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Published in: BMC Geriatrics 1/2016

Open Access 01-12-2016 | Research article

Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria: a cross-sectional population based study

Authors: You-Seon Nam, Jong Soo Han, Ju Young Kim, Woo Kyung Bae, Kiheon Lee

Published in: BMC Geriatrics | Issue 1/2016

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Abstract

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.
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Literature
1.
go back to reference 2010 Population-house national survey. In. Dae-jeon: Statistics Korea; 2011. 2010 Population-house national survey. In. Dae-jeon: Statistics Korea; 2011.
2.
go back to reference Howe N, Jackson R, Nakashima K. The aging of Korea. Demographics and retirement policy in the Land of the Morning Calm. 2007 Howe N, Jackson R, Nakashima K. The aging of Korea. Demographics and retirement policy in the Land of the Morning Calm. 2007
3.
go back to reference Jano E, Aparasu RR. Healthcare outcomes associated with beers’ criteria: a systematic review. Ann Pharmacother. 2007;41(3):438–47.CrossRefPubMed Jano E, Aparasu RR. Healthcare outcomes associated with beers’ criteria: a systematic review. Ann Pharmacother. 2007;41(3):438–47.CrossRefPubMed
4.
go back to reference McLeod PJ, Huang AR, Tamblyn RM, Gayton DC. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ. 1997;156(3):385–91.PubMedPubMedCentral McLeod PJ, Huang AR, Tamblyn RM, Gayton DC. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ. 1997;156(3):385–91.PubMedPubMedCentral
5.
go back to reference Campanelli CM. American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.CrossRefPubMedCentral Campanelli CM. American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.CrossRefPubMedCentral
6.
go back to reference Laroche ML, Charmes JP, Merle L. Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol. 2007;63(8):725–31.CrossRefPubMed Laroche ML, Charmes JP, Merle L. Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol. 2007;63(8):725–31.CrossRefPubMed
7.
go back to reference Gallagher P, Ryan C, Byrne S, Kennedy J, O'Mahony D. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72–83.CrossRefPubMed Gallagher P, Ryan C, Byrne S, Kennedy J, O'Mahony D. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72–83.CrossRefPubMed
8.
go back to reference Basger BJ, Chen TF, Moles RJ. Inappropriate medication use and prescribing indicators in elderly Australians: development of a prescribing indicators tool. Drugs Aging. 2008;25(9):777–93.CrossRefPubMed Basger BJ, Chen TF, Moles RJ. Inappropriate medication use and prescribing indicators in elderly Australians: development of a prescribing indicators tool. Drugs Aging. 2008;25(9):777–93.CrossRefPubMed
9.
go back to reference Rognstad S, Brekke M, Fetveit A, Spigset O, Wyller TB, Straand J. The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients. A modified Delphi study. Scand J Prim Health Care. 2009;27(3):153–9.CrossRefPubMedPubMedCentral Rognstad S, Brekke M, Fetveit A, Spigset O, Wyller TB, Straand J. The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients. A modified Delphi study. Scand J Prim Health Care. 2009;27(3):153–9.CrossRefPubMedPubMedCentral
10.
go back to reference Korea Food and Drug Administration. Appropriate prescribing guideline for the elderly. Seoul: Korea Food and Drug Administration; 2009. (Korean only). Korea Food and Drug Administration. Appropriate prescribing guideline for the elderly. Seoul: Korea Food and Drug Administration; 2009. (Korean only).
11.
go back to reference Bo Ram Yang Y-JK, Jin X-M, Choi N-K, Park B-J. A comparison and application of explicit criteria for potentially inappropriate medication in the elderly. KOPERM. 2013;6:59–72. Bo Ram Yang Y-JK, Jin X-M, Choi N-K, Park B-J. A comparison and application of explicit criteria for potentially inappropriate medication in the elderly. KOPERM. 2013;6:59–72.
12.
go back to reference 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(9):1825–32.CrossRefPubMed 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(9):1825–32.CrossRefPubMed
13.
go back to reference Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med. 1997;157(14):1531–6.CrossRefPubMed Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med. 1997;157(14):1531–6.CrossRefPubMed
14.
go back to reference Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716–24.CrossRefPubMed Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716–24.CrossRefPubMed
