Abstract
Purpose: This study aims to evaluate the relationship between frailty and polypharmacy, Polypharmacy, Potentially Inappropriate Medication (PIM) and Potential Prescription Omission (PPO)
Materials and Methods: Patients aged 65 years and older who applied to the geriatrics outpatient clinic on October 1, 2021 and April 1, 2022 were evaluated retrospectively. Demographic data of the patients, active ingredients of the drugs they used, comorbid diseases and Clinical Frailty Scale (CFS) score were recorded. Patients were divided into two groups as frail and non-frail according to the CFS score. Turkish Inappropriate Medication use in the Elderly (TIME) to STOP criteria were used to evaluate PIMs, and TIME to START was used to determine PPOs.
Results: The mean age of 143 patients was 75.9±8.7 years, and of the patietns, 63.1% were female. While the median number of drugs used by the patients was 7 (0-17), 79.6% of the participants had polypharmacy. Polypharmacy was present in 69.5% (n=42) of frail patients, and this rate was 22.5% (n=18) in non-frail patients. The rate of PPOs of oral nutrition products, 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors and dementia treatment in frail patients was significantly higher non-frail ones. The rate of inappropriate use of proton pump inhibitors, antipsychotics, acetylsalicylic acid, and betahistine was higher in frail patients than in non-frail patients.
Conclusion: Frailty should be considered when evaluating patients with polypharmacy, PRI and PUIK, and the use of TIME criteria, which are specific to our country, may provide an essential advantage since each country has different prescribing habits.
Keywords
Frailty polypharmacy potentially inappropriate medication prescribing omission TIME criteria
References
- 1. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community‐dwelling older persons: a systematic review. Journal of the American Geriatrics Society 2012;60:1487-92.
- 2. Vermeiren S, Vella-Azzopardi R, Beckwée D, et al. Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis. Journal of the American Medical Directors Association 2016;17:1163.e1-.e17.
- 3. Gnjidic D, Hilmer SN. Use of potentially inappropriate medications in the care of frail older people. Aging Health 2010;6:705-16.
- 4. Rochat S, Cumming RG, Blyth F, et al. Frailty and use of health and community services by community-dwelling older men: the Concord Health and Ageing in Men Project. Age and Ageing 2010;39:228-33.
- 5. Gnjidic D, Hilmer SN, Blyth FM, et al. High-Risk Prescribing and Incidence of Frailty Among Older Community-Dwelling Men. Clinical Pharmacology & Therapeutics 2012;91:521-8.
- 6. Bonaga B, Sánchez-Jurado PM, Martínez-Reig M, et al. Frailty, polypharmacy, and health outcomes in older adults: the frailty and dependence in albacete study. Journal of the American Medical Directors Association 2018;19:46-52.
- 7. Kim J, Parish AL. Polypharmacy and medication management in older adults. Nursing Clinics 2017;52:457-68.
- 8. Gómez C, Vega-Quiroga S, Bermejo-Pareja F, Medrano MJ, Louis ED, Benito-León J. Polypharmacy in the elderly: a marker of increased risk of mortality in a population-based prospective study (NEDICES). Gerontology 2015;61:301-9.
- 9. Panel BtAGSBCUE. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society 2019;67:674-94.
- 10. O'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age and ageing 2014;44:213-8.
- 11. Bahat G, Ilhan B, Erdogan T, et al. Turkish inappropriate medication use in the elderly (TIME) criteria to improve prescribing in older adults: TIME-to-STOP/TIME-to-START. European geriatric medicine 2020;11:491-8.
- 12. Gutiérrez-Valencia M, Izquierdo M, Cesari M, Casas-Herrero Á, Inzitari M, Martínez-Velilla N. The relationship between frailty and polypharmacy in older people: A systematic review. British Journal of Clinical Pharmacology 2018;84:1432-44.
- 13. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. Cmaj 2005;173:489-95.
- 14. Özsürekci C, Balcı C, Kızılarslanoğlu MC, et al. An important problem in an aging country: identifying the frailty via 9 Point Clinical Frailty Scale. Acta Clinica Belgica 2019.
