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
. 2022 Aug 8;5(5):e759.
doi: 10.1002/hsr2.759. eCollection 2022 Sep.

Under-prescription of medications in older adults according to START criteria: A cross-sectional study in Lebanon

Affiliations

Under-prescription of medications in older adults according to START criteria: A cross-sectional study in Lebanon

Venise Hanna et al. Health Sci Rep. .

Abstract

Background and aims: Under-prescription is defined as the exclusion of medications indicated for the treatment of certain conditions without any rationale for not prescribing them. The under-prescription of medications is highly prevalent among older adults (≥65 years) receiving polypharmacy. This study aimed to assess the prevalence of the under-prescription of medications using the Screening Tool to Alert to Right Treatment (START) criteria version 2 and to identify the predictors of having potential prescribing omissions (PPOs).

Methods: This cross-sectional, face-to-face interview study was carried out between September 2021 and February 2022. The study comprised community-dwelling older adults taking at least one medication on a regular basis. The study questionnaire included the patients' demographics, clinical data, and comorbidities. PPOs were identified using the START criteria. The χ 2 test was used to assess the association between under-prescription of medication and the demographic/clinical variables. Multivariable logistic regression was performed to explore factors associated with under-prescription of medications as the dependent variable and taking all variables that showed a p < 0.05 in the bivariate analysis as independent.

Results: A total of 444 older adults agreed to participate in this study. The mean age of participants was 71 ± 8.6; the majority of them, 305 (68.7%), were men. Polypharmacy was present in 261 patients (58.8%) and underprescribing of medications in 260 patients (58.6%). The highest percentage of under-prescribing of medications was reported with statins in 115 patients (44.2%) followed by aspirin in 93 (35.7%), and angiotensin-converting enzyme inhibitors in 61 (23.4%). The results of the multivariable analysis showed that patients with underprescribed medications had higher odds of polypharmacy (odds ratio [OR]: 2.015, confidence interval [CI] 95% 1.362-2.980, p < 0.001) and higher Charlson Comorbidity Index (OR 2.807, CI 95% 1.463-5.85, p = 0.02).

Conclusion: The present findings highlight that PPOs are highly prevalent among community-dwelling older adults in Lebanon. Multimorbidity and polypharmacy were the identified predictors for under-prescription of medications in this population.

Keywords: START screening tool; elderly; inappropriate prescribing.

PubMed Disclaimer

Conflict of interest statement

The author declares no conflict of interest.

Figures

Figure 1
Figure 1
Number of potential prescribing omissions (PPOs) per patient (0 = 0 PPO, 1 = 1 PPO, 2 = 2 PPOs, 3 = 3 PPOs, 4 = 4 PPOs)

Similar articles

Cited by

References

    1. United Nations . Department of Economics and Social Affairs. Population Dynamics. 2019 Revision of World Population Prospects; 2019. Accessed May 28, 2021. https://population.un.org/wpp/
    1. Abdulrahim S, Ajrouch KJ, Antonucci TC. Aging in Lebanon: challenges and opportunities. Gerontologist. 2015;55(4):511‐518. 10.1093/geront/gnu095 - DOI - PMC - PubMed
    1. Bootman JL, Harrison DL, Cox E. The health care cost of drug‐related morbidity and mortality in nursing facilities. Arch Intern Med. 1997;157(18):2089‐2096. - PubMed
    1. Merle L, Laroche ML, Dantoine T, Charmes JP. Predicting and preventing adverse drug reactions in the very old. Drugs Aging. 2005;22(5):375‐92. - PubMed
    1. Kowal P, Dowd JE. Definition of an older person. Proposed Working Definition of an Older Person In Africa for the MDS Project. World Health Organization; 2001.

LinkOut - more resources