Potentially Inappropriate Medication Use Highly Prevalent in Older Adults

Polypharmacy may be raising the risk of inappropriate medication use, and avoiding this is crucial.

Use of potentially inappropriate medications (PIMs) is highly prevalent in older adults, according to a study published in the Canadian Journal on Aging.

The study also explained that approximately half of adults aged 65 and older have been prescribed PIMs, and that comprehensive geriatric assessment (CGA) recommendations have lessened PIM use.

“This is significant, as many older adults with complex comorbidities could benefit from geriatrician-led CGA not only in terms of the usual geriatric syndromes (e.g., cognition problems, falls) but also in reducing PIM use,” the authors said.

To determine the prevalence of PIM use among older patients, 2 retrospective chart reviews were performed. One included 200 older patients from Glenrose Rehabilitation Hospital (Glenrose) and the other included 164 older patients from Misericordia Community Hospital (Misericordia). All patients previously underwent CGAs at the outpatient geriatrics clinics at Glenrose between 2012 and 2013 and at Misericordia between 2016 and 2017.

Outcome measures included:

  • Demographics
  • Prevalence of PIM use
  • Common PIMs used
  • Whether PIM use was addressed, and if so, how
  • Total number of oral medications.

At Glenrose, the prevalence of PIM use was 45% (90/200), and 46.7% (42/90) of patients who used PIMs had 1 or more of their medications stopped or modified after the CGA.

At Glenrose, the mean patient age was 79.4 years (and most were female (60.5%). The median number of co-morbidities was 7, and the average number of medications per patient was 9.0). In 77.5% of cases (155/200), the reason for referral was cognitive assessment.

At Misericordia, the prevalence of PIM use was higher at 57.3% (94/164), with 47.9% (45/94) of those patients having at least 1 of their medications stopped or modified after the CGA.

The mean patient age was slightly higher at 81.8 years), again with the majority being female (62.2%). The median number of comorbidities was slightly higher at 8, and the average number of medications per patient was slightly lower at 8.5. Cognitive assessment was, again, the leading reason for referral at 86.5% (141/163) of cases.

“The increase in the prevalence of PIM use at the Misericordia site was most likely related to the change in criteria (e.g., proton-pump inhibitors being included in the 2015 PIM use criteria) between the 2 time periods for the chart reviews,” the authors wrote. “However, if proton-pump inhibitors are excluded from our data, there were fewer PIMs being prescribed at the Misericordia outpatient clinic in 2016–2017 than in the Glenrose outpatient clinic in 2012–2013 (42.1% vs 45.0%).”

The authors also noted that more PIMs were being addressed at the Misericordia outpatient clinic compared with the Glenrose outpatient clinic during the set time periods. “We postulate that with the increasing awareness of PIMs, there is less prescribing and more efforts to reduce PIM use at the later date,” they said.

The study suggests polypharmacy (defined as the use of 5 or more medications at a time) increases the likelihood of PIM use, and that avoiding this is crucial to prevent both adverse drug effects in the elderly and increased health care expenses.

This is the first study showing that CGA led by geriatricians can reduce PIM use at 2 different points in time.

“These results suggest that an increased awareness of PIM among physicians is needed to further decrease PIM use,” the authors said.

Reference

Charles L, Kumar E, Elghol E, et al. Potentially inappropriate medication use in the elderly. Can J Aging. Published online July 29, 2021. doi:10.1017/S0714980821000234