Exploring Potentially Inappropriate Medication Use on Elderly Patients in a General Medicine Ward Using 2023 AGS Beers Criteria

Abstract

Objectives

Potentially inappropriate medication (PIM) use is a significant concern among the elderly, a vulnerable population, due to physiological changes, and the risk of multiple comorbidities and polypharmacy. This study aimed to assess the use of PIM among elderly inpatients in tertiary care hospital in eastern Nepal.

Methods

A three-month prospective observational study was conducted, involving 200 eligible elderly patients admitted to general medicine ward. Relevant data were collected from patient case sheets, nursing and doctor cardex, discharge summaries, and via patient interviews. PIMs were identified based on the latest 2023 AGS Beers Criteria.

Results

Among the 200 eligible patients, 108 (54.0%) were prescribed at least one PIM. Medications that should be avoided in older patients accounted for 32.2%, where prazosin and hyoscine were the most common. Additionally, 52.8% of the medications required cautious use, with diuretics being the most frequent one. Multivariate analysis revealed that patients with chronic kidney disease (CKD) and the number of prescribed medicines significantly influenced the likelihood of PIMs with an adjusted odd ratio of 6.730 (2.111–21.456) and 2.764 (1.448–5.276), respectively, at p < 0.05.

Conclusion

PIMs are more common among the elderly, with CKD and polypharmacy contributing significantly to their prevalence. To reduce PIM use, healthcare professionals, including clinical pharmacists, should implement targeted interventions, particularly for older adults with CKD who are managing with multiple medications.