Prevalence of potentially inappropriate medications use and associated risk factors among elderly cardiac patients using the 2015 American Geriatrics Society beers criteria
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Comparison of polypharmacy and pharmacotherapy among seniors in social institutions in 2001 and 2019
Polypharmacy (polypharmacotherapy) is a serious problem among seniors. The aim of the work was to compare pharmacotherapy and polypharmacy among seniors in social facilities in 2001 and 2019.
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Polypharmacy/polymedicine/multiple drugs is the use of four or more medications by a patient. Geriatrics or geriatric medicine is a specialty that focuses on health care of elderly people. Polypharmacy are the major risk factor of adverse drug reactions (ADRs). Elders are prone to multiple diseases is the leading cause for the using of polypharmacy. It increases hospital staying, cost of medications. Health care providers should evaluate the prescription, simplifying the prescription, obtaining of medication history. Keywords: ADRs, NSAIDs, geriatrics, polypharmacy Cite this Article K. Sangeetha, S. Varalakshmi. A Study on Polypharmacy Effects in Geriatrics in a Tertiary Care Teaching Hospital. Research & Reviews: A Journal of Pharmacognosy . 2017; 4(1): 36–38p.
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Abstract Background Medical practice sometimes involves the prescription of multiple medications (5 or more) at once, known as polypharmacy. Most frequently it occurs when a patient receives care from multiple doctors as a result of poly morbidity. The study aimed to identify polypharmacy cases (prescribing 5 or more than 5 medications) and irrational pharmacotherapy. Methods Polypharmacy and irrational pharmacotherapy cases in Georgia from 1 July to 30 September 2021 were evaluated using an electronic prescription system. The total number of polypharmacy was 7665, where 5 or more medications were prescribed. Out of 7665 cases, 612 (8%) were irrational pharmacotherapy that was assessed according to Beers criteria (American Geriatrics Association, 2015) and STOP/START criteria (recommendations of the Great Britain National Health Organization, NHS, 2014). Results Out of 612 cases 95 (15.6%) indicated irrational prescription (2 or more drugs) containing the same active ingredient under different trade names, which represented 1.2% of the total number of prescriptions; out of 612 cases 72% (440) and 5.9% out of a total number of cases the simultaneous appointment of drugs of the same and/or similar pharmacological group was detected. In 9.4% of cases (57) non-rational pharmacotherapy (an incompatibility of drugs) was revealed that was 0.8% of the total cases; out of 612 cases 20, or 3%, and 0.3% of the total cases showed that the prescription contained more than 2 antibiotics. Conclusions Medical polypharmacy is widespread in Georgia, especially in co-morbid elderly patients, which further increases their morbidity and mortality rates. The obtained results could be used to increase the efficiency of treatment, improve the population's health and reduce treatment costs. Key messages • The selection drug or combination of drugs is a complex process and requires justification of the appropriateness of the prescription for a particular patient. • A major goal of the best clinical practice is to optimize the use of medical preparations, improve quality of life and reduce expenses on drugs.
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Introduction: Many older patients experience polypharmacy and risk taking potentially inappropriate medications (PIMs) leading to adverse events. Recent studies have demonstrated the association between frailty and an increase in PIMs among community-dwelling older people and those with cancer. We evaluated whether frailty in hospitalised older patients is associated with polypharmacy and PIMs.
Methods: A cross-sectional study of inpatients aged ≥70 years admitted to one UK hospital. Frailty was assessed using the Fried Frailty Phenotype and FRAIL Scale. Polypharmacy and hyper-polypharmacy were defined as the concomitant use of five + and 10 + medications, respectively. PIMs were identified using the Beers and STOPP criteria.
