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Donna M. Fick - One of the best experts on this subject based on the ideXlab platform.
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prevalence of potentially inappropriate medication use in older adults using the 2012 Beers Criteria
Journal of the American Geriatrics Society, 2015Co-Authors: Amy J Davidoff, Edward G Miller, Eric M Sarpong, Eunice Yang, Nicole Brandt, Donna M. FickAbstract:Objectives To use the most recently available population-based data to estimate potentially inappropriate medication (PIM) prevalence under the 2012 update of the Beers list of PIMs and to provide a benchmark from which to measure future changes. Design Retrospective cohort study using nationally representative data. Setting 2006–2010 Medical Expenditure Panel Survey (MEPS). Participants Community-dwelling sample of U.S. older adults (N = 18,475). Measurements The updated Beers Criteria were operationalized, generating a “broad” PIM definition that incorporated form, route, or dose restrictions where clearly specified and a “qualified” definition that applied specific exceptions where mentioned in the rationale associated with each drug category. Bivariate analyses described PIM prevalence, comparing the two operational definitions, and examined time trends. Results Of older adults with prescription medications, 42.6% had at least one medication fill that met the broad definition, with nonsteroidal anti-inflammatory drugs (NSAIDs) having the highest prevalence (10.9%). The rate declined from 45.5% in 2006–2007 to 40.8% in 2009–2010. The categories with the largest absolute decline were NSAIDs, selected sulfonylureas, and estrogens. PIM prevalence was 30.9% using the qualified definition. Conclusion Despite the overall high use of PIMs, there has been a decline observed in recent years. Future studies should test the effect of educational and clinical interventions on changes in PIM use and outcomes. The current study results can aid in targeting these interventions.
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2012 Beers Criteria Update: How Should Practicing Nurses Use the Criteria?
Journal of Gerontological Nursing, 2012Co-Authors: Donna M. Fick, Barbara ResnickAbstract:The continued development of explicit lists of medications to avoid in older adults, such as the Beers Criteria, is a key initiative in geriatrics. The involvement of nurse in this endeavor is critical , and nursing research, education, and practice will help not only develop but also disseminate important pharmacological management information to the public and thereby decrease drug-related problems and improve the health of older adults. Lastly, we wish to acknowledge Dr. Mark Beers' tremendous leadership in conceptualizing the importance of medication management in older adults and in acknowledging the significance of the full-team approach in patient care. Mark, who passed away in 2009, was an incredible mentor and true champion of safe medication use in adults.
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2012 american geriatrics society Beers Criteria new year new Criteria new perspective
Journal of the American Geriatrics Society, 2012Co-Authors: Donna M. Fick, Todd P SemlaAbstract:Mark Beers, MD, recognized more than 2 decades ago that the prevention of adverse drug events in older adults is crucial to the public health of this vulnerable population. The Beers Criteria remain simultaneously one of the most used and most controversial sets of medication Criteria in the world. Although not without limitations, the Beers Criteria have done more than any other tool in the past decade to improve the awareness of and clinical outcomes for older adults with polypharmacy and for the most vulnerable older adults at risk of adverse drug events. They have accomplished this because of their explicit nature, simple application for nonpharmacy experts, and wide dissemination. The continued development of explicit lists of medications to avoid in older adults, such as the Beers Criteria, is a critical component, albeit not the only one, in the public health imperative to decrease drug-related problems and improve the health of older adults. Nevertheless, continuing challenges include evaluating and communicating a drug’s risks and benefits in older adults to individual clinicians across all settings of care and developing an explicit list of these medications as part of a concise document that meets the needs of patients, clinicians, educators, researchers, policy-makers, and regulators. This article provides a perspective from the co-chairs of the 2012 American Geriatrics Society (AGS) Beers Criteria by addressing these issues, exploring the major differences and intended use of the Criteria in this AGS-sponsored update, and proposing an agenda for future work. The authors believe the 2012 Criteria are vastly improved from previous iterations because they include important updates to the established method for developing the explicit list of medications to avoid in older adults and consider the challenges of guiding individual clinicians in avoiding certain drugs in older adults or using them with caution. Most importantly, the quality of the Criteria has been improved by the application of an evidence-based approach and the support of AGS. The decision to follow the Institute of Medicine standards for evidence and transparency was an important benchmark—one that was clearly a transition for Criteria that have been traditionally developed using a Delphi consensus process. Because of the nature of clinical drug trials in older adults, evidence was at times difficult to find and to apply cleanly. The literature search was complex because of the large number and diversity of search terms