Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria: a cross-sectional population based study

BMC Geriatrics, Jun 2016

Background A high number of elderly people with multiple comorbidities are exposed to the risk of polypharmacy and prescription of potentially inappropriate medication (PIM). The purpose of this study was to determine the prevalence and patterns of PIM prescription in Korean older adults according to the 2012 Beers Criteria. Methods A retrospective study was conducted using data from the Korean Health Insurance Review and Assessment (KHIRA) database of outpatient prescription claims collected from January 1, 2009 to December 31, 2011. A total of 523,811 elderly subjects aged 65 years and older were included in the study, and several covariates related to the prescription of PIMs were obtained from the KHIRA database. These covariates were analyzed using Student’s t test and the chi-square test; furthermore, multivariate logistic regression analysis was used to evaluate the risk factors associated with the prescription of PIMs. Results A total of 80.96 % subjects were prescribed at least one PIM independent of their diagnosis or condition according to the 2012 Beers Criteria. The most commonly prescribed medication class was first-generation antihistamines with anticholinergic properties (52.33 %). Pain medications (43.04 %) and benzodiazepines (42.53 %) were next in line. When considering subjects’ diagnoses or conditions, subjects diagnosed with central nervous system conditions were most often prescribed PIMs. Female sex, severity of comorbidities, and polypharmacy were significant risk factors for PIM prescriptions. Conclusions This study confirmed that PIM prescription is common among elderly Koreans. A clinical decision support system should be developed to decrease the prevalence of PIM prescriptions.

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Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria: a cross-sectional population based study

Nam et al. BMC Geriatrics Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria: a cross-sectional population based study You-Seon Nam 1 2 4 Jong Soo Han 1 2 3 Ju Young Kim 0 2 Woo Kyung Bae 2 3 Kiheon Lee 0 2 0 Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam , South Korea 1 Equal contributors 2 Co-first author , Jong Soo Han 3 Health Promotion Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam , South Korea 4 Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine , Seoul , South Korea Background: A high number of elderly people with multiple comorbidities are exposed to the risk of polypharmacy and prescription of potentially inappropriate medication (PIM). The purpose of this study was to determine the prevalence and patterns of PIM prescription in Korean older adults according to the 2012 Beers Criteria. Methods: A retrospective study was conducted using data from the Korean Health Insurance Review and Assessment (KHIRA) database of outpatient prescription claims collected from January 1, 2009 to December 31, 2011. A total of 523,811 elderly subjects aged 65 years and older were included in the study, and several covariates related to the prescription of PIMs were obtained from the KHIRA database. These covariates were analyzed using Student's t test and the chi-square test; furthermore, multivariate logistic regression analysis was used to evaluate the risk factors associated with the prescription of PIMs. Results: A total of 80.96 % subjects were prescribed at least one PIM independent of their diagnosis or condition according to the 2012 Beers Criteria. The most commonly prescribed medication class was first-generation antihistamines with anticholinergic properties (52.33 %). Pain medications (43.04 %) and benzodiazepines (42.53 %) were next in line. When considering subjects' diagnoses or conditions, subjects diagnosed with central nervous system conditions were most often prescribed PIMs. Female sex, severity of comorbidities, and polypharmacy were significant risk factors for PIM prescriptions. Conclusions: This study confirmed that PIM prescription is common among elderly Koreans. A clinical decision support system should be developed to decrease the prevalence of PIM prescriptions. Potentially inappropriate medication (PIM); Beers Criteria; Polypharmacy; Adverse drug effects (ADEs) Background As of 2011, elderly adults over 65 years old make up around 11.3 % of the Korean population. This is expected to continue to increase to 14 % by 2018, which would make the Korean population an “aged society” [ 1, 2 ]. Elderly adults are more likely to have more than one chronic illness or condition, which would require the concomitant prescription of several drugs. This makes them more vulnerable to the prescription of potentially inappropriate medications (PIMs), which can lead to an increased risk of adverse drug effects and unnecessary hospitalizations [3]. PIMs in older adults can be categorized into three groups: inappropriate medications regardless of comorbidities, medications that may exacerbate underlying diseases, and medications that may interact with other medications already in use [ 4 ]. Guidelines for PIMs have been developed in many countries, including the United States [ 5 ], Canada [ 4 ], France [ 6 ], Ireland [ 7 ], Australia [ 8 ], Norway [ 9 ], and South Korea [ 10 ]. Among these guidelines, the Beers Criteria, which were developed to be used as a guideline to avoid inappropriate prescribing in older adults, are the most commonly used explicit criteria for retrospective studies on the prescription rate of PIMs [ 11 ]. The Beers Criteria were initially developed and published by Beers and colleagues for nursing home residents in 1991 [ 12 ], and were subsequently expanded and revised in 1997 [ 13 ] and 2003 [ 14 ] to include all geriatric care settings. Then, an updated version was published in 2012 and was supported by the American Geriatrics Society. As a result, the 2012 Beers Criteria comprise fifty-three medications and medication classes divided into three categories: PIMs and classes to avoid in all older adults, PIMs and classes to avoid in older adults with certain diseases and syndromes that the drugs listed may exacerbate, and medications to be used with caution in older adults [ 5 ]. Researchers suggest that the PIMs specified in the Beers Criteria can exacerbate the condition and prognosis of older adults and have a negative influence on healthcare outcomes [ 3, 15–17 ]. In the case of the Korean population, clinicians have reported on the prevalence of PIMs in community-dwelling elderly [18], in older outpatients just before their admission to a general hospital [ 19 ], in a mixture of ou (...truncated)


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You-Seon Nam, Jong Soo Han, Ju Young Kim, Woo Kyung Bae, Kiheon Lee. Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria: a cross-sectional population based study, BMC Geriatrics, 2016, pp. 118, 16, DOI: 10.1186/s12877-016-0285-3