15.
go back to reference Chang CM, Liu PYY, Yang YHK, Yang YC, Wu CF, Lu FH. Use of the Beers criteria to predict adverse drug reactions among first‐visit elderly outpatients. Pharmacotherapy. 2005;25(6):831–8.CrossRefPubMed Chang CM, Liu PYY, Yang YHK, Yang YC, Wu CF, Lu FH. Use of the Beers criteria to predict adverse drug reactions among first‐visit elderly outpatients. Pharmacotherapy. 2005;25(6):831–8.CrossRefPubMed
16.
go back to reference Dedhiya SD, Hancock E, Craig BA, Doebbeling CC, Thomas III J. Incident use and outcomes associated with potentially inappropriate medication use in older adults. Am J Geriatr Pharmacother. 2010;8(6):562–70.CrossRefPubMed Dedhiya SD, Hancock E, Craig BA, Doebbeling CC, Thomas III J. Incident use and outcomes associated with potentially inappropriate medication use in older adults. Am J Geriatr Pharmacother. 2010;8(6):562–70.CrossRefPubMed
17.
go back to reference Stockl KM, Le L, Zhang S, Harada AS. Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly. Am J Manag Care. 2010;16(1):e1–10.PubMed Stockl KM, Le L, Zhang S, Harada AS. Clinical and economic outcomes associated with potentially inappropriate prescribing in the elderly. Am J Manag Care. 2010;16(1):e1–10.PubMed
18.
go back to reference Lee JS, Lee JE, Jung KY, Ma SH, Kim MY, Yoo SH, Yoon JL. Polypharmacy and inappropriate drug prescription in community-dwelling elderly. J Korean Acad Fam Med. 2008;29(12):925–31. Lee JS, Lee JE, Jung KY, Ma SH, Kim MY, Yoo SH, Yoon JL. Polypharmacy and inappropriate drug prescription in community-dwelling elderly. J Korean Acad Fam Med. 2008;29(12):925–31.
19.
go back to reference Seo DS, Yoon JL, Kim SJ, Park JS, Lee WJ, Kim MY. Polypharmacy in Older Patients Admitted to a General Hospital. J Kor Geriatrics Society. 2012;16(3):133–40.CrossRef Seo DS, Yoon JL, Kim SJ, Park JS, Lee WJ, Kim MY. Polypharmacy in Older Patients Admitted to a General Hospital. J Kor Geriatrics Society. 2012;16(3):133–40.CrossRef
20.
go back to reference Lee J-H, Roh J-H, Suh Y-W, Lee J-H, Lee E-S, Lee B-K, Kim K-I, Kim C-H. Comparison between Beers criteria and Screening Tool of Older Person's Prescriptions as a screening tool for the detection of potentially inappropriate medicines and adverse drug events in the elderly patients. J Kor Geriatrics Society. 2013;17(1):28–36.CrossRef Lee J-H, Roh J-H, Suh Y-W, Lee J-H, Lee E-S, Lee B-K, Kim K-I, Kim C-H. Comparison between Beers criteria and Screening Tool of Older Person's Prescriptions as a screening tool for the detection of potentially inappropriate medicines and adverse drug events in the elderly patients. J Kor Geriatrics Society. 2013;17(1):28–36.CrossRef
21.
go back to reference Hwang H-J, Kim S-H, Lee KS. Potentially Inappropriate Medications in the Elderly in Korean Long-Term Care Facilities. Drugs Real World Outcomes. 2015;2(4):355–61.CrossRefPubMedPubMedCentral Hwang H-J, Kim S-H, Lee KS. Potentially Inappropriate Medications in the Elderly in Korean Long-Term Care Facilities. Drugs Real World Outcomes. 2015;2(4):355–61.CrossRefPubMedPubMedCentral
22.
go back to reference Kim J-Y, Kim H-J, Jung S-Y, Kim K-I, Song H, Lee J-Y, Seong J-M, Park B-J. Utilization of evidence-based treatment in elderly patients with chronic heart failure: using Korean Health Insurance claims database. BMC Cardiovasc Disord. 2012;12(1):60.CrossRefPubMedPubMedCentral Kim J-Y, Kim H-J, Jung S-Y, Kim K-I, Song H, Lee J-Y, Seong J-M, Park B-J. Utilization of evidence-based treatment in elderly patients with chronic heart failure: using Korean Health Insurance claims database. BMC Cardiovasc Disord. 2012;12(1):60.CrossRefPubMedPubMedCentral
23.
go back to reference World Health Organization. International statistical classification of disease and related health problems, Tenth Revision (ICD-10). Geneva: World Health Organization; 1992. World Health Organization. International statistical classification of disease and related health problems, Tenth Revision (ICD-10). Geneva: World Health Organization; 1992.
24.
go back to reference Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, Januel J-M, Sundararajan V. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676–82.CrossRefPubMed Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, Januel J-M, Sundararajan V. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676–82.CrossRefPubMed
25.