required, the extended time period searched, and the lack of clinical trial data in older adults often resulting in reliance on observational data. With AGS support, the development of databases to support more-frequent updates of the Criteria and continual grading of the evidence as it emerges will continue to enhance this process. Past criticisms of the Beers Criteria correctly pointed out that many of the drugs were off the market or not in widespread use, lessening their relevance to clinicians and their association with health outcomes. The support of AGS has made this list more dynamic and relevant to the real-world practice of medicine. Still, caveats in their recommendation or rationale complicate some of the resulting Criteria. These caveats offer additional guidance to clinicians about when to avoid a drug but at times cannot be used as a performance measure if extracted from a large database or by surveyors without sufficient clinical insight to discern these nuances. The Beers Criteria are situated within a larger perspective of strategies to improve medication safety in older adults. Previous studies have found that a small number of medications are responsible for most adverse drug events in older adults. In a recent study, four medications or medication classes (warfarin, insulin, oral antiplatelet agents, and oral hypoglycemic agents) were associated with most
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Developing explicit positive Beers Criteria for preferred central nervous system medications in older adults.
The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists, 2009Co-Authors: Richard G. Stefanacci, Elizabeth Cavallaro, Mark H. Beers, Donna M. FickAbstract:The Beers Criteria have been extensively used over the past decade to identify and evaluate potentially inappropriate medication use in adults 65 years of age and older in the United States. In contrast to the Beers Criteria, the purpose of this pilot initiative was to develop a new set of explicit Criteria for determining preferred (rather then potentially inappropriate) medications to use in older adults, using similar methodology as used in the three iterations of the Beers Criteria. This initiative organized its evaluations around classes of medications that are both frequently used and associated with drug-related problems in older adults-central nervous system (CNS) medications. This pilot study used a modified Delphi method-a set of procedures and methods for reaching group consensus for a subject matter in which precise information is lacking-to determine medications that are preferred for use in persons 65 years of age or older known to have specific medical conditions. Medications were selected as preferred because they are both effective, based upon a thorough evaluation of the clinical evidence, and pose less risk for older persons compared with alternative medications for the condition. Expert panelists evaluated 78 individual medications within four medical conditions (dementia, depression, Parkinson's disease, and psychosis). This study identified 13 preferred medications to be used in older adults with these conditions. This study expands explicit Criteria to more precisely define preferred medication use in older adults. This refinement of the Beers Criteria will enable providers to select medications with the greatest benefit-to-risk ratio for older adults, thereby minimizing drug-related problems. These Criteria will need to be expanded to include other medication classes and medical conditions frequently encountered in older adults.
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Developing Explicit Positive Beers Criteria for Preferred Central Nervous System Medications in Older Adults Research and Reports
2009Co-Authors: Richard G. Stefanacci, Elizabeth Cavallaro, Mark H. Beers, Donna M. FickAbstract:Background: The Beers Criteria have been extensively used over the past decade to identify and evaluate potentially inappropriate medication use in adults 65 years of age and older in the United States. In contrast to the Beers Criteria, the purpose of this pilot initiative was to develop a new set of explicit Criteria for determining preferred (rather then potentially inappropriate) medications to use in older adults, using similar methodology as used in the three iterations of the Beers crite ria. This initiative organized its evaluations around classes of medications that are both frequently used and associated with drug-related problems in older adults—central nervous system (CNS) medications. Methods: This pilot study used a modified Delphi method— a set of procedures and methods for reaching group consensus for a subject matter in which precise information is lacking—to determine medications that are preferred for use in persons 65 years of age or older known to have specific medical conditions. Medications were selected as preferred because they are both effective, based upon a thorough evaluation of the clinical evidence, and pose less risk for older persons compared with alternative medications for the condition. Expert panelists evaluated 78 individual medications within four medical conditions (dementia, depression, Parkinson’s disease, and psychosis). Results : This study identified 13 preferred medications to be used in older adults with these conditions. Conclusions : This study expands explicit Criteria to more precisely define preferred medication use in older adults. This refinement of the Beers Criteria will enable providers to select medications with the greatest benefit-to-risk ratio for older adults, thereby minimizing drug-related problems. These Criteria will need to be expanded to include other medication classes and medical conditions frequently encountered in older adults.
