A prevalence study of potentially inappropriate medications use in hospitalized Pakistani elderly

Abstract

Background: Inappropriate prescribing in elderly patients is a widespread health problem. It is associated with increased drug-related problems and health expenditure.

Aims: To determine the prevalence and types of potentially inappropriate medications (PIM) prescribed to elderly patients with polypharmacy and the factors associated with their use in these patients.

Methods: A cross-sectional study conducted among 228 elderly hospitalized patients with polypharmacy. Elderly patients were defined as patients ≥65 years of age, and polypharmacy was defined as taking ≥5 drugs. Based on previously published criteria (Beers and STOPP), a list of 32 PIM was developed using a Delphi technique, which was used as a tool to detect the prevalence of PIM. Age, gender, comorbidity, patients' functional status, and complete medication history were recorded to evaluate as variables related to PIM. The association between PIM used and independent variables was also assessed.

Results: The prevalence of PIM used among the hospitalized elderly patients was 64%. PIM use according to STOPP criteria was identified in 44% of patients, whereas Beers-listed PIM were identified in 50% of patients. The most frequently observed PIM were the combination of nonsteroidal anti-inflammatory drugs (NSAIDs) with antihypertensives and long-term NSAIDs, which account for more than 90 and 75% of the total observed PIM, respectively. Patients with age ≥85 years were more likely to be prescribed PIM. High comorbidity was found to be an independent predictor of PIM use. Polypharmacy with ≥10 drugs prescribed to patients predicted the presence of PIM.

Discussion: The study showed a high prevalence of PIM use among hospitalized elderly patients. The consensus-validated list of PIM was a useful tool for screening inappropriate prescribing in this particular patient population.

Conclusion: Our findings support the need for measures to improve the quality of drug treatment in the elderly Pakistani population, especially among dependent patients with polypharmacy.

Keywords: Beers criteria; Hospitalized elderly patients; Polypharmacy; Potentially inappropriate medications; STOPP/START criteria.