Prescribing potentially inappropriate medications for the elderly according to Beers Criteria: systematic review

Praxedes, Marcus Fernando da Silva; Pereira, Gleideson Cerqueira dos Santos; Lima, Claudia Feio da Maia; Santos, Djanilson Barbosa dos; Berhends, Jamille Sampaio

doi:10.1590/1413-81232021268.05672020

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW • Ciênc. saúde coletiva 26 (08) • Aug 2021 • https://doi.org/10.1590/1413-81232021268.05672020 copy

Prescribing potentially inappropriate medications for the elderly according to Beers Criteria: systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The study aimed to perform a systematic review to identify and evaluate the prevalence of potentially inappropriate medicines (PIM) prescriptions for the elderly, according to Beers Criteria, in hospitalized elderly individuals aged 65 years or older. Five databases consulted: VHL; Cochrane Library; CINAHL; MEDLINE and Web of Science. Nineteen articles identified, selected based on eligibility criteria. The mean age was 78.2 years and the most used criterion for the identification of PIM for the elderly was Beers 2015 (57.9%). A total of 221,879 elderly received a prescription for PIM, the mean prevalence was 65.0%, for the gastrointestinal system (15.3%) and proton-pump inhibitors (27.7%) highlighted as the main class of medicine prescribed. It concluded that the Beers Criteria have made it possible to identify the high prevalence in the prescription of PIM. The results of this review may help in the decision making of health professionals, to avoid the administration of PIM and to propose best practices to ensure the safety of the elderly hospitalized.

Key words:
Inappropriate Prescribing; Potentially Inappropriate Medication List; Aged

Study/Year	Country	Type of study	Sample n	Average age (years)	Beer’s criteria	PIM/Patient Prevalence N (%)	Quality score
Chukwulebe et al., 2019²²22 Chukwulebe SB, Kim HS, McCarthy DM, Courtney DM, Lank PM, Gravenor SJ, Dresden SM. Potentially Inappropriate Medication Prescriptions for Older Adults with Painful Conditions and Association with Return Emergency Department Visits. J Am Geriatr Soc 2019; 67(4):719-725.	United States	Cohort	11,822	71.5 (67.0-78.0)	2015	3,392 (28.7)	6
Lester et al., 2019²³23 Lester E, Dykstra M, Grant C, Fawcett V, Tsang B, Widder S. High-risk medications in older patients with trauma: a cross-sectional study of risk mitigation. Can J Surg 2019; 62(2):100-104.	Canada	Transverse	319	76.0 (75.0-76.8)	2015	304 (95.3)	6
Ma et al., 2019²⁴24 Ma Z, Zhang C, Cui X, Liu L. Comparison of three criteria for potentially inappropriate medications in Chinese older adults. Clin Interv Aging 2019; 14:65-72.	China	Transverse	863	75.4 (65.0-98.0)	2015	501 (58.1)	6
Chang et al., 2018²⁵25 Chang CB, Lai HY, Hwang SJ, Yang SY, Wu RS, Liu HC, Chan DC. Prescription of potentially inappropriate medication to older patients presenting to the emergency department: a nationally representative population study. Sci Rep 2018; 8(1):11727.	Taiwan	Transverse	313,733	76.7	2015	199,882 (63.7)	7
Komagamine, 2018²⁶26 Komagamine J. Prevalence of potentially inappropriate medications at admission and discharge among hospitalised elderly patients with acute medical illness at a single centre in Japan: a retrospective cross-sectional study. BMJ Open 2018; 8(7):e021152.	Japan	Transverse	689	82.0 (76.0-88.0)	2015	330 (47.9)	6
Komagamine et al., 2018²⁷27 Komagamine J, Sugawara K, Hagane K. Characteristics of elderly patients with polypharmacy who refuse to participate in an in-hospital deprescribing intervention: a retrospective cross-sectional study. BMC Geriatrics 2018; 18(1):1-6.	Japan	Transverse	136	81.1	2015	105 (77.2)	6
Najjar et al., 2018²⁸28 Najjar MF, Sulaiman SAS, Al Jeraisy M, Balubaid H. The impact of a combined intervention program: an educational and clinical pharmacist’s intervention to improve prescribing pattern in hospitalized geriatric patients at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Ther Clin Risk Manag 2018; 14:557-564.	Saudi Arabia	Cohort	200	78.0	2015	122 (61.0)	7
Sarwar et al., 2018²⁹29 Sarwar MR, Dar AR, Mahar SY, Riaz T, Danish U, Iftikhar S. Assessment of prescribing potentially inappropriate medications listed in Beers criteria and its association with the unplanned hospitalization: a cross-sectional study in Lahore, Pakistan. Clin Interv Aging 2018; 13:1485-1495.	Pakistan	Transverse	385	78 (65.0-85.0)	2015	342 (88.8)	6
Sharma et al., 2018³⁰30 Sharma J, Parulekar M, Stewart P, Blatt M, Zielonka T, Nyirenda T, Rogers C, Tank L. Geriatric Consultation Reduces High-risk Medication Usage at Discharge in Elderly Trauma Patients. Cureus 2018; 10(11):e3649.	United States	Transverse	104	82 (70.0-90.0)	2015	104 (91.3)	6
Komagamine e Hagane, 2017³¹31 Komagamine J, Hagane K. Intervention to improve the appropriate use of polypharmacy for older patients with hip fractures: an observational study. BMC Geriatrics 2017; 17(1):288.	Japan	Cohort	158	84.8	2015	124 (78.4)	6
Li et al., 2017³²32 Li H, Pu S, Liu Q, Huang X, Kuang J, Chen L, Shen J, Cheng S, Wu T, Li R, Li Y, Mo L, Jiang W, Song Y, He J. Potentially inappropriate medications in Chinese older adults: The beers criteria compared with the screening tool of older persons’ prescriptions criteria. Geriatr Gerontol Int 2017; 17(11):1951-1958.	China	Transverse	6,337	81.3	2012	4,593 (72.5)	7
Zhang et al., 2017³³33 Zhang X, Zhou S, Pan K, Li X, Zhao X, Zhou Y, Cui Y, Liu X. Potentially inappropriate medications in hospitalized older patients: a cross-sectional study using the Beers 2015 criteria versus the 2012 criteria. Clin Interv Aging 2017; 12:1697-1703.	China	Transverse	456	81.8 (65.0-103.0)	2015	244 (53.5)	6
Arellano et al., 2016³⁴34 Arellano C, Saldivia G, Cordova P, Fernandez P, Morales F, Lopez M, Villa L. Using two tools to identify Potentially Inappropriate Medications (PIM) in elderly patients in Southern Chile. Arch Gerontol Geriatr 2016; 67:139-144.	Chile	Cohort	250	77.5 (65.0-97.0)	2012	198 (79.2)	6
Di Giorgio et al.,2016³⁵35 Di Giorgio C, Provenzani A, Polidori P. Potentially inappropriate drug prescribing in elderly hospitalized patients: an analysis and comparison of explicit criteria. Int J Clin Pharm 2016; 38(2):462-468.	Italy	Cohort	1,027	73.3	2012	507 (49.0)	7
Rongen et al., 2016³⁶36 Rongen S, Kramers C, O’Mahony D, Feuth TB, Olde Rikkert MG, Ahmed AI. Potentially inappropriate prescribing in older patients admitted to psychiatric hospital. Int J Geriatr Psychiatry 2016; 31(2):137-145.	Holland	Transverse	164	74.9 (65.0-92.0)	2012	77 (47.0)	6
Yang et al., 2015³⁷37 Yang PJ, Lee YT, Tzeng SL, Lee HC, Tsai CF, Chen CC, Chen SC, Lee MC. Potentially Inappropriate Prescribing in Disabled Older Patients with Chronic Diseases: A Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions versus Beers 2012 Criteria. Med Princ Pract 2015; 24(6):565-570.	China	Transverse	141	81.5 (65.0-97.0)	2012	94 (66.7)	6
Matanovic e Vlahovic-Palcevski, 2014³⁸38 Matanovic SM, Vlahovic-Palcevski V. Potentially inappropriate prescribing to the elderly: comparison of new protocol to Beers criteria with relation to hospitalizations for ADRs. Eur J Clin Pharmacol 2014; 70(4):483-490.	Croatia	Cohort	454	74.0	2012	263 (57.9)	6
Tosato et al., 2014³⁹39 Tosato M, Landi F, Martone AM, Cherubini A, Corsonello A, Volpato S, et al. Potentially inappropriate drug use among hospitalised older adults: results from the CRIME study. Age Ageing 2014; 43(6):767-773.	Italy	Cohort	871	80.2	2012	509 (58.4)	7
Napolitano et al., 2013⁴⁰40 Napolitano F, Izzo MT, Di Giuseppe G, Angelillo IF. Frequency of inappropriate medication prescription in hospitalized elderly patients in Italy. PloS One 2013; 8(12):e82359.	Italy	Transverse	605	76.7	2012	188 (31.1)	6

