e033322. https://doi.org/10.1136/bmjopen-2019-033322.
9. World Health Organization (WHO). Obesity: preventing and managing the global epidemic. Report of a WHO Consultation [Internet]. Geneva: WHO; 2000. (WHO Technical Report Series; no. 894). Available from: https://iris.who.int/bitstreams/72fe01f6-8c54-4a64-984e-7e20f4700b44/download.
10. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing. 2019 Jan 1;48(1):16–31. https://doi.org/10.1093/ageing/afy169.
11. Ortonobes S, Herranz S, Lleal M, et al. Multidisciplinary medication review during older patient hospitalization according to STOPP/START criteria reduces potentially inappropriate prescriptions: MoPIM cohort study. BMC Geriatr. 2024 Jul 8;24(1):584. https://doi.org/10.1186/s12877-024-05185-w.
12. Andrade A, Nascimento T, Cabrita C, Leitão H, Pinto E. Potentially Inappropriate Medication: A Pilot Study in Institutionalized Older Adults. Healthcare. 2024 Jun 26;12(13):1275. https://doi.org/10.3390/healthcare12131275.
13. Kojima T, Hamaya H, Ishii S, Hattori Y, Akishita M. Association of disability level with polypharmacy and potentially inappropriate medication in community dwelling older people. Arch Gerontol Geriatr. 2023 Mar;106:104873. https://doi.org/10.1016/j.archger.2022.104873.
14. Hagiwara S, Komiyama J, Iwagami M, et al. Polypharmacy and potentially inappropriate medications in older adults who use long-term care services: a cross-sectional study. BMC Geriatr. 2024 Aug 21;24(1):696. https://doi.org/10.1186/s12877-024-05296-4.
15. Burcu Kelleci̇ Çakir B, Kizilarslanoğlu MC, Kiliç MK, et al. Assessment of the Appropriateness of Prescriptions in a Geriatric Outpatient Clinic. Turk J Pharm Sci. 2022 Feb 25;19(1):54–62. https://doi.org/10.4274/tjps.galenos.2021.77010.
16. Albayrak A, Demirbaş H. Evaluation of potentially inappropriate medications use and medication complexity in elderly patients applying to community pharmacy in Turkey. BMC Geriatr. 2023 Oct 13;23(1):655. https://doi.org/10.1186/s12877-023-04381-4.
17. Patel M, Mark A, Shah N. Assessment of appropriateness of prescribing among Indian geriatric outpatients using STOPP and START Criteria Version 2 at a tertiary care teaching hospital. Natl J Physiol Pharm Pharmacol. 2022;12(7):1. https://doi.org/10.5455/njppp.2023.13.05208202221052022.
18. Pala E, Ersoy S, Engin VS, Benli AR. Effectiveness of STOPP/START criteria in primary prevention of polypharmacy and under-treatment in older patients. Therapies. 2022 May;77(3):361–9. https://doi.org/10.1016/j.therap.2021.07.003.
19. Mekonnen AB, Reijnierse EM, Soh CH, Lim WK, Maier AB, Manias E. Associations between potentially inappropriate prescribing and increased number of medications with postdischarge health outcomes among geriatric rehabilitation inpatients: RESORT study. Brit J Clin Pharmacol. 2023 Nov;89(11):3375–88. https://doi.org/10.1111/bcp.15838.
20. Chiam R, Saedon N, Khor HM, A/P. Subramaniam S, Binti Mohmad Nasir SS, Binti Abu Hashim NFI, et al. Potentially inappropriate prescribing in a falls clinic using the STOPP and START criteria. Int J Clin Pharm. 2022 Feb;44(1):163–71. https://doi.org/10.1007/s11096-021-01329-9.
21. De Ruiter SC, Biesheuvel SS, Van Haelst IMM, Van Marum RJ, Jansen RWMM. To STOPP or to START?: Potentially inappropriate prescribing in older patients with falls and syncope. Maturitas. 2020 Jan;131:65–71. https://doi.org/10.1016/j.maturitas.2019.10.013.
22. Maclagan LC, Maxwell CJ, Gandhi S, et al. Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition. J Am Geriatr Soc. 2017 Oct;65(10):2205–12. https://doi.org/10.1111/jgs.15016.
23. Bonfiglio V, Umegaki H, Kuzuya M. Potentially Inappropriate Medications and Polypharmacy: A Study of Older People with Mild Cognitive Impairment and Mild Dementia. Fougère B, editor. J Alzheimers Dis. 2019 Oct 1;71(3):889–97. https://doi.org/10.3233/JAD-190284.
24. Webber C, Milani C, Bjerre LM, et al. Potentially Inappropriate Prescribing in Long-Term Care and Its Relationship with Probable Delirium. J Am Med Dir Assoc. 2024 Jan;25(1):130–7.e4. https://doi.org/10.1016/j.jamda.2023.08.019.
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