Assessment of prescribing potentially inappropriate medications listed in Beers criteria and its association with the unplanned hospitalization: a cross-sectional study in Lahore, Pakistan

• Published in: Clinical interventions in aging 2018-01, Vol.13, p.1485-1495
• Main Authors: Sarwar, Muhammad Rehan, Dar, Abdur-Rehman, Mahar, Saad Yousaf, Riaz, Tayyab, Danish, Usman, Iftikhar, Sadia
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Ambulatory care; Analysis; Aspirin; Beer; Beer’s criteria; Cross-Sectional Studies; Data collection; Diphenhydramine; Drugs; Elderly patients; Female; Geriatric Assessment; Geriatrics; Health care; Hospital patients; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Inappropriate Prescribing - statistics & numerical data; Insulin; Male; Medical records; Medical research; Older people; Omeprazole; Original Research; Pakistan; Patients; Pharmacy; Physiological aspects; Physiology; Polypharmacy; Population; Potentially Inappropriate Medication List - statistics & numerical data; Potentially Inappropriate Medicines; Prescription writing; Quality of life; Regression analysis; Risk Assessment; Risk Factors; Spreadsheet software; Unplanned Hospitalization
• ISSN: 1178-1998; 1176-9092; 1178-1998
• DOI: 10.2147/CIA.S173942

Due to physiological and pharmacological variations, geriatrics are at high risk of experiencing life-threatening outcomes related to the use of potentially inappropriate medications (PIMs). Thus, the present study aims to evaluate prescribing practices of PIMs among elderly patients who may lead to unplanned hospitalization and associated risk factors. A cross-sectional study was conducted in different hospitals of Lahore, Pakistan. The study population consisted of geriatric patients aged ≥65 years. Data were collected from the medical records of geriatric patients, who attended these selected hospitals between December 1, 2017, and February 28, 2018. Data were analyzed using SPSS (IBM SPSS Statistics for Windows, Version 21.0) and Microsoft Excel (MS Office 2010). The records of 385 geriatric patients were investigated. More than half (60.8%) of the patients were subjected to polypharmacy, which can be defined as the utilization of 5-9 drugs by the patient at the same time, whereas 36.4% were prescribed with one PIM and 56.4% were hospitalized due to PIMs. Majority of them were prescribed with PIMs including N02BA01 (aspirin, 32.4%), A02BC01 (omeprazole, 23.6%), A10AB02 (insulin, 17.4%), A02BC05 (esomeprazole, 8.5%), C08CA01 (amlodipine, 8.3%), and R06AA02 (diphenhydramine, 5.9%). Results of regression analysis revealed that patients exposed to polypharmacy (OR=2.556, 95% CI=1.579-4.135, -value≤0.001) and excessive polypharmacy (OR=37.828, 95% CI=4.754-300.9, -value≤0.001) were significantly associated with unplanned hospitalization, whereas factors such as age 75-84 years (OR=0.343, 95% CI=0.156-0.756, -value=0.008) and polypharmacy (OR=2.480, 95% CI=1.219-5.048, -value=0.012) were significantly correlated with PIMs. The utilization of PIMs listed in Beers criteria among geriatric population can cause unplanned hospitalization. As the patients receiving polypharmacy are at high risk of unplanned hospitalization, so caution must be exercised in prescribing PIMs for elderly people.