Organ System, Therapeutic Category	Mean prevalence (%)	Medication (%)	Mean prevalence (%)
Anticholinergics	5.7	Diphenhydramine	7.9
		Anticholinergics	7.2
		First-generation antihistamines	6.9
		Antispasmodic	6.7
Antithrombotics	5.1	Ticlopine	6.3
		Antithrombotics	3.9
Anti-infectious	2.8	Anti-infectious	5.1
		Nitrofurantoin	0.5
Cardiovascular	8.1	Cardiac medicines	27.0
		Amiodarone	12.4
		Spironolactone	12.1
		Antiarrhythmic	11.1
		Doxazosin	7.6
		Clonidine	7.4
		Terazosin	5.3
		Alpha1 blockers	4.0
		Niphedipine	4.3
		Digoxin	3.2
		Verapamil	2.0
		Propafenone	1.1
Central nervous system	9.7	Central nervous system medications	33.8
		Benzodiazepines	19.0
		TCA tertiaries	16.5
		Antipsychotics	16.4
		Hypnotics (non-benzodiazepines)	14.0
		Antidepressants	11.7
		Selective Serotonin Reuptake Inhibitors	6.6
		Barbiturates	6.5
		Anticonvulsant medications	4.6
		Diazepam	4.3
		Promazine	4.2
		Lorazepam	3.9
		Haloperidol	1.6
		Olanzapine	1.5
		Meprobamate	1.0
Endocrine	7.8	Insulin	14.0
		Long-term sulfonylureas	8.6
		Megestrol	5.27
		Endocrine medicines	3.4
Gastrointestinal	15.3	Gastrointestinal medicines	28.9
		PPI	27.7
		Metoclopramide	12.7
		Ranitidine	6.3
		Petroleum jelly oil	1.0
Pain medications	10.5	Opioids	27.2
		NSAIDs (0.4-87.7%)	15.9
		Meperidine	5.5
		Pain medications	3.4
		Skeletal muscle relaxant	0.6

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Collaborations

CFM Lima and MFS Praxedes were responsible for the conception, research, methodology and final writing of the article. GCS Pereira, JS Berhends and DB Santos responsible for the methodology and critical review.