Potentially Inappropriate Medications and the Risk of Adverse Drug Events in Older Patients

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Medication Management".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 8646

Special Issue Editors


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Guest Editor
1. Clinical Pharmacology Department, La Paz University Hospital-IdiPAZ, Paseo de la Castellana, 261, 28046 Madrid, Spain
2. Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo sn, 28049 Madrid, Spain
Interests: pharmacology and therapeutics; clinical pharmacology; pharmacovigilance; adverse drug reactions; adverse drug events

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Guest Editor
Geriatric Research Group, Biomedical Research Foundation at Getafe University Hospital, 28905 Getafe, Spain
Interests: clinical pharmacy

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Guest Editor
Geriatric Research Group, Biomedical Research Foundation at Getafe University Hospital, 28905 Getafe, Spain
Interests: clinical pharmacology; clinical trials in older people; adverse drug reactions; adverse drug events

Special Issue Information

Dear Colleagues,

Older people comprise approximately 13% of the population; however, they consume 40% of prescription drugs and 35% of all over-the-counter drugs. The older population are particularly susceptible to adverse drug events or drug interactions, due to the physiological changes they experience, genetic predisposition, and environmental exposure. It is necessary to adapt health systems with comprehensive and multidisciplinary approaches suitable for older patients, since knowledge about proper prescription, clinical pharmacology and the use of medications in the elderly has become essential.

This Special Issue invites research to attempt to explore the adverse effects of medications in elderly patients, and to analyze the prescribers' adherence to appropriate prescribing guidelines in elderly patients. Original research, reviews, and short communications are all welcome.

Since the journal is multidisciplinary in nature, we encourage the submission of interdisciplinary papers and collaborative research from different (low, middle, and high income) countries.

Prof. Dr. Elena Ramírez
Dr. Olga Laosa
Dr. Laura Pedraza
Guest Editors

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Keywords

  • pharmacovigilance
  • elderly
  • adverse drug reactions
  • adverse drugs events
  • inappropriate prescribing
  • patient safety

Published Papers (4 papers)