go back to reference Schuler J, Duckelmann C, Beindl W, Prinz E, Michalski T, Pichler M. Polypharmacy and inappropriate prescribing in elderly internal-medicine patients in Austria. Wien Klin Wochenschr. 2008;120(23–24):733–41.CrossRefPubMed Schuler J, Duckelmann C, Beindl W, Prinz E, Michalski T, Pichler M. Polypharmacy and inappropriate prescribing in elderly internal-medicine patients in Austria. Wien Klin Wochenschr. 2008;120(23–24):733–41.CrossRefPubMed
26.
go back to reference Fialova D, Topinkova E, Gambassi G, Finne-Soveri H, Jonsson PV, Carpenter I, Schroll M, Onder G, Sorbye LW, Wagner C, et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005;293(11):1348–58.CrossRefPubMed Fialova D, Topinkova E, Gambassi G, Finne-Soveri H, Jonsson PV, Carpenter I, Schroll M, Onder G, Sorbye LW, Wagner C, et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005;293(11):1348–58.CrossRefPubMed
27.
go back to reference Niwata S, Yamada Y, Ikegami N. Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities. BMC Geriatr. 2006;6(1):1.CrossRefPubMedPubMedCentral Niwata S, Yamada Y, Ikegami N. Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities. BMC Geriatr. 2006;6(1):1.CrossRefPubMedPubMedCentral
28.
go back to reference Buck MD, Atreja A, Brunker CP, Jain A, Suh TT, Palmer RM, Dorr DA, Harris CM, Wilcox AB. Potentially inappropriate medication prescribing in outpatient practices: prevalence and patient characteristics based on electronic health records. Am J Geriatr Pharmacother. 2009;7(2):84–92.CrossRefPubMed Buck MD, Atreja A, Brunker CP, Jain A, Suh TT, Palmer RM, Dorr DA, Harris CM, Wilcox AB. Potentially inappropriate medication prescribing in outpatient practices: prevalence and patient characteristics based on electronic health records. Am J Geriatr Pharmacother. 2009;7(2):84–92.CrossRefPubMed
29.
go back to reference Hong CH, Oh BH. Inappropriate prescribing in the elderly patients. J Kor Med Assoc. 2009;52(1):91–9.CrossRef Hong CH, Oh BH. Inappropriate prescribing in the elderly patients. J Kor Med Assoc. 2009;52(1):91–9.CrossRef
30.
go back to reference Lai H-Y, Hwang S-J, Chen Y-C, Chen T-J, Lin M-H, Chen L-K. Prevalence of the prescribing of potentially inappropriate medications at ambulatory care visits by elderly patients covered by the Taiwanese National Health Insurance program. Clin Ther. 2009;31(8):1859–70.CrossRefPubMed Lai H-Y, Hwang S-J, Chen Y-C, Chen T-J, Lin M-H, Chen L-K. Prevalence of the prescribing of potentially inappropriate medications at ambulatory care visits by elderly patients covered by the Taiwanese National Health Insurance program. Clin Ther. 2009;31(8):1859–70.CrossRefPubMed
31.
go back to reference Bell JS, Ahonen J, Lavikainen P, Hartikainen S. Potentially inappropriate drug use among older persons in Finland: application of a new national categorization. Eur J Clin Pharmacol. 2013;69(3):657–664.CrossRefPubMed Bell JS, Ahonen J, Lavikainen P, Hartikainen S. Potentially inappropriate drug use among older persons in Finland: application of a new national categorization. Eur J Clin Pharmacol. 2013;69(3):657–664.CrossRefPubMed
32.
go back to reference Fadare JO, Agboola SM, Opeke OA, Alabi RA. Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital. Ther Clin Risk Manag. 2013;6:115.CrossRef Fadare JO, Agboola SM, Opeke OA, Alabi RA. Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital. Ther Clin Risk Manag. 2013;6:115.CrossRef
33.
go back to reference Faustino CG, Passarelli M, Jacob-Filho W. Potentially inappropriate medications among elderly Brazilian outpatients. Sao Paulo Med J. 2013;131(1):19–26.CrossRefPubMed Faustino CG, Passarelli M, Jacob-Filho W. Potentially inappropriate medications among elderly Brazilian outpatients. Sao Paulo Med J. 2013;131(1):19–26.CrossRefPubMed
34.
go back to reference Curtis LH, Ostbye T, Sendersky V, Hutchison S, Dans PE, Wright A, Woosley RL, Schulman KA. Inappropriate prescribing for elderly Americans in a large outpatient population. Arch Intern Med. 2004;164(15):1621–5.CrossRefPubMed Curtis LH, Ostbye T, Sendersky V, Hutchison S, Dans PE, Wright A, Woosley RL, Schulman KA. Inappropriate prescribing for elderly Americans in a large outpatient population. Arch Intern Med. 2004;164(15):1621–5.CrossRefPubMed
35.
go back to reference van der Hooft CS, Jong GW, Dieleman JP, Verhamme KM, van der Cammen TJ, Stricker BH, Sturkenboom MC. Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria - a population-based cohort study. Br J Clin Pharmacol. 2005;60(2):137–44.CrossRefPubMedPubMedCentral van der Hooft CS, Jong GW, Dieleman JP, Verhamme KM, van der Cammen TJ, Stricker BH, Sturkenboom MC. Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria - a population-based cohort study. Br J Clin Pharmacol. 2005;60(2):137–44.CrossRefPubMedPubMedCentral
