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Prevalence of potentially inappropriate medications among geriatric residents in nursing care homes in Malaysia: a cross-sectional study

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Abstract

Background Polypharmacy has been associated with an increased risk of morbidity and mortality among older adults especially those living in nursing homes. Explicit criteria to evaluate the appropriateness of medications have recently been updated. Objective To estimate and compare the prevalence of potentially inappropriate medications (PIMs) among older adults in nursing homes using screening tool for older people’s prescription (STOPP-2) and the 2015 Beers criteria. Setting Nursing care homes in the Klang Valley, Malaysia. Method A cross-sectional survey of medications used among residents living in nursing homes was performed. The 2015 Beers criteria and STOPP-2 criteria were used to evaluate the use of PIMs among this population. These PIMs were subsequently classified using the Pharmaceutical Network Europe classification (PCNE). Main outcome measure Number of PIMs among residents using both criteria. Results A total of 155 residents were recruited into the study. The prevalence of PIMs was 9.7% using the STOPP-2 criteria, 17.6% using the 2015 Beers criteria and 21.3% when both tools were used in combination. The PCNE criteria identified a total of 198 drug related issues, with an average of 1.27 issue per resident. Factors associated with higher risk of having PIM include multiple medication use and history of psychiatric disorder. Conclusion The 2015 Beers criteria was able to identify more PIM’s compared to STOPP-2 criteria. The findings also support the expansion of pharmacists’ services in nursing homes in Malaysia.

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References

  1. Romli MH, Tan MP, Mackenzie L, Lovarini M, Suttanon P, Clemson L. Falls amongst older people in Southeast Asia: a scoping review. Public Health. 2017;145:96–112.

    Article  CAS  PubMed  Google Scholar 

  2. Tey NP, Siraj SB, Kamaruzzaman SBB, Chin AV, Tan MP, Sinnappan GS, et al. Aging in Multi-ethnic Malaysia. Gerontologist. 2016;56:603–9.

    Article  PubMed  Google Scholar 

  3. Lee SWH, Chong CS, Chong DWK. Identifying and addressing drug-related problems in nursing homes: an unmet need in Malaysia? Int J Clin Pract. 2016;70:512.

    Article  CAS  PubMed  Google Scholar 

  4. Lee SWH, Mak VSL. Changing demographics in Asia: a case for enhanced pharmacy services to be provided to nursing homes. JPPR. 2016;46:152–5.

    Google Scholar 

  5. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17:230.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Maher RL, Hanlon JT, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13:57–65.

    Article  PubMed  Google Scholar 

  7. Chua SS, Kok LC, Yusof FAM, Tang GH, Lee SWH, Efendie B, et al. Pharmaceutical care issues identified by pharmacists in patients with diabetes, hypertension or hyperlipidaemia in primary care settings. BMC Health Serv Res. 2012;12:388.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Muhlack DC, Hoppe LK, Weberpals J, Brenner H, Schöttker B. The association of potentially inappropriate medication at older age with cardiovascular events and overall mortality: a systematic review and meta-analysis of cohort studies. JAMDA. 2017;18:211–20.

    PubMed  Google Scholar 

  9. Fialova D, Topinkova E, Gambassi G, Finne-Soveri H, Jonsson PV, Carpenter I, et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005;293:1348–58.

    Article  CAS  PubMed  Google Scholar 

  10. Fog AF, Kvalvaag G, Engedal K, Straand J. Drug-related problems and changes in drug utilization after medication reviews in nursing homes in Oslo, Norway. Scand J Prim Health Care. 2017;35:329–35.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nishtala PS, McLachlan AJ, Bell JS, Chen TF. A retrospective study of drug-related problems in Australian aged care homes: medication reviews involving pharmacists and general practitioners. J Eval Clin Pract. 2011;17:97–103.

    Article  PubMed  Google Scholar 

  12. Chen LL, Tangiisuran B, Shafie AA, Hassali MA. Evaluation of potentially inappropriate medications among older residents of Malaysian nursing homes. Int J Clin Pharm. 2012;34:596–603.

    Article  CAS  PubMed  Google Scholar 

  13. Hasan SS, Kow CS, Verma RK, Ahmed SI, Mittal P, Chong DW. An evaluation of medication appropriateness and frailty among residents of aged care homes in Malaysia: a cross-sectional study. Medicine. 2017;96:e7929.

    Article  PubMed  PubMed Central  Google Scholar 

  14. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. JAGS. 2015;63:2227–46.

    Article  Google Scholar 

  15. 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 Ageing. 2015;44:213–8.

    Article  PubMed  Google Scholar 

  16. Pharmaceutical Care Network Europe Foundation. Pharmaceutical Care Network Europe Classification for drug related problems v7.0. 2017. https://www.pcne.org/working-groups/2/drug-related-problem-classification. Accessed 30 Nov 2017.

  17. Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med. 1991;151:1825–32.

