Beers criteria for potentially inappropriate medication use in older adults

Nurses can decrease the risk of adverse drug problems with medication review and prompt interventions. The Beers Criteria lists medications to avoid using among elderly clients. The origin of the Beers Criteria, its 2002 modification, and application in acute care settings are explained.     

老年人潜在不适当用药Beers标准2019修订版解读

Beers标准是一个用于避免老年人潜在不适当用药的实用工具。该标准于1991年由老年医学专家Beers首次公布,自2011年开始由美国老年医学会(American geriatrics society,AGS)管理,每3年更新一次,最近AGS更新发布了2019版。Beers标准的主要目的在于指导医务工作者为老年患者选择适当药物,确保老年人用药安全。     

Factors influencing the use of potentially inappropriate medication in older patients in Slovakia

Background: Although increasing attention has been given to the evaluation of use of potentially inappropriate medication in the older European Union (EU) member countries, information on this topic from Central and Eastern Europe is scarce. Objectives: The aims of the present study were: to identify risk factors enhancing the probability of use of potentially inappropriate medication in hospitalized older patients under the conditions of the Slovak healthcare system and to compare our results with previously published European studies. Methods: The evaluation was performed in 600 patients aged ≥65 years, hospitalized in a general hospital between 1 December 2003 and 31 March 2005. To identify the use of potentially inappropriate medication, the Beers 2003 criteria were applied. Particular socio‐demographic and clinical characteristics, as well as comorbid medical conditions were evaluated among possible factors enhancing the probability of use of potentially inappropriate medication. Results: At least one potentially inappropriate medication was prescribed to 126 (21%) of 600 patients. Multivariate analysis identified polypharmacy [odds ratio (OR) 2·38; 95% confidence interval (CI): 1·50–3·79], depression (OR 2·03; 95% CI: 1·08–3·82), immobilization (OR 1·87; 95% CI: 1·16–3·00) and heart failure (OR 1·73; 95% CI: 1·13–2·64) as factors associated with an increased risk of use of inappropriate medication. In contrast, patients aged ≥75 years had a lower risk of being prescribed potentially inappropriate medication (OR 0·58; 95% CI: 0·39–0·88). Conclusions: Polypharmacy, immobilization, heart failure and depression were documented as predictors of use of potentially inappropriate medication. In depressive patients, drugs other than antidepressants contributed to the extensive use of potentially inappropriate medication. The observed prevalence of use of potentially inappropriate medication in older hospitalized Slovak patients was lower than the prevalence previously documented in Poland and the Czech Republic, but higher than in Croatia and Turkey. The identified risk factors were consistent with previous findings from other parts of Europe.     

Patterns of potentially inappropriate medication use across three cohorts of older Medicaid recipients

BACKGROUND: Potentially inappropriate medication use is a serious quality concern, especially when it occurs in more vulnerable older adults or for extended durations. OBJECTIVE: To characterize patterns of inappropriate medication use and duration among 3 cohorts with differing health status. METHODS: We identified unconditionally inappropriate drug use, using Beers 1997 criteria, among 3185 older Kansas Medicaid beneficiaries. Claims from May 2000 to April 2001 provided data for 3 cohorts: nursing facility (NF) residents, recipients of home- and community-based services through the Frail Elderly (FE) program, and persons with neither NF/FE care (Ambulatory). Duration, categorized as short-term (< or = 1 month's supply), extended (> 1-9 mo), or chronic (> 9-12 mo), was determined for each drug and cohort. Drug-disease associations were explored. RESULTS: Any inappropriate medication use occurred in 21%, 48%, and 38% of Ambulatory, FE, and NF cohorts, respectively. Inappropriate analgesics, antihistamines, antidepressants, muscle relaxants, and oxybutynin were most common, but prevalence and duration varied by cohort. Short-term analgesic and antihistamine use was common. FE cohort members had the highest use rates for all drugs. The NF cohort had less antidepressant and muscle relaxant use. Drug-disease associations were noted for amitriptyline use in diabetes mellitus, propoxyphene use in musculoskeletal and upper gastrointestinal conditions, and muscle relaxant use in musculoskeletal conditions. CONCLUSIONS: Cross-sectional, one-year prevalence figures are comprised of both short- and long-term use that varies by drug and cohort. NF residence is associated with reduced use of drugs scrutinized during mandated medication review. Relevant diseases are associated with specific inappropriate prescribing. Future efforts should target extended and chronic duration of use and persons at highest risk for adverse effects, including recipients of home- and community-based care.     

潜在不适当用药对老年人不良健康结局影响的系统评价

目的 明确潜在不适当用药对老年人不良健康结局的影响,为预防不良健康结局提供依据.方法 检索PubMed、The Cochrane Library、Web of Science、EMBASE、中国生物医学文献数据库、中国知网和万方数据库,搜集建库至2019年2月关于潜在不适当用药对老年人不良健康结局影响的文献,采用RevMan 5.3软件进行分析.结果 共纳入33项队列研究,结果显示潜在不适当用药对药物不良反应、再次入院率有影响(RR=1.69,95%CI=1.28~2.23,P<0.001;RR=1.47,95%CI=1.30~ 1.66,P<0.001),但不会增加死亡率(RR=1.02,95%CI=0.98~ 1.07,P=0.310).结论 潜在不适当用药是老年人发生药物不良反应/药物不良事件和再次入院的危险因素,增加了社会经济负担,耗费了医疗资源.     

Adverse outcomes associated with inappropriate drug use in nursing homes

BACKGROUND: Little empirical evidence exists regarding the influence and outcomes of inappropriate medication use among elderly nursing home residents. OBJECTIVE: To identify the prevalence of inappropriate medication use among elderly patients in Georgia nursing homes using the Beers criteria and identify the relationship between inappropriate drug use and the likelihood of an adverse health outcome. METHODS: A cohort design was used to review 1117 patient medical records in 15 Georgia nursing homes with a high risk of polypharmacy. Prevalence of inappropriate medication use among elderly patients, as defined by the Beers criteria, was estimated. The adverse health outcomes of hospitalizations, emergency department visits, or deaths were identified from Medicaid claims data. RESULTS: A total of 519 (46.5%) patients received at least one inappropriate medication and 143 (12.8%) patients experienced at least one adverse health outcome. Logistic regression revealed that the total number of medications taken (OR 1.139, 95% CI 1.105 to 1.173) significantly increased the likelihood of receiving an inappropriate drug, while having a diagnosis of "dementia" (OR 0.748, 95% CI 0.565 to 0.991) decreased the likelihood. Inappropriate medication use increased the likelihood of experiencing at least one adverse health outcome more than twofold (OR 2.34, 95% CI 1.61 to 3.40). Propoxyphene use alone was significantly associated with the occurrence of an adverse health outcome (OR 2.39, 95% CI 1.54 to 3.71). CONCLUSIONS: Inappropriate drug use was common in our study cohort. Inappropriate use of medication in the elderly, particularly propoxyphene, is associated with a higher risk of adverse health outcomes.