36.
go back to reference Lee EK, Lee YJ. Prescription patterns of anticholinergic agents and their associated factors in Korean elderly patients with dementia. Int J Clin Pharm. 2013;35(5):711–718.CrossRefPubMed Lee EK, Lee YJ. Prescription patterns of anticholinergic agents and their associated factors in Korean elderly patients with dementia. Int J Clin Pharm. 2013;35(5):711–718.CrossRefPubMed
37.
go back to reference Liu X, Liu L. Sleep habits and insomnia in a sample of elderly persons in China. Sleep. 2005;28(12):1579–87.PubMed Liu X, Liu L. Sleep habits and insomnia in a sample of elderly persons in China. Sleep. 2005;28(12):1579–87.PubMed
38.
go back to reference Morgan K, Dallosso H, Ebrahim S, Arie T, Fentem PH. Characteristics of subjective insomnia in the elderly living at home. Age Ageing. 1988;17(1):1–7.CrossRefPubMed Morgan K, Dallosso H, Ebrahim S, Arie T, Fentem PH. Characteristics of subjective insomnia in the elderly living at home. Age Ageing. 1988;17(1):1–7.CrossRefPubMed
39.
go back to reference Newman AB, Enright PL, Manolio TA, Haponik EF, Wahl PW. Sleep disturbance, psychosocial correlates, and cardiovascular disease in 5201 older adults: the Cardiovascular Health Study. J Am Geriatr Soc. 1997;45(1):1–7.CrossRefPubMed Newman AB, Enright PL, Manolio TA, Haponik EF, Wahl PW. Sleep disturbance, psychosocial correlates, and cardiovascular disease in 5201 older adults: the Cardiovascular Health Study. J Am Geriatr Soc. 1997;45(1):1–7.CrossRefPubMed
40.
go back to reference Korea pharmaceutical information center drug information Korea pharmaceutical information center drug information
41.
go back to reference Lund BC, Charlton ME, Steinman MA, Kaboli PJ. Regional differences in prescribing quality among elder veterans and the impact of rural residence. J Rural Health. 2013;29(2):172–9.CrossRefPubMedPubMedCentral Lund BC, Charlton ME, Steinman MA, Kaboli PJ. Regional differences in prescribing quality among elder veterans and the impact of rural residence. J Rural Health. 2013;29(2):172–9.CrossRefPubMedPubMedCentral
42.
go back to reference Park BJ SJ, Park KD, Seo SW, Kim SW. Report of the evaluation for validity of discharged diagnoses in Korean Health Insurance database. Seoul: Seoul National University; 2003. Park BJ SJ, Park KD, Seo SW, Kim SW. Report of the evaluation for validity of discharged diagnoses in Korean Health Insurance database. Seoul: Seoul National University; 2003.
43.
go back to reference Naugler CT, Brymer C, Stolee P, Arcese ZA. Development and validation of an improving prescribing in the elderly tool. Can J Clin Pharmacol. 2000;7(2):103–7.PubMed Naugler CT, Brymer C, Stolee P, Arcese ZA. Development and validation of an improving prescribing in the elderly tool. Can J Clin Pharmacol. 2000;7(2):103–7.PubMed
44.
go back to reference Kim DS, Heo SI, Lee SH. Development of a list of potentially inappropriate drugs for the korean elderly using the delphi method. Healthcare Informa Res. 2010;16(4):231–52.CrossRef Kim DS, Heo SI, Lee SH. Development of a list of potentially inappropriate drugs for the korean elderly using the delphi method. Healthcare Informa Res. 2010;16(4):231–52.CrossRef
45.
go back to reference By the American Geriatrics Society Beers Criteria Update Expert P: American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2015. By the American Geriatrics Society Beers Criteria Update Expert P: American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2015.
46.
go back to reference Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, Burdick E, Hickey M, Kleefield S, Shea B, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280(15):1311–6.CrossRefPubMed Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, Burdick E, Hickey M, Kleefield S, Shea B, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280(15):1311–6.CrossRefPubMed
Metadata
Title
Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria: a cross-sectional population based study
Authors
You-Seon Nam
Jong Soo Han
Ju Young Kim
Woo Kyung Bae
Kiheon Lee
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2016
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-016-0285-3

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