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PREVALENCE AND PREDICTORS OF POTENTIALLY INAPPROPRIATE MEDICATION USE IN ELDERLY PATIENTS IN TWO INDIAN TEACHING HOSPITALS PARTHASARATHI G, HARUGERI A, JOSEPH J, RAMESH M, GUIDO S. Presenting Author G Parthasarathi JSS University, INDIA. Introduction.
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PREVALENCE AND PREDICTORS OF POTENTIALLY INAPPROPRIATE MEDICATION USE IN ELDERLY PATIENTS IN TWO INDIAN TEACHING HOSPITALSPARTHASARATHI G, HARUGERI A, JOSEPH J, RAMESH M, GUIDO S.Presenting AuthorG ParthasarathiJSS University, INDIA
Introduction • Several factors contribute to greater propensity of ADRs in the elderly, including potentially inappropriate medication use • About one-fourth of the adverse outcomes in the elderly are estimated to be due to PIM use • Indian elderly -12.8% of worldwide elderly (2007)– expected to reach 100 million by 2013 • There is a need for prospective studies that evaluate PIM use and burden of adverse events due to PIM use in India
Objectives • General • To determine the nature and frequency of PIM use in hospitalized Indian elderly • Specific • To determine the prevalence of PIM use in hospitalized elderly • Identify the predictors of PIM use • Assess the relationship between PIM use and ADRs
Methods • The prospective observational study was conducted in medicine wards of two teaching hospitals • Patients aged > 60 years admitted to medicine wards receiving at least one medication were randomly included. • Patients were reviewed from the day of admission to discharge for PIM use and ADRs. • Beers Criteria 2003 were used to assess PIM use
Methods • Causality of the ADRs was assessed using Naranjo’salgorithm • Polypharmacy (5–9 medications) and High-level Polypharmacy (≥10 medications) • Association between ADRs and PIM use and Predictors associated with PIM use was assessed • Bivariate analysis and multivariate logistic regression
Results • Three most frequent diagnoses in the study population • Essential hypertension (41.5%) • Non-insulin-dependent diabetes mellitus (34%) • Chronic obstructive pulmonary disease (18.5%). • PIMs were received by 191 (23.5%) patients • PIM use was observed both at admission and during hospital stay • One, two and three PIMs were received by 134, 46 and 11 patients respectively
Results • Polypharmacy was observed in 44.5% and 90.4% of patients at admission and during hospital stay. • High severity PIM use showed a higher prevalence compared to low severity (26.8% Vs. 5.5%). • A total of 360 ADRs were observed in 292 patients. Of these, 11 (3%) ADRs were due to medications listed in BC. Of these 11 ADRs, 3 were due to clonidine, 2 each were due to amiodarone, diazepam, hydroxyzine and digoxin. • Among the ADRs due to medications not listed in BC (349), insulin (14%, 49), furosemide (6.3%, 22) and prednisolone (5.1%, 18) were the most frequently implicated in ADRs. • Medications not listed in BC resulted in more number of ADRs than medications listed in BC [χ2=98.4, p<0.001 (df=1)] [Odds ratio (OR): 13.51 {95% confidence interval (CI): 7.19-25}; p<0.001].
Prevalence of PIM Use Predictors of PIM Use: Multivariate Regression Analysis
Summary • The largest prospective study of PIM usage evaluation in hospitalized elderly in India. • The main findings of the study are: • 23.5% of study patients received at least one PIM (at admission or during the hospital stay). • More than one third of these patients were prescribed with aspirin/non-steroidal anti inflammatory drug (NSAID) in the presence of bleeding disorder or anticoagulant. • Medications not listed in BC were associated with increased occurrence of ADRs compared to medications listed in BC (χ2=98.4, p<0.001). • Multivariative analysis showed that patients receiving >9 medications during the hospital stay was the influential predictor of PIM use.
Policy Implications and Conclusion • PIM use was found to be common among the hospitalized elderly of medicine ward • Campaigns promoting rational drug use in elderly in India should focus on decreasing the occurrence of PIM use • PIM use was associated with patients’ age, number of concurrent medications used and length of hospital stay • Measures to reduce the risk of ADRs in the elderly should target medications commonly implicated in ADRs rather than focusing only on medications listed in Beers Criteria • Interventions aimed at rational medication use in elderly Indians should focus on the predictors of PIM use • There is a great scope for conducting intense research to determine inappropriate medication use and its health-related adverse consequences in the increasing Indian elderly population