PosterPDF Available

Potentially inappropriate medication in nursing homes: application of the Beers criteria

Abstract

This poster describes the results of the project SOS Pharma idoso focusing on the detection of potentially inappropriate medicines in elderly polypharmacy residing in nursing homes. Only results obtained from the application of the Beers criteria (AGS, 2012) are presented.
The elderly population is frequently polymedicated,
including with potentially inappropriate medications
(PIM). The use of explicit criteria can play an important
role in the identification of areas for pharmaceutical
intervention.
Introduction
The application of the Beers criteria in an elderly sample
enabled the identification of a considerable number of
PIM, consistent with previous studies (2,3). The most
commonly detected drugs as PIM can lead to falls and
fractures and nearly half of the sample with PIM were
patients with a history of fractures, as reported
elsewhere(3). Therefore, this specific aspect of geriatric
patient care should be more carefully addressed. This
study did not address interdisciplinary collaboration in
the resolution of PIM detected, an issue to be explored
in future studies which may enable the development of
pharmaceutical competencies for the care of geriatric
patients with unquestionable benefit for patient safety.
Discussion/Conclusions
To characterize and to quantify the occurrence of PIM
detected during medication review in a sample of
institutionalized elderly patients.
Objectives
References
Potentially inappropriate medication in
nursing homes: application of the Beers criteria
Periquito, C., Cavaco-Silva, P., Oliveira, P., Carneiro, C., Fernandes, A.I., Costa, F.A.
CiiEM, Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Portugal
Campus Universitário, Quinta da Granja. Monte de Caparica. 2829 - 511 Caparica (alvesdacosta.f@gmail.com)
Methods
Ethical approval
Invitation of 4 nursing homes
Population (n=224)
Application of elegibility criteria: aged ≥65
and using ≥5 medicinesSample (n=161)
Cross-sectional study
Analysis of Clinical files
Medication review using Beers criteria(1)
Description and quantification of PIM
Data analysis 2, Spearman, One-way
ANOVA, Mann-Whitney U and Kruskal-
Wallis). CI 95%
9th PCNE Working Conference, Mechelen (Belgium). 4-7 Feb 2015
The mean age was 84.7 years (SD=6.35), 68.9% of the
recruits were female, had 4.1 diseases (SD=2.14), used
10.1 medicines (SD=3.89) taken in 12.3 daily doses
(SD=5.76).
.
Nearly half of the sample (42.1%) taking PIM were
patients with a history of fractures. The location of the
nursing home had no impact on the distribution of
PIM-ID. The number of PIM was neither influenced by
patients’ socio-demographic characteristics, nor by the
number of comorbidities, but directly correlated,
although weakly, with the number of medicines
prescribed (Pearson r=0.241; p=0.002).
Results
4,3
75,0 88,0 92,8 85,1
0
59,4
28,0 39,1 42,1
0
20
40
60
80
100
1 2 3 4 Total
Prevalance (%)
PIM detected applying Beers Criteria(American Geriatrics
Society, 2012)
Independent of
diagnosis (ID)
Dependent of
diagnosis (DD) *
*Information missing from
35 individuals , all form the
same nursing home
Nursing homes (p=0,002)
14
73
105
256
First generation antihistamine
Antipsychotics
Benzodiazepines
Total
Drug (n; %)
Top 3 Drugs most commonly detected as PIM-ID
(100%)
(41,0%)
(28,5%)
(5,5%)
1. American Geriatrics Society (2012). American Geriatrics Society Updated Beers Criteria for
Potentially Inappropriate Medication Use in Older Adults: The American Geriatrics Society
2012 Beers Criteria Update Expert Panel. J Am Geriatr, 60(4), 616631.
2. Matanović, S. M., & Vlahović-Palčevski, V. (2014). Potentially inappropriate prescribing to
the elderly: comparison of new protocol to Beers criteria with relation to hospitalizations for
ADRs. Eur J Clin Pharmacol, 70(4), 483490.
3. Vieira de Lima, T. J., Garbin, C. A. S., Garbin, A. J. I., Sumida, D. H., & Saliba, O. (2013).
Potentially inappropriate medications used by the elderly: prevalence and risk factors in
Brazilian care homes. BMC Geriatr, 13, 52.
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Article
Full-text available
Screening tools for detecting potentially inappropriate medications (PIMs) represent an important way to assess drug prescribing in the elderly. Recently, we introduced a new comprehensive tool to detect both PIMs and clinically important drug-drug interactions (DDI). The aim of the study was to assess the applicability of the new tool. The new tool was used to detect PIMs and DDI and to assess their relation to morbidity and hospital admissions. It was also compared to the widely used Beers criteria. The study population included 454 consecutive patients aged ≥65 years who were acutely admitted to the Department of Internal Medicine of the University Hospital of Osijek. The Naranjo protocol was used to analyze the causal relationship between a drug and an adverse event. According to the new protocol, 44 % patients were taking PIMs, while 33 % patients were taking drugs with potentially serious DDIs. In 11 % of the overall number of patients, the cause of admission was adverse drug reaction (ADR), and among contributing drugs, 44 % were potentially inappropriate according to our protocol. Gastrointestinal bleeding was the most common diagnosis causing ADR-associated admission, and in 72 % cases, either PIM or a potentially serious DDI was involved. The new Croatian tool detected a high number of patients taking PIMs and/or having potentially important drug-drug interactions. The tool also detected almost half of the drugs contributing to ADR-associated admission. We expect the tool to be useful in prescription evaluation for the elderly inpatient and outpatient population.
Article
Full-text available
Background: The use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems. This study's objective was to verify the prevalence of and the factors associated with the use of PIMs by elderly Brazilians in institutional settings. Methods: We performed a transversal study, by consulting the case files of elderly people living in Long Term Care for the Elderly (LTC) in towns in the State of São Paulo, Brazil, as well as structured interviews with the nurses responsible for them.We identified PIMs using the list of recently updated Beers criteria developed by a group of specialists from the American Geriatrics Society (AGS), who reviewed the criteria based on studies with high scientific evidence levels. We defined the factors studied to evaluate the association with PIM use prior to the statistical analyses, which were the chi-square test and multiple logistic regression. Results: Among the elderly who used drugs daily, 82.6% were taking at least one PIM, with antipsychotics (26.5%) and analgesics (15.1%) being the most commonly used. Out of all the medications used, 32.4% were PIMs, with 29.7% of these being PIMs that the elderly should avoid independent of their condition, 1.1% being inappropriate medication for older adults with certain illnesses or syndromes, and 1.6% being medications that older adults should use with caution. In the multivariate analysis, the factors associated with PIM use were: polypharmacy (p = 0.0187), cerebrovascular disease (p = 0.0036), psychiatric disorders (p < 0.0001) and dependency (p = 0.0404). Conclusions: The results of this study showed a high prevalence of PIM use in institutionalized elderly Brazilian patients. and the associated factors were polypharmacy, psychiatric disorders, cerebrovascular diseases and dependency.
American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults: The American Geriatrics Society 2012 Beers Criteria Update Expert Panel
American Geriatrics Society (2012). American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults: The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. J Am Geriatr, 60(4), 616-631.