- 15. Bonaga B, Sánchez-Jurado PM, Martínez-Reig M, et al. Frailty, Polypharmacy, and Health Outcomes in Older Adults: The Frailty and Dependence in Albacete Study. Journal of the American Medical Directors Association 2018;19:46-52.
- 16. Eyigor S, Kutsal YG, Toraman F, et al. Polypharmacy, physical and nutritional status, and depression in the elderly: do polypharmacy deserve some credits in these problems? Experimental aging research 2021;47:79-91.
- 17. Soysal P, Perera G, Isik AT, et al. The relationship between polypharmacy and trajectories of cognitive decline in people with dementia: a large representative cohort study. Experimental gerontology 2019;120:62-7.
- 18. Kara Ö, Arık G, Kızılarslanoglu MC, et al. Potentially inappropriate prescribing according to the STOPP/START criteria for older adults. Aging clinical and experimental research 2016;28:761-8.
- 19. Özsürekci C, Ceylan S, Halil MG. Polypharmacy and Potentially Inappropriate Medication Use in Older Adults with Dementia: Check with TIME Criteria. dementia 2021;4:5.
- 20. Çakmur H. Frailty among elderly adults in a rural area of Turkey. Medical science monitor: international medical journal of experimental and clinical research 2015;21:1232.
- 21. Herr M, Robine J-M, Pinot J, Arvieu J-J, Ankri J. Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiology and Drug Safety 2015;24:637-46.
- 22. Morin L, Laroche M-L, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. Journal of the American Medical Directors Association 2016;17:862. e1-. e9.
- 23. Volkert D. Malnutrition in the elderly — prevalence, causes and corrective strategies. Clinical Nutrition 2002;21:110-2.
- 24. Leij-Halfwerk S, Verwijs MH, van Houdt S, et al. Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults ≥65 years: A systematic review and meta-analysis. Maturitas 2019;126:80-9.
- 25. Uragami Y, Takikawa K, Kareki H, Kimura K, Yamamoto K, Iihara N. Effect of number of medications and use of potentially inappropriate medications on frailty among early-stage older outpatients. Journal of Pharmaceutical Health Care and Sciences 2021;7:15.
- 26. Bradley MC, Motterlini N, Padmanabhan S, et al. Potentially inappropriate prescribing among older people in the United Kingdom. BMC Geriatrics 2014;14:72.
- 27. Maxwell CJ, Campitelli MA, Hogan DB, et al. Relevance of frailty to mortality associated with the use of antipsychotics among community-residing older adults with impaired cognition. Pharmacoepidemiology and Drug Safety 2018;27:289-98.
- 28. Maclagan LC, Maxwell CJ, Gandhi S, et al. Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition. Journal of the American Geriatrics Society 2017;65:2205-12.
- 29. Landi F, Russo A, Liperoti R, et al. Anticholinergic drugs and physical function among frail elderly population. Clinical Pharmacology & Therapeutics 2007;81:235-41.
- 30. Ruiz SJ, Cevallos V, Baskaran D, Mintzer MJ, Ruiz JG. The cross-sectional association of frailty with past and current exposure to strong anticholinergic drugs. Aging Clinical and Experimental Research 2021;33:2283-9.
- 31. Luz AC, Oliveira MG, Noblat L. Potential prescribing omissions according to START criteria at the time of hospital discharge. Brazilian Journal of Pharmaceutical Sciences 2021;57.
- 32. San-José A, Agustí A, Vidal X, et al. Inappropriate prescribing to older patients admitted to hospital: a comparison of different tools of misprescribing and underprescribing. European journal of internal medicine 2014;25:710-6.
- 33. Roberts S, Collins P, Rattray M. Identifying and managing malnutrition, frailty and sarcopenia in the community: a narrative review. Nutrients 2021;13:2316.
Abstract
Amaç: Çalışmamızın amacı kırılganlık ile çoklu ilaç kullanımı, Potansiyel Uygunsuz İlaç Kullanımı (PUİK) ve Potansiyel Reçete İhmali (PRİ) ilişkisini değerlendirmektedir.
