Evaluation of appropriateness of prescription and polypharmacy in the geriatric population: a cross sectional study at a comprehensive geriatric clinic in a tertiary care hospital
Objective: To assess the prescription quality in a comprehensive geriatric clinic and to determine the frequency of inappropriate prescription and polypharmacy.
Methods: Both males and female patients above the age of 60 y attending a comprehensive geriatric clinic of a tertiary care hospital were included in the study. Medications taken by the patients, excluding vitamins, minerals and herbal medications were counted in each patient and analyzed by considering their medical history and using universally accepted tools like medication appropriateness index, START, STOPP & Beerâ€™s criteria. In this study, polypharmacy was considered as having 6 or more medications per prescription.
Results: A total of 120 patients were included in the study. Around 82 (68.33%) patients had less than 6 prescribed medications and 38 patients (31.66%) were on 6 or more than 6 medications. The number of medications used by the patients is 4.37Â±2.33. Around 21 (17.5%) were on medications that are not indicated, 25 patients (20.83%) were receiving medications which are to be avoided in elderly as per the Beerâ€™s and STOPP criteria. Medication was underused in 24 patients (20%) as per START criteria. When both overused drugs and drugs to be avoided were considered for assessment of inappropriateness, 39 patients (32.5%) were found to be receiving inappropriate medication. Among the drugs to be avoided in elderly, amitriptyline was the most common drug and was used in 15 (12.5%) patients. Antihypertensives were the most common potential prescribing omissions in geriatric patients.
Conclusion: Polypharmacy is seen in a significant proportion of geriatric patients. Inappropriate prescription and potential prescribing omissions were observed in a significant proportion of geriatric patients.
Keywords: Polypharmacy, Geriatrics, Beerâ€™s criteria, STOPP criteria
2. Barry PJ, Gallagher P, Ryan C, Oâ€™mahony D. START (screening tool to alert doctors to the right treatment)â€”an evidence-based screening tool to detect prescribing omissions in elderly patients. Age Ageing 2007;36:632-8.
3. Bushardt RL, Massey EB, Simpson TW, Ariail JC, Simpson KN. Polypharmacy: Misleading, but manageable. Clin Interv Aging 2008;3:383â€“9.
4. Campbell SM, Cantrill JA. Consensus methods in prescribing research. J Clin Pharm Ther 2001;26:5-14.
5. Sergi G, De Rui M, Sarti S, Manzato E. Polypharmacy in the elderly: can comprehensive geriatric assessment reduce inappropriate medication use? Drugs Aging 2011;28:509-18.
6. American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The American Geriatrics Society, 2012 beers criteria, update expert panel. J Am Geriatr Soc; 2012. p. 1-16.
7. Gallagher P, O'Mahony D. STOPP (Screening tool of older persons' potentially inappropriate prescriptions): application to acutely ill elderly patients and comparison with beers' criteria. Age Ageing 2008;37:673â€“9.
8. Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol 1992;45:1045â€“51.
9. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: Implications for pay for performance. JAMA 2005;294:716â€“24.
10. Harugeri A, Joseph J, Parthasarathi G, Ramesh M, Guido S. Prescribing patterns and predictors of high-level polypharmacy in the elderly population: A prospective surveillance study from two teaching hospitals in India. Am J Geriatr Pharmacother 2010;8:271-80.
11. Crentsil V, Ricks MO, Xue QL, Fried LP. A pharmacoepidemiological study of community-dwelling disabled older women: factors associated with medication use. Am J Geriart Pharmacother 2010;8:215â€“24.
12. Rajska-Neumann A, Wieczorowska-Tobis K. Polypharmacy and potential inappropriateness of pharmacological treatment among community-dwelling elderly patients. Arch Gerontol Geriatr 2007;44(Suppl 1):303â€“9.
13. Haider SI, Johnell K, Thorslund M, Fastbom J. Analysis of the association between polypharmacy and socioeconomic position among elderly aged 77 y in sweden. Clin Ther 2008;30:419â€“27.
14. Moen J, Antonov K, Larsson CA, Lindblad U, Nilsson JL, RÃ¥stam L, et al. Factors associated with multiple medication use in different age groups. Ann Pharmacother 2009;43:1978â€“85.
15. Harugeri A, Joseph J, Parthasarathi G, Ramesh M, Guido S. Potentially inappropriate medication use in elderly patients: a study of prevalence and predictors in two teaching hospitals. J Postgrad Med 2010;56:186-91.
16. Zhan C, Sangl J, Bierman AS, Miller MR, Friedman B, Wickizer SW, et al. Potentially inappropriate medication use in the community-dwelling elderly: Findings from the 1996 medical expenditure panel survey. JAMA 2001;286:2823â€“9.
17. FialovÃ¡ D, TopinkovÃ¡ E, Gambassi G, Finne-Soveri H, JÃ³nsson PV, Carpenter I, et al. AdHOC project research group. potentially inappropriate medication use among elderly home care patients in Europe. JAMA 2005;293:1348â€“58.
18. Lai HY, Hwang SJ, Chen YC, Chen TJ, Lin MH, Chen LK. Prevalence of the prescribing of potentially inappropriate medications at ambulatory care visits by elderly patients covered by the taiwanese national health insurance program. Clin Ther 2009;31:1859-70.
19. Chung H, Suh Y, Chon S, Lee E, Lee BK, Kim K. Analysis of inappropriate medication use in hospitalized geriatric patients. J Korean Soc Health Syst Pharm 2007;24:115â€“23.
20. Lee SJ, Cho SW, Lee YJ, Choi JH, Ga H, Kim YH, et al. Survey of a potentially inappropriate prescription using STOPP/START criteria in inha university hospital. Korean J Fam Med 2013;34:319â€“26.
21. Ryan C, O'Mahony D, Kennedy J, Weedle P, Byrne S. Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol 2009;68:936â€“47.
22. Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc 2006;54:1516â€“23.