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11 pages, 1577 KiB  
Article
Improved Medication Adherence of an Elderly Diabetic Patient at a Dwelling Home Using a Pill Dispenser and Personal Health Records
by Ryoji Suzuki, Emiri Takahashi and Ikuo Tofukuji
Healthcare 2024, 12(4), 499; https://doi.org/10.3390/healthcare12040499 - 19 Feb 2024
Viewed by 857
Abstract
Fookkun® is a pill dispenser in which single doses of several medications intended to be taken simultaneously are sealed in single film bags rolled onto a medication rotating drum. The system makes musical alert sounds when it is time for the patient [...] Read more.
Fookkun® is a pill dispenser in which single doses of several medications intended to be taken simultaneously are sealed in single film bags rolled onto a medication rotating drum. The system makes musical alert sounds when it is time for the patient to take the medications. If the patient misses a dose, a designated contact, such as the patient’s child, is alerted. We conducted an experiment monitoring the use of a pill dispenser (Fookkun®) by an older patient. The participant was a 71-year-old woman with diabetes living in a dwelling home. The experiment lasted approximately 6 months. Fookkun® and the prototype data transmitter were installed at the patient’s home. Fookkun®’s medication history data are displayed on the electronic medication record book (E-MRB) and the patient’s pharmacist checks the patient’s medication history on the E-MRB. The Fookkun® was effective in facilitating medication adherence. The pharmacist and the patient’s daughter did not need to check the E-MRB because Fookkun® alerted them when the patient missed her medication. We believe that if the medication history data linked between a pill dispenser and an E-MRB can be shared among medical staff, this will contribute to a medical digital transformation in Japan in the future. Full article
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12 pages, 289 KiB  
Article
Potentially Inappropriate Medications in Older Adults—Prevalence, Trends and Associated Factors: A Cross-Sectional Study in Saudi Arabia
by Fouad F. Jabri, Yajun Liang, Tariq M. Alhawassi, Kristina Johnell and Jette Möller
Healthcare 2023, 11(14), 2003; https://doi.org/10.3390/healthcare11142003 - 12 Jul 2023
Cited by 4 | Viewed by 1453
Abstract
(1) Background: Potentially inappropriate medications (PIMs) in older adults are associated with drug-related problems, adverse health consequences, repeated hospital admissions and a higher risk of mortality. In Saudi Arabia and some Arab countries, studies of PIMs among large cohorts of older adults are [...] Read more.
(1) Background: Potentially inappropriate medications (PIMs) in older adults are associated with drug-related problems, adverse health consequences, repeated hospital admissions and a higher risk of mortality. In Saudi Arabia and some Arab countries, studies of PIMs among large cohorts of older adults are limited. This study aimed to determine the prevalence of PIMs, trends and associated factors among outpatient older adults in Saudi Arabia. (2) Methods: A cross-sectional study was carried out. Over three years (2017–2019), data on 23,417 people (≥65 years) were retrieved from outpatient clinics in a tertiary hospital in Riyadh, Saudi Arabia. PIMs were assessed using the 2019 Beers Criteria. Covariates included sex, age, nationality, number of dispensed medications, and number of diagnoses. A generalized estimating equation model was used to assess trends and factors associated with PIMs. (3) Results: The prevalence of PIMs was high and varied between 57.2% and 63.6% over the study years. Compared with 2017, the prevalence of PIMs increased significantly, with adjusted odds ratios (OR) (95% confidence interval (95% CI)) of 1.23 (1.18–1.29) and 1.15 (1.10–1.21) for 2018 and 2019, respectively. Factors associated with being prescribed PIMs included ≥5 dispensed medications (OR_adjusted = 23.91, 95% CI = 21.47–26.64) and ≥5 diagnoses (OR_adjusted = 3.20, 95% CI = 2.88–3.56). Compared with females, males had a lower risk of being prescribed PIMs (OR_adjusted = 0.90, 95% CI = 0.85–0.94); (4) Conclusions: PIMs were common with an increasing trend among older adults in Saudi Arabia. A higher number of dispensed medications, increased number of diagnoses and female sex were associated with being prescribed PIMs. Recommendations on how to optimize prescriptions and implement de-prescribing strategies are urgently needed. Full article
13 pages, 1481 KiB  
Article
Trends and Geographic Variabilities in Benzodiazepines Prescription in Primary Care to Older Adults: A 3-Year Population-Based Ecological Study in Portugal
by Ana Bárbara Tavares, Ana Isabel Placido, Daniela Almeida Rodrigues, Manuel Morgado, Adolfo Figueiras, Maria Teresa Herdeiro and Fátima Roque
Healthcare 2022, 10(7), 1342; https://doi.org/10.3390/healthcare10071342 - 19 Jul 2022
Cited by 1 | Viewed by 2603
Abstract
(1) Background: According to the World Health Organization (WHO), benzodiazepines (BZD) are considered essential medicines for the treatment of several mental disorders in older adults over 65 years old. However, the long-term use of BZD could present a harmful impact on this population, [...] Read more.