Gereç ve Yöntem: Geriatri polikliniğine 1 Ekim 2021 ve 1 Nisan 2022 ayaktan başvuran 65 yaş ve üzeri hastalar retrospektif değerlendirildi. Hastaların demografik verileri, kullandıkları ilaçların etken maddeleri, komorbid hastalıkları ve Klinik Kırılganlık Skalası (KKS) skoru kayıt edildi. KKS skoruna göre hastalar kırılgan ve kırılgan olmayan olarak ikiye ayrıldı. Turkish Inappropriate Medication use in the Elderly (TIME) to STOP kriterleri PUİK değerlendirmek için, TIME to START ise PRİ’yi belirlemek için kullanıldı.
Bulgular: Hastaların ortalama yaşı 75,9±8,7 olup, hastaların %63,1 kadın idi. Hastaların kullandığı ortanca ilaç sayısı 7 (0-17) iken, katılımcıların %79,6’sında polifarmasi mevcuttu. Kırılgan hastaların %69,5 (n=42)’ inde polifarmasi mevcut olup, kırılgan olmayan hastalarda bu oran %22,5 (n=18) idi. Kırılgan hastalarda oral beslenme ürünü, 3-hidroksi-3-metil-glutaril-KoA reduktaz inhibitörleri ve demans tedavisi reçete ihmali oranı anlamlı olarak normal popülasyondan daha fazla idi. Proton pompa inhibitörleri, antipsikotikler, asetilsalisilik asit ve betahistinin uygunsuz kullanım oranı kırılgan hastalarda, kırılgan olmayan hastalardan daha fazla idi.
Sonuç: Polifarmasi, PRİ ve PUİK hastalarda değerlendirilirken kırılganlık göz önünde bulundurulmalıdır ve her ülkenin farklı reçeteleme alışkanlığı olmasından dolayı ülkemize özel olan TIME kriterlerinin kullanımı önemli bir avantaj sağlayabilir.
References
- 1. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community‐dwelling older persons: a systematic review. Journal of the American Geriatrics Society 2012;60:1487-92.
- 2. Vermeiren S, Vella-Azzopardi R, Beckwée D, et al. Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis. Journal of the American Medical Directors Association 2016;17:1163.e1-.e17.
- 3. Gnjidic D, Hilmer SN. Use of potentially inappropriate medications in the care of frail older people. Aging Health 2010;6:705-16.
- 4. Rochat S, Cumming RG, Blyth F, et al. Frailty and use of health and community services by community-dwelling older men: the Concord Health and Ageing in Men Project. Age and Ageing 2010;39:228-33.
- 5. Gnjidic D, Hilmer SN, Blyth FM, et al. High-Risk Prescribing and Incidence of Frailty Among Older Community-Dwelling Men. Clinical Pharmacology & Therapeutics 2012;91:521-8.
- 6. Bonaga B, Sánchez-Jurado PM, Martínez-Reig M, et al. Frailty, polypharmacy, and health outcomes in older adults: the frailty and dependence in albacete study. Journal of the American Medical Directors Association 2018;19:46-52.
- 7. Kim J, Parish AL. Polypharmacy and medication management in older adults. Nursing Clinics 2017;52:457-68.
- 8. Gómez C, Vega-Quiroga S, Bermejo-Pareja F, Medrano MJ, Louis ED, Benito-León J. Polypharmacy in the elderly: a marker of increased risk of mortality in a population-based prospective study (NEDICES). Gerontology 2015;61:301-9.
- 9. Panel BtAGSBCUE. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society 2019;67:674-94.
- 10. O'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age and ageing 2014;44:213-8.
- 11. Bahat G, Ilhan B, Erdogan T, et al. Turkish inappropriate medication use in the elderly (TIME) criteria to improve prescribing in older adults: TIME-to-STOP/TIME-to-START. European geriatric medicine 2020;11:491-8.
- 12. Gutiérrez-Valencia M, Izquierdo M, Cesari M, Casas-Herrero Á, Inzitari M, Martínez-Velilla N. The relationship between frailty and polypharmacy in older people: A systematic review. British Journal of Clinical Pharmacology 2018;84:1432-44.
- 13. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. Cmaj 2005;173:489-95.