Paul Gallagher - One of the best experts on this subject based on the ideXlab platform.
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appropriate prescribing in the elderly an investigation of two screening tools Beers Criteria considering diagnosis and independent of diagnosis and improved prescribing in the elderly tool to identify inappropriate use of medicines in the elderly in
Journal of Clinical Pharmacy and Therapeutics, 2009Co-Authors: Cristin Ryan, Paul Gallagher, Denis Omahony, P Barry, Julia Kennedy, Peter Weedle, Stephen ByrneAbstract:Summary Background: Elderly patients are particularly vulnerable to inappropriate prescribing, with increased risk of adverse drug reactions and consequently higher rates of morbidity and mortality. A large proportion of inappropriate prescribing is preventable by adherence to prescribing guidelines, suitable monitoring and regular medication review. As a result, screening tools have been developed to help clinicians improve their prescribing. Objectives: To compare identification rates of inappropriate prescribing in elderly patients in primary care using two validated screening tools: Beers’ Criteria and improved prescribing in the elderly tool (IPET); to calculate the net ingredient cost (NIC) per month (€) of the potentially inappropriate medicines in this population of patients. Method: A consecutive cohort of 500 patients 65 years of age and over were recruited prospectively from primary care over a 6 month period in a provincial town in Ireland. Patients’ medical records (electronic and paper) were screened and all relevant information concerning current illnesses and medications was recorded on a standardized data collection form to which Beers’ Criteria [considering diagnosis (CD) and independent of diagnosis (ID)] and IPET tools were applied. The NIC was calculated from an edition of the Irish monthly index of medical specialities published concurrently with the data collection. Results: Beers’ Criteria identified a total of 69 medicines that were prescribed inappropriately (eight CD and 61 ID) in 65 patients (13%), costing €824·88 per month while IPET identified 63 potentially inappropriate medicines in 52 (10·4%) patients costing €381·28 per month. Conclusions: Potentially inappropriate medications are prescribed in a significant proportion of elderly people in primary care, with significant economic implications.
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stopp screening tool of older persons potentially inappropriate prescriptions application to acutely ill elderly patients and comparison with Beers Criteria
Age and Ageing, 2008Co-Authors: Paul Gallagher, Denis OmahonyAbstract:Introduction: STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) is a new, systems-defined medicine review tool. We compared the performance of STOPP to that of established Beers’ Criteria in detecting potentially inappropriate medicines (PIMs) and related adverse drug events (ADEs) in older patients presenting for hospital admission. Methods: we prospectively studied 715 consecutive acute admissions to a university teaching hospital. Diagnoses, reason for admission and concurrent medications were recorded. STOPP and Beers’ Criteria were applied. PIMs with clear causal connection or contribution to the principal reason for admission were determined. Results:median patient age (interquartile range) was 77 (72‐82) years. Median number of prescription medicines was 6 (range 0‐21). STOPP identified 336 PIMs affecting 247 patients (35%), of whom one-third (n = 82) presented with an associated ADE. Beers’ Criteria identified 226 PIMs affecting 177 patients (25%), of whom 43 presented with an associated ADE. STOPP-related PIMs contributed to 11.5% of all admissions. Beers’ Criteria-related PIMs contributed to significantly fewer admissions (6%). Conclusion: STOPP Criteria identified a significantly higher proportion of patients requiring hospitalisation as a result of PIM-related adverse events than Beers’ Criteria. This finding has significant implications for hospital geriatric practice.