Results: 201 participants (median age 80.7 years; 120 (60%) men) were recruited. 1738 medications were prescribed in this cohort, median 9 medications/ patient. Frailty was identified in 56% and 36% using the Fried Frailty Phenotype and FRAIL scale, respectively. Polypharmacy (46%) and hyper-polypharmacy (41%) were also common. Frailty using both scales was significantly associated with polypharmacy (P< 0.001). The Beers’ criteria identified 90 PIMs in 57 (28%) patients. 33 (58%) received one and 24 (42%) received 2+ PIMs. 108 PIMs in 76 (38%) patients were identified using the STOPP criteria. 53 patients (70%) received one and 23 (30%) received 2+ PIMs. Both frailty tools were significantly associated with PIMs using the STOPP criteria but not using the Beers’ criteria.
Conclusion: Frailty in older inpatients was significantly associated with polypharmacy and PIMs using the STOPP criteria. Structured medication review is essential for older people in hospital.
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The population of older adult patients in the United States is growing each year. Appropriate pharmacotherapy has allowed many older patients to live longer and maintain healthy lives. Unfortunately, the inappropriate utilization of medications can be harmful to older adult patients. Inappropriate pharmacotherapy may lead to overusing medications and polypharmacy. Polypharmacy can contribute to a higher incidence of adverse effects, increase the risk of dangerous drug interactions, cause noncompliance with appropriate medication use, and significantly increase the cost of health care. The polypharmacy issue with geriatric patients has been described as an epidemic and this issue must be addressed. This review provides objective rules that may help prevent polypharmacy. Consideration of these rules when prescribing, dispensing, and caring for older adult patients will improve the overall pharmacotherapy regimens instituted by healthcare providers.
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Population Ageing
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Polypharmacy, defined as concurrent of five or more drugs, can occur in patients of all ages. Polypharmacy may be appropriate or inappropriate. Appropriate polypharmacy is defined as use of the correct drugs under appropriate conditions [in order] to treat the right diseases. A prescribed drug becomes inappropriate when its benefits no longer outweigh its risks. Inappropriate polypharmacy has been shown to increase the risks of hospitalization, adverse drug events, clinically relevant drug interactions, and all-cause mortality. Many tools are available to aid physicians in identifying inappropriate polypharmacy. Implicit tools, such as the Medication Appropriateness Index (MAI), provide guidance to be used alongside clinical judgement. Explicit tools, such as the American Geriatrics Society (AGS) Beers Criteria, provide lists of potentially inappropriate drugs and recommend alternatives. Collaboration with pharmacists is important in assessing drug appropriateness. It has been shown to reduce drug-related problems, emergency department visits, and hospitalizations and to improve overall patient health. A patient-centered, team-based approach is recommended in the process of deprescribing inappropriate drugs. Deprescribing should be approached in the same stepwise manner as prescribing of new drugs, and should include patient agreement to changes, evidence-based rationales, and of dosage tapering strategies.
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The population of older adult patients in the United States is growing each year. Appropriate pharmacotherapy has allowed many older patients to live longer and maintain healthy lives. Unfortunately, the inappropriate utilization of medications can be harmful to older adult patients. Inappropriate pharmacotherapy may lead to overusing medications and polypharmacy. Polypharmacy can contribute to a higher incidence of adverse effects, increase the risk of dangerous drug interactions, cause noncompliance with appropriate medication use, and significantly increase the cost of health care. The polypharmacy issue with geriatric patients has been described as an epidemic and this issue must be addressed. This review provides objective rules that may help prevent polypharmacy. Consideration of these rules when prescribing, dispensing, and caring for older adult patients will improve the overall pharmacotherapy regimens instituted by healthcare providers.
Pharmacotherapy
Population Ageing
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Polypharmacy and Potentially Inappropriate Medication (PIM) are major public health concerns. They are associated with higher morbi-mortality and a socio-economic burden. The medication review is a solution to limit PIM, especially in the elderly, and in cases of poly-morbidity. Many tools are available to support medication review. We will introduce here the Beers criteria, the PRISCUS list, the STOPP/START criteria, the MAI (Medication Appropriateness Index) and the Good-Palliative-Geriatric Practice Algorithm.
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Medication Reconciliation
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