Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct;27(5):408-423.
doi: 10.1111/ijpp.12541. Epub 2019 Apr 9.

Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review

Stephanie K Nothelle  1 , Ritu Sharma  2 , Allison Oakes  2 , Madeline Jackson  2 , Jodi B Segal  1   2   3
Affiliations

Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review

Stephanie K Nothelle et al. Int J Pharm Pract. 2019 Oct.

Abstract

Objectives: Potentially inappropriate medication (PIM) use in older adults is a prevalent problem associated with poor health outcomes. Understanding drivers of PIM use is essential for targeting interventions. This study systematically reviews the literature about the patient, clinician and environmental/system factors associated with PIM use in community-dwelling older adults in the United States.

Methods: PRISMA guidelines were followed when completing this review. PubMed and EMBASE were queried from January 2006 to September 2017. Our search was limited to English-language studies conducted in the United States that assessed factors associated with PIM use in adults ≥65 years who were community-dwelling. Two independent reviewers screened titles and abstracts. Reviewers abstracted data sequentially and assessed risk of bias independently.

Key findings: Twenty-two studies were included. Nineteen examined patient factors associated with PIM use. The most common statistically significant factors associated with PIM use were taking more medications, female sex, and higher outpatient and emergency department utilization. Only three studies examined clinician factors, and few were statistically significant. Fifteen studies examined system-level factors such as geographic region and health insurance. The most common statistically significant association was the south and west geographic region relative to the northeast United States.

Conclusions: Amongst older adults, women and persons on more medications are at higher risk of PIM use. There is evidence that increased healthcare use is also associated with PIM use. Future studies are needed exploring clinician factors, such as specialty, and their association with PIM prescribing.

Keywords: geriatric ambulatory care; potentially inappropriate medications.

PubMed Disclaimer

References

    1. Hajjar ER, et al. Unnecessary drug use in frail older people at hospital discharge. J Am Geriatr Soc 2005; 53: 1518–1523. - PubMed
    1. Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 1997; 157: 1531–1536. - PubMed
    1. Lucchetti G, Lucchetti ALG. Inappropriate prescribing in older persons: a systematic review of medications available in different criteria. Arch Gerontol Geriatr 2017; 68: 55–61. - PubMed
    1. Hanlon JT, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol 1992; 45: 1045–1051. - PubMed
    1. Chang C-M, et al. Use of the Beers criteria to predict adverse drug reactions among first-visit elderly outpatients. Pharmacotherapy 2005; 25: 831–838. - PubMed

Publication types