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)