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STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): Application to acutely ill elderly patients and comparison with Beers' Criteria
Age and Ageing, 2008Co-Authors: Paul Gallagher, Denis O'mahonyAbstract:Introduction: STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) is a new, systems-defined medicine review tool. We compared the performance of STOPP to that of established Beers' Criteria in detecting potentially inappropriate medicines (PIMs) and related adverse drug events (ADEs) in older patients presenting for hospital admission. METHODS: we prospectively studied 715 consecutive acute admissions to a university teaching hospital. Diagnoses, reason for admission and concurrent medications were recorded. STOPP and Beers' Criteria were applied. PIMs with clear causal connection or contribution to the principal reason for admission were determined. RESULTS: median patient age (interquartile range) was 77 (72-82) years. Median number of prescription medicines was 6 (range 0-21). STOPP identified 336 PIMs affecting 247 patients (35%), of whom one-third (n = 82) presented with an associated ADE. Beers' Criteria identified 226 PIMs affecting 177 patients (25%), of whom 43 presented with an associated ADE. STOPP-related PIMs contributed to 11.5% of all admissions. Beers' Criteria-related PIMs contributed to significantly fewer admissions (6%). CONCLUSION: STOPP Criteria identified a significantly higher proportion of patients requiring hospitalisation as a result of PIM-related adverse events than Beers' Criteria. This finding has significant implications for hospital geriatric practice.
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inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers Criteria
Age and Ageing, 2008Co-Authors: Paul Gallagher, P Barry, Cristin Ryan, Irene Hartigan, Denis OmahonyAbstract:Introduction: Adverse drug events (ADEs) are associated with inappropriate prescribing (IP) and result in increased morbidity, mortality and resource utilisation. We used Beers' Criteria to determine the three-month prevalence of IP in a non-selected community-dwelling population of acutely ill older people requiring hospitalisation.Methods: A prospective, observational study of 597 consecutive acute admissions was performed. Diagnoses and concurrent medications were recorded before hospital physician intervention, and Beers' Criteria applied.Results: Mean patient age (SD) was 77 (7) years. Median number of medications was 5, range 0-13. IP occurred in 32% of patients (n = 191), with 24%, 6% and 2% taking 1, 2 and 3 inappropriate medications respectively. Patients taking >5 medications were 3.3 times more likely to receive an inappropriate medication than those taking ≤5 medications (OR 3.34: 95%, CI 2.37-4.79; P<0.001). Forty-nine per cent of patients with inappropriate prescriptions were admitted with adverse effects of the inappropriate medications. Sixteen per cent of all admissions were associated with such adverse effects.Conclusion: IP is highly prevalent in acutely ill older patients and is associated with polypharmacy and hospitalisation. However, Beers' Criteria cannot be used as a gold standard as they do not comprehensively address all aspects of IP in older people.
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Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers' Criteria
Age and Ageing, 2007Co-Authors: Paul Gallagher, P Barry, Cristin Ryan, Irene Hartigan, Denis O'mahonyAbstract:Introduction: Adverse drug events (ADEs) are associated with inappropriate prescribing (IP) and result in increased morbidity, mortality and resource utilisation. We used Beers' Criteria to determine the three-month prevalence of IP in a non-selected community-dwelling population of acutely ill older people requiring hospitalisation.Methods: A prospective, observational study of 597 consecutive acute admissions was performed. Diagnoses and concurrent medications were recorded before hospital physician intervention, and Beers' Criteria applied.Results: Mean patient age (SD) was 77 (7) years. Median number of medications was 5, range 0-13. IP occurred in 32% of patients (n = 191), with 24%, 6% and 2% taking 1, 2 and 3 inappropriate medications respectively. Patients taking >5 medications were 3.3 times more likely to receive an inappropriate medication than those taking ≤5 medications (OR 3.34: 95%, CI 2.37-4.79; P
Denis Omahony - One of the best experts on this subject based on the ideXlab platform.
