Date of Award

Winter 1-4-2020

Document Type

Dissertation

Degree Name

PharmD

Department

Department of Pharmacy Practice

First Advisor

Dr. Girish Thunga

Second Advisor

Dr. Raviraj V. Acharya

Abstract

Background: A major safety concern in elderly population is the use of inappropriate medication. Owing to aging associated with anatomic and physiologic changes, pharmacokinetic and pharmacodynamics of drugs are prone to alter in these elderlies. Inappropriate drug prescribing and polypharmacy in this population elevates the risk of adverse drug reactions. Objectives: To assess the prevalence and factors influencing Potentially Inappropriate Medication (PIM) use in elderly patients according to updated Beers Criteria. Methodology: A retrospective observational study was carried out. Case records of 580 patients aged 65 years and above were reviewed. Every case record was identified for at least one PIM based on the American Geriatric Society 2019 Updated Beers Criteria for PIM use in elderly patients. Analysis of collected data was done using Statistical Package for Social Sciences (SPSS) software. Results: A total of 580 elderly general medicine patients were reviewed amongst them, 301 were identified as test group with the age of mean 73.7±6.4 years and 101 patients as control group with the age of mean 70.5±5.5 years. Most of the study population were males 59.1% in test and 63.4% in control groups. The prevalence of PIMs to be used with caution were 54% and PIMs to be avoided were 45% the most prescribed PIMs were aspirin (23.51%), diuretics (15.56%), long acting sulphonylureas (12.75%) and Proton Pump inhibitors(PPIs) (11.92%). Increasing age polypharmacy, number of drugs in medication history, certain Chronic diseases were associated with high probability of PIM’s use among elderly patients. Risk of developing serious, moderate drug-drug interactions (DDIs) was high in elderly patients with PIMs. Conclusion: Potentially inappropriate medication use poses a sizable health safety hazard in elderly patients. After evaluating the potentially inappropriate medications of elderly patients using the updated Beers Criteria 2019.Prevalence of PIMs that should be used with caution (54%) was found to be highest followed by PIMs to be avoided (45%) and recommendation for reduce dose to be (1%) .Age, gender, comorbidities, and polypharmacy were identified as risk factors leading to PIM use. It was also observed that patients with PIMs are at a higher risk of developing DDIs. A significant increase in the older population and the need to reduce preventable harm calls for more multidisciplinary strategies to account for the use of high-risk medications. Prescribers can use this data to determine patients at a higher risk for PIMs and be attentive to them while prescribing. Continuous medication and prescription review done by a clinical pharmacist can aid in reducing the occurrence of PIMs.

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