    Article  CAS  PubMed  Google Scholar 

  18. O’Mahony D, Gallagher P, Ryan C, Byrne S, Hamilton H, Barry P, et al. STOPP & START criteria: a new approach to detecting potentially inappropriate prescribing in old age. Eur Geriatr Med. 2010;1:45–51.

    Article  Google Scholar 

  19. Pitkala KH, Strandberg TE, Tilvis RS. Inappropriate drug prescribing in home-dwelling, elderly patients: a population-based survey. Arch Intern Med. 2002;162:1707–12.

    Article  PubMed  Google Scholar 

  20. Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol. 2015;71:1415–27.

    Article  PubMed  Google Scholar 

  21. Storms H, Marquet K, Aertgeerts B, Claes N. Prevalence of inappropriate medication use in residential long-term care facilities for the elderly: a systematic review. Eur J Gen Pract. 2017;23:69–77.

    Article  PubMed  PubMed Central  Google Scholar 

  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. JAMDA. 2016;17:e1–9.

    Google Scholar 

  23. Ministry of Health Malaysia. Clinical practice guidelines: Management of hypertension, 4th ed. 2014. http://www.moh.gov.my/penerbitan/CPG2017/Hypertension1.pdf. Accessed 30 Nov 2017.

  24. Rumah Seri Kenangan. 2019. http://www.jkm.gov.my/jkm/index.php?r=portal/left&id=M2k3Q2xST0JJWE9Qa2Z2L253VDl2dz09. Accessed 22 Apr 2019.

  25. Kua KP, Saw PS, Lee SWH. Attitudes towards deprescribing among multi-ethnic community-dwelling older patients and caregivers in Malaysia: a cross-sectional questionnaire study. Int J Clin Pharm. 2019. https://doi.org/10.1007/s11096-019-00829-z.

    Article  PubMed  Google Scholar 

  26. Lee SWH, Mak VSL. Train-the-trainer program on cardiovascular health for community pharmacists in Malaysia. IJCP. 2017;39:1166–70.

    PubMed  Google Scholar 

  27. Kua C-H, Mak VSL, Huey Lee SW. Health outcomes of deprescribing interventions among older residents in nursing homes: a systematic review and meta-analysis. JAMDA. 2019;20(362–72):e11.

    Google Scholar 

  28. Mak VSL, Lee SWH, March G. Pharmacists’ roles in nursing homes in Malaysia. JPPR. 2018;48:493–4.

    Google Scholar 

  29. Lee SWH, Lai NM, Chaiyakunapruk N, Chong DWK. Adverse effects of herbal or dietary supplements in G6PD deficiency: a systematic review. Br J Clin Pharmacol. 2017;83:172–9.

    Article  CAS  PubMed  Google Scholar 

  30. Lee SWH, Chaiyakunapruk N, Lai NM. What G6PD-deficient individuals should really avoid. Br J Clin Pharmacol. 2017;83:211–2.

    Article  PubMed  Google Scholar 

  31. Schwingshackl L, Boeing H, Stelmach-Mardas M, Gottschald M, Dietrich S, Hoffmann G, Chaimani A. Dietary supplements and risk of cause-specific death, cardiovascular disease, and cancer: a systematic review and meta-analysis of primary prevention trials. Adv Nutr. 2017;8(1):27–39. https://doi.org/10.3945/an.116.013516.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Vieira de Lima TJ, Garbin CAS, Garbin A, Sumida DH, Saliba, O. Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes. BMC Geriatr. 2013;13:52.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Pérez T, Moriarty F, Wallace E, McDowell R, Redmond P, Fahey T. Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study. BMJ. 2018;363:k4524.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We wish to thank all the participating nursing care homes and residents for their support and agreeing to participate in this study.

Funding

This work was supported by a research grant awarded to Shaun Wen Huey Lee to support educational initiatives of pharmacy students.

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Authors and Affiliations

  1. School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia

    Ngit Yi Liew, Ying Yee Chong, Shiau Huey Yeow, Pui San Saw & Shaun Wen Huey Lee

  2. Department of Pharmacy, Klinik Kesihatan Puchong, Puchong, Selangor, Malaysia

    Kok Pim Kua

  3. Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia

    Shaun Wen Huey Lee

  4. Gerentology Laboratory, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia

    Shaun Wen Huey Lee

  5. School of Pharmacy, Taylor’s University, Jalan Taylors, 47500, Subang Jaya, Selangor, Malaysia

    Shaun Wen Huey Lee

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  1. Ngit Yi Liew
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  2. Ying Yee Chong
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  4. Kok Pim Kua
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  6. Shaun Wen Huey Lee
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Correspondence to Shaun Wen Huey Lee.

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Liew, N.Y., Chong, Y.Y., Yeow, S.H. et al. Prevalence of potentially inappropriate medications among geriatric residents in nursing care homes in Malaysia: a cross-sectional study. Int J Clin Pharm 41, 895–902 (2019). https://doi.org/10.1007/s11096-019-00843-1

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