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appropriate prescribing in the elderly an investigation of two screening tools Beers Criteria considering diagnosis and independent of diagnosis and improved prescribing in the elderly tool to identify inappropriate use of medicines in the elderly in
Journal of Clinical Pharmacy and Therapeutics, 2009Co-Authors: Cristin Ryan, Paul Gallagher, Denis Omahony, P Barry, Julia Kennedy, Peter Weedle, Stephen ByrneAbstract:Summary Background: Elderly patients are particularly vulnerable to inappropriate prescribing, with increased risk of adverse drug reactions and consequently higher rates of morbidity and mortality. A large proportion of inappropriate prescribing is preventable by adherence to prescribing guidelines, suitable monitoring and regular medication review. As a result, screening tools have been developed to help clinicians improve their prescribing. Objectives: To compare identification rates of inappropriate prescribing in elderly patients in primary care using two validated screening tools: Beers’ Criteria and improved prescribing in the elderly tool (IPET); to calculate the net ingredient cost (NIC) per month (€) of the potentially inappropriate medicines in this population of patients. Method: A consecutive cohort of 500 patients 65 years of age and over were recruited prospectively from primary care over a 6 month period in a provincial town in Ireland. Patients’ medical records (electronic and paper) were screened and all relevant information concerning current illnesses and medications was recorded on a standardized data collection form to which Beers’ Criteria [considering diagnosis (CD) and independent of diagnosis (ID)] and IPET tools were applied. The NIC was calculated from an edition of the Irish monthly index of medical specialities published concurrently with the data collection. Results: Beers’ Criteria identified a total of 69 medicines that were prescribed inappropriately (eight CD and 61 ID) in 65 patients (13%), costing €824·88 per month while IPET identified 63 potentially inappropriate medicines in 52 (10·4%) patients costing €381·28 per month. Conclusions: Potentially inappropriate medications are prescribed in a significant proportion of elderly people in primary care, with significant economic implications.
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stopp screening tool of older persons potentially inappropriate prescriptions application to acutely ill elderly patients and comparison with Beers Criteria
Age and Ageing, 2008Co-Authors: Paul Gallagher, Denis OmahonyAbstract:Introduction: STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) is a new, systems-defined medicine review tool. We compared the performance of STOPP to that of established Beers’ Criteria in detecting potentially inappropriate medicines (PIMs) and related adverse drug events (ADEs) in older patients presenting for hospital admission. Methods: we prospectively studied 715 consecutive acute admissions to a university teaching hospital. Diagnoses, reason for admission and concurrent medications were recorded. STOPP and Beers’ Criteria were applied. PIMs with clear causal connection or contribution to the principal reason for admission were determined. Results:median patient age (interquartile range) was 77 (72‐82) years. Median number of prescription medicines was 6 (range 0‐21). STOPP identified 336 PIMs affecting 247 patients (35%), of whom one-third (n = 82) presented with an associated ADE. Beers’ Criteria identified 226 PIMs affecting 177 patients (25%), of whom 43 presented with an associated ADE. STOPP-related PIMs contributed to 11.5% of all admissions. Beers’ Criteria-related PIMs contributed to significantly fewer admissions (6%). Conclusion: STOPP Criteria identified a significantly higher proportion of patients requiring hospitalisation as a result of PIM-related adverse events than Beers’ Criteria. This finding has significant implications for hospital geriatric practice.
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inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers Criteria
Age and Ageing, 2008Co-Authors: Paul Gallagher, P Barry, Cristin Ryan, Irene Hartigan, Denis OmahonyAbstract:Introduction: Adverse drug events (ADEs) are associated with inappropriate prescribing (IP) and result in increased morbidity, mortality and resource utilisation. We used Beers' Criteria to determine the three-month prevalence of IP in a non-selected community-dwelling population of acutely ill older people requiring hospitalisation.Methods: A prospective, observational study of 597 consecutive acute admissions was performed. Diagnoses and concurrent medications were recorded before hospital physician intervention, and Beers' Criteria applied.Results: Mean patient age (SD) was 77 (7) years. Median number of medications was 5, range 0-13. IP occurred in 32% of patients (n = 191), with 24%, 6% and 2% taking 1, 2 and 3 inappropriate medications respectively. Patients taking >5 medications were 3.3 times more likely to receive an inappropriate medication than those taking ≤5 medications (OR 3.34: 95%, CI 2.37-4.79; P<0.001). Forty-nine per cent of patients with inappropriate prescriptions were admitted with adverse effects of the inappropriate medications. Sixteen per cent of all admissions were associated with such adverse effects.Conclusion: IP is highly prevalent in acutely ill older patients and is associated with polypharmacy and hospitalisation. However, Beers' Criteria cannot be used as a gold standard as they do not comprehensively address all aspects of IP in older people.