- 14. Özsürekci C, Balcı C, Kızılarslanoğlu MC, et al. An important problem in an aging country: identifying the frailty via 9 Point Clinical Frailty Scale. Acta Clinica Belgica 2019.
- 15. Bonaga B, Sánchez-Jurado PM, Martínez-Reig M, et al. Frailty, Polypharmacy, and Health Outcomes in Older Adults: The Frailty and Dependence in Albacete Study. Journal of the American Medical Directors Association 2018;19:46-52.
- 16. Eyigor S, Kutsal YG, Toraman F, et al. Polypharmacy, physical and nutritional status, and depression in the elderly: do polypharmacy deserve some credits in these problems? Experimental aging research 2021;47:79-91.
- 17. Soysal P, Perera G, Isik AT, et al. The relationship between polypharmacy and trajectories of cognitive decline in people with dementia: a large representative cohort study. Experimental gerontology 2019;120:62-7.
- 18. Kara Ö, Arık G, Kızılarslanoglu MC, et al. Potentially inappropriate prescribing according to the STOPP/START criteria for older adults. Aging clinical and experimental research 2016;28:761-8.
- 19. Özsürekci C, Ceylan S, Halil MG. Polypharmacy and Potentially Inappropriate Medication Use in Older Adults with Dementia: Check with TIME Criteria. dementia 2021;4:5.
- 20. Çakmur H. Frailty among elderly adults in a rural area of Turkey. Medical science monitor: international medical journal of experimental and clinical research 2015;21:1232.
- 21. Herr M, Robine J-M, Pinot J, Arvieu J-J, Ankri J. Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiology and Drug Safety 2015;24:637-46.
- 22. Morin L, Laroche M-L, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. Journal of the American Medical Directors Association 2016;17:862. e1-. e9.
- 23. Volkert D. Malnutrition in the elderly — prevalence, causes and corrective strategies. Clinical Nutrition 2002;21:110-2.
- 24. Leij-Halfwerk S, Verwijs MH, van Houdt S, et al. Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults ≥65 years: A systematic review and meta-analysis. Maturitas 2019;126:80-9.
- 25. Uragami Y, Takikawa K, Kareki H, Kimura K, Yamamoto K, Iihara N. Effect of number of medications and use of potentially inappropriate medications on frailty among early-stage older outpatients. Journal of Pharmaceutical Health Care and Sciences 2021;7:15.
- 26. Bradley MC, Motterlini N, Padmanabhan S, et al. Potentially inappropriate prescribing among older people in the United Kingdom. BMC Geriatrics 2014;14:72.
- 27. Maxwell CJ, Campitelli MA, Hogan DB, et al. Relevance of frailty to mortality associated with the use of antipsychotics among community-residing older adults with impaired cognition. Pharmacoepidemiology and Drug Safety 2018;27:289-98.
- 28. Maclagan LC, Maxwell CJ, Gandhi S, et al. Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition. Journal of the American Geriatrics Society 2017;65:2205-12.
- 29. Landi F, Russo A, Liperoti R, et al. Anticholinergic drugs and physical function among frail elderly population. Clinical Pharmacology & Therapeutics 2007;81:235-41.
- 30. Ruiz SJ, Cevallos V, Baskaran D, Mintzer MJ, Ruiz JG. The cross-sectional association of frailty with past and current exposure to strong anticholinergic drugs. Aging Clinical and Experimental Research 2021;33:2283-9.
- 31. Luz AC, Oliveira MG, Noblat L. Potential prescribing omissions according to START criteria at the time of hospital discharge. Brazilian Journal of Pharmaceutical Sciences 2021;57.
- 32. San-José A, Agustí A, Vidal X, et al. Inappropriate prescribing to older patients admitted to hospital: a comparison of different tools of misprescribing and underprescribing. European journal of internal medicine 2014;25:710-6.
- 33. Roberts S, Collins P, Rattray M. Identifying and managing malnutrition, frailty and sarcopenia in the community: a narrative review. Nutrients 2021;13:2316.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research |
| Authors | |
| Publication Date | September 30, 2022 |
| Acceptance Date | August 3, 2022 |
| Published in Issue | Year 2022 Volume: 47 Issue: 3 |
