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. 2024 May 14;21(2):159-166.
doi: 10.4274/tjps.galenos.2023.89457.

Analyzing the Iatrogenic Triad: Discovering Strategies for Preventing Harm in the Elderly

Vinodkumar Mugada  1 , Srinivasa Rao Yarguntla  2 , Satya Sai Srinivas Allada  1 , Kamala Kumari Paravastu  2 , Stephanie Margaret Puvvada  1
Affiliations

Analyzing the Iatrogenic Triad: Discovering Strategies for Preventing Harm in the Elderly

Vinodkumar Mugada et al. Turk J Pharm Sci. .

Abstract

Objectives: The iatrogenic triad is a significant global health problem in the elderly population. This study aimed to evaluate the iatrogenic triad in the elderly and identify potential preventive measures to mitigate its occurrence.

Materials and methods: A preliminary observational study was conducted on 150 ambulatory elderly patients to assess potentially inappropriate medications (PIMs), polypharmacy, and drug interactions. The AGS Beers Criteria 2019, Polypharmacy, Medication Complexity Regimen Index (MRCI), and Micromedex (a drug information software) were used to assess the harmful triad. Before and after data collection, we observed, identified, and unfolded potential strategies to avoid the harmful triad in the elderly population.

Results: MRCI is 30.49 ± 13.77, suggesting a moderate level of complexity in the drug regimens of elderly patients. Among the PIMs identified by the AGS Beer criteria for 2019, glimepiride (45) and diclofenac (23) were found to be the most frequently prescribed. Moderate-level drug-drug interactions were identified between aspirin and metoprolol (20), metoprolol and metformin (13), and aspirin and enalapril (11). All drug-ethanol and drug-food interactions were rapid and often unknown to patients. Furthermore, the study found that MRCI and polypharmacy were significantly associated with the number of PIMs and drug interactions (p < 0.01). Based on data collection, this study identified three possible ways to prevent the iatrogenic triad in elderly patients: interaction, collaboration, and continuing education.

Conclusion: In conclusion, this study sheds light on medication regimen complexity, PIMs, and drug interactions in elderly patients. The study also highlights three possible ways to prevent the iatrogenic triad: interaction, collaboration, and continuing education. By implementing these strategies, healthcare providers can help prevent harm and improve the quality of care for elderly patients.

Keywords: Aged; drug interactions; medication regimen complexity index; polypharmacy; potentially inappropriate medication list.

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Conflict of interest statement

Conflict of Interest: The authors have no relevant financial or non-financial interests to disclose.

Figures

Figure 1
Figure 1
Interaction of outpatients, continuing education, and collaboration of physicians with a clinical pharmacist BPMH: Best possible medication history
See this image and copyright information in PMC

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