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inappropriate prescribing in the elderly a comparison of the Beers Criteria and the improved prescribing in the elderly tool ipet in acutely ill elderly hospitalized patients
Journal of Clinical Pharmacy and Therapeutics, 2006Co-Authors: P Barry, N Okeefe, Kieran Oconnor, Denis OmahonyAbstract:Summary Background: In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used Criteria for the identification of inappropriate prescribing are the Beers’ Criteria [both independent of diagnosis (ID) and considering diagnosis (CD) – 2003 version]. The Beers’ Criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers’ Criteria CD contains 19 different categories containing possible drug–disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug–disease interactions. Objectives: The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. Methods: A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80·3 ± 6·1 years) and all patients had both Beers’ Criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. Results: The results of the study identified a high rate of inappropriate prescribing among this population of community-dwelling subjects. The total number of inappropriate prescriptions identified using the Beers’ Criteria (ID) was 148 affecting 121 patients. The Beers’ Criteria (CD) identified 69 inappropriate prescriptions in 60 patients and the IPET identified 112 inappropriate prescriptions in 78 patients. The Beers Criteria (ID and CD combined) identified at least one inappropriate prescription in 34% of subjects and the IPET identified one in at least 22% of subjects. Conclusions: This study identifies high rates of use of inappropriate medications in community-dwelling elderly presenting with acute illness to hospital. These are comparable with inappropriate prescribing rates identified in previous studies. The revised Beers’ Criteria (2003) identified more inappropriate prescriptions than the IPET in this population of elders.
Encarnacion Blancoreina - One of the best experts on this subject based on the ideXlab platform.
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2015 Beers Criteria and stopp v2 for detecting potentially inappropriate medication in community dwelling older people prevalence profile and risk factors
European Journal of Clinical Pharmacology, 2019Co-Authors: Encarnacion Blancoreina, Gabriel Arizazafra, Ricardo Ocanariola, Jenifer Valdellos, Lorena Aguilarcano, Maria Rosa Garciamerino, Inmaculada BellidoestevezAbstract:To comparatively assess the prevalence rates of potentially inappropriate medications (PIMs) obtained by the former and latest versions of American Geriatrics Society Beers Criteria (AGS BC) and screening tool of older person’s potentially inappropriate prescriptions (STOPP), and analyze the factors of influence on PIM. Cross-sectional study including 582 community-dwelling older adults over the age of 65. Sociodemographic, clinical, functional, and comprehensive drug therapy data were collected. The primary endpoint was the percentage of patients receiving at least one PIM. A total of 3626 prescriptions were analyzed. PIMs were detected in 35.4% and 47.9% of patients according to the STOPP v1 and the 2012 AGS BC, respectively. This percentage rose to 54% when 2015 AGS BC were used and reached 66.8% with STOPP v2. The kappa coefficient between STOPP v2 and its former version was lower than the one between the updated Beers Criteria and their former version (0.41 vs 0.85). The agreement was good (0.65) between both latest Criteria. The number of medications, psychological disorders, and insomnia were predictors of PIM. A novel finding was that bone and joint disorders increased the odds for PIM by 78%. The 2015 AGS BC showed high sensitivity and good applicability to the European older patients. Both updated tools identified some pharmacological groups (benzodiazepines, PPIs, and opioids, among others) and certain health problems (insomnia, psychological disorders, and osteoarticular diseases) as factors of influence on PIM. Based on these findings, interventions aimed at promoting appropriate use of medications should be developed.