(1) Background: According to the World Health Organization (WHO), benzodiazepines (BZD) are considered essential medicines for the treatment of several mental disorders in older adults over 65 years old. However, the long-term use of BZD could present a harmful impact on this population, leading to cognitive deficits, drug dependence, falls, and fractures. This study aims to analyze trends of BZD prescription to Portuguese older adults in the primary care setting, and to analyze the change in the prescription rate of BZD over time, assessing the geographical variability in mainland Portugal. (2) Methods: A nationwide, retrospective ecological study was performed between January 2019 and December 2021 for BZD prescribing data reported in a national public database for all persons aged 65 and older in mainland Portugal (about 2.4 million). Trends of BZD by defined daily doses (DDD) and per 1000 older adults’ inhabitants per day (DID) were analyzed. (3) Results: A total of 19 BZD were included in this study and more than 1 million BZD prescriptions were recorded in each year of this study period. BZD prescriptions were three times higher in females than in males. Alprazolam, lorazepam, diazepam, ethyl loflazepate, and bromazepam were the most prescribed BZD over the years, presenting the higher DDD and DID values. (4) Conclusions: Despite the DID value growth of several BZD, Portugal is now showing stable BZD prescriptions in older adults, between the years 2019 to 2021. More studies are needed to access if these results are a consequence of successful health programs or just a consequence of the pandemic context that we are facing, which limited older adults’ clinical appointments. Full article
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25 pages, 566 KiB  
Systematic Review
Prevalence of Potentially Inappropriate Prescriptions According to the New STOPP/START Criteria in Nursing Homes: A Systematic Review
by Isabel Díaz Planelles, Elisabet Navarro-Tapia, Óscar García-Algar and Vicente Andreu-Fernández
Healthcare 2023, 11(3), 422; https://doi.org/10.3390/healthcare11030422 - 1 Feb 2023
Cited by 5 | Viewed by 3109
Abstract
The demand for long-term care is expected to increase due to the rising life expectancy and the increased prevalence of long-term illnesses. Nursing home residents are at an increased risk of suffering adverse drug events due to inadequate prescriptions. The main objective of [...] Read more.
The demand for long-term care is expected to increase due to the rising life expectancy and the increased prevalence of long-term illnesses. Nursing home residents are at an increased risk of suffering adverse drug events due to inadequate prescriptions. The main objective of this systematic review is to collect and analyze the prevalence of potentially inadequate prescriptions based on the new version of STOPP/START criteria in this specific population. Databases (PubMed, Web of Science and Cochrane) were searched for inappropriate prescription use in nursing homes according to the second version of STOPP/START criteria. The risk of bias was assessed with the STROBE checklist. A total of 35 articles were assessed for eligibility. One hundred and forty nursing homes and more than 6900 residents were evaluated through the analysis of 13 studies of the last eight years. The reviewed literature returned prevalence ranges between 67.8% and 87.7% according to the STOPP criteria, according to START criteria prevalence ranged from 39.5% to 99.7%. The main factors associated with the presence of inappropriate prescriptions were age, comorbidities, and polypharmacy. These data highlight that, although the STOPP/START criteria were initially developed for community-dwelling older adults, its use in nursing homes may be a starting point to help detect more efficiently inappropriate prescriptions in institutionalized patients. We hope that this review will help to draw attention to the need for medication monitoring systems in this vulnerable population. Full article
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: POTENTIALLY INAPPROPRIATE MEDICATIONS PRESCRIBED TO ELDERLY PEOPLE WITH REDUCED MOBILITY AND/OR BEDRIDDEN
Authors: Dr. Anderson da Silva Rego; Rafael A. Bernardes; Luísa Texeira; Dr. João Alves Apostle; Dr. Pedro Parreira; Dra. Anabela Salgueiro-Oliveira
Affiliation: Dr. Anderson da Silva Rego - Postdoctoral Fellow at Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal. Rafael A. Bernardes - PhD student at Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal. Luísa Texeira - Assistant Researcher at the Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal. We also had another contributor, who assisted in the data collection at homes. She is the head of a community center and supplied us with a list of patients' names and addresses, and aided in the data collection both at the household level and via the system, which contained all information relevant to each patient's medication profile. Dr. João Alves Apostle - Professor and Researcher Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal. Dr. Pedro Parreira - Professor and Researcher Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal. Dra. Anabela Salgueiro-Oliveira - Professor and Researcher Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal.
Abstract: This cross-sectional study collected data from elderly individuals with reduced mobility, those who are bedridden, and those living in nursing homes, continuing care centers, and homes within a city under the jurisdiction of Portugal. Our findings revealed that out of the 54 participants, 85% are prescribed these medications. The article will report the outcomes of the anthropometric profile, the Braden scale evaluating the risk of pressure injury, and the clinical characterization of the patients. The results also indicate a tendency towards the prescription of certain medications listed in the Beers Criteria. Among these, some medications increase the risk of immobility (due to the prescribed psychotics) and the incidence of pressure injuries, as well as complications in their treatment. This is particularly concerning considering that most individuals with these injuries are on anticoagulants and face challenges or restrictions related to nutrition, which complicates treatment. The study also prompts a reflection on the use of certain medications, even in environments staffed by health professionals, such as hospitals, continuing care centers, and homes.

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