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2012 american geriatrics society Beers Criteria enhanced applicability for detecting potentially inappropriate medications in european older adults a comparison with the screening tool of older person s potentially inappropriate prescriptions
Journal of the American Geriatrics Society, 2014Co-Authors: Encarnacion Blancoreina, Gabriel Arizazafra, Ricardo Ocanariola, Matilde LeonortizAbstract:Objectives: To determine the prevalence of potentially inappropriate medications (PIMs) and related factors through a comparative analysis of the Screening Tool of Older Person's Potentially Inappropriate Prescriptions (STOPP), the 2003 Beers Criteria, and the 2012 AGS update of the Beers Criteria. Design: Cross-sectional. Setting: Primary care. Participants: Community-dwelling persons aged 65 and older who live on the island of Lanzarote, Spain (N = 407). Measurements: Sociodemographic characteristics; independence in activities of daily living; cognitive function; Geriatric Depression Scale; clinical diagnoses; and complete data on indication, dosage, and length of drug treatments. One thousand eight hundred seventh-two prescriptions were examined, and the rate of PIMs was assessed with the three Criteria. The primary endpoint was the percentage of participants receiving at least one PIM. Multivariate logistic regression was used to examine the factors related to PIMs. Results: Potentially inappropriate medications were present in 24.3%, 35.4%, and 44% of participants, according to the 2003 Beers Criteria, STOPP, and 2012 Beers Criteria, respectively. The profile of PIMs was also different (the most frequent being benzodiazepines in both Beers Criteria lists and aspirin in the STOPP). The number of drugs was associated with risk of prescribing PIMs in all three models, as was the presence of a psychological disorder in the 2003 Beers Criteria (odds ratio (OR) = 2.07, 95% confidence interval (CI) = 1.26–3.40) and the 2012 Beers Criteria (OR = 2.91, 95% CI = 1.83–4.66). The kappa for degree of agreement between STOPP and the 2012 Beers Criteria was 0.35 (95% CI = 0.25–0.44). Conclusion: The 2012 Beers Criteria detected the highest number of PIMs, and given the scant overlapping with the STOPP Criteria, the use of both tools may be seen as complementary.
Denis O'mahony - One of the best experts on this subject based on the ideXlab platform.
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STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): Application to acutely ill elderly patients and comparison with Beers' Criteria
Age and Ageing, 2008Co-Authors: Paul Gallagher, Denis O'mahonyAbstract:Introduction: STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) is a new, systems-defined medicine review tool. We compared the performance of STOPP to that of established Beers' Criteria in detecting potentially inappropriate medicines (PIMs) and related adverse drug events (ADEs) in older patients presenting for hospital admission. METHODS: we prospectively studied 715 consecutive acute admissions to a university teaching hospital. Diagnoses, reason for admission and concurrent medications were recorded. STOPP and Beers' Criteria were applied. PIMs with clear causal connection or contribution to the principal reason for admission were determined. RESULTS: median patient age (interquartile range) was 77 (72-82) years. Median number of prescription medicines was 6 (range 0-21). STOPP identified 336 PIMs affecting 247 patients (35%), of whom one-third (n = 82) presented with an associated ADE. Beers' Criteria identified 226 PIMs affecting 177 patients (25%), of whom 43 presented with an associated ADE. STOPP-related PIMs contributed to 11.5% of all admissions. Beers' Criteria-related PIMs contributed to significantly fewer admissions (6%). CONCLUSION: STOPP Criteria identified a significantly higher proportion of patients requiring hospitalisation as a result of PIM-related adverse events than Beers' Criteria. This finding has significant implications for hospital geriatric practice.
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Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers' Criteria
Age and Ageing, 2007Co-Authors: Paul Gallagher, P Barry, Cristin Ryan, Irene Hartigan, Denis O'mahonyAbstract:Introduction: Adverse drug events (ADEs) are associated with inappropriate prescribing (IP) and result in increased morbidity, mortality and resource utilisation. We used Beers' Criteria to determine the three-month prevalence of IP in a non-selected community-dwelling population of acutely ill older people requiring hospitalisation.Methods: A prospective, observational study of 597 consecutive acute admissions was performed. Diagnoses and concurrent medications were recorded before hospital physician intervention, and Beers' Criteria applied.Results: Mean patient age (SD) was 77 (7) years. Median number of medications was 5, range 0-13. IP occurred in 32% of patients (n = 191), with 24%, 6% and 2% taking 1, 2 and 3 inappropriate medications respectively. Patients taking >5 medications were 3.3 times more likely to receive an inappropriate medication than those taking ≤5 medications (OR 3.34: 95%, CI 2.37-4.79; P