Many Older Adults Still Take Potentially Inappropriate Medications (PIMs)
Nearly 43 percent of older adults on prescription medicines take at least one medication that geriatrics experts consider a “potentially inappropriate medication” (PIM) because its risks are usually greater than its benefits in older adults, and safer options are available, according to a March 2015 study published in the Journal of the American Geriatrics Society.
Older adults tolerate medications differently than do younger people. Knowing this fact, geriatrics expert Mark Beers, MD, devised a clinical guide in 1991 known as the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults to help healthcare professionals improve patient safety. His list identified medicines often linked to poor outcomes and health issues (sometimes referred to as “adverse events”) in older adults.
The American Geriatrics Society now manages the Beers Criteria® list, and the present study was based on the most recent list update in 2012. This version of the AGS Beers Criteria® reflects some 38 categories of medicines that should be evaluated carefully and perhaps avoided among older patients.
In the JAGS study of more than 18,400 older adults, researchers from several leading health institutions examined data from the Medical Expenditure Panel Survey (MEPS), the most complete source of information on the use and cost of health care (including medication) based on survey data from families, individuals, and health providers. More than four in 10 older adults received at least one PIM. Nearly 11 percent of the older adults evaluated had prescriptions for non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen, making these the most frequently used PIMs evaluated. NSAIDs are sometimes recommended to treat pain, inflammation, fever, and certain other conditions, but they may increase an older person’s risk for heart failure and kidney damage, or they may lead to bleeding in the stomach or intestine.
Although the researchers note that PIM use remains high, they also note that it has declined overall. Less than 41% of older adults were taking PIMs in 2009-2010, for example, compared with more than 45% of older adults in 2006-2007. Specific PIM categories posting large declines in use include selected sulfonylureas (medications used to treat type 2 diabetes) and estrogens (a type of hormone used to treat symptoms of menopause).
However, the use of other types of PIMs, like skeletal muscle relaxants, increased over the same period of time. But some medications classified as PIMs were used for brief periods of time or among patients with health concerns where use was warranted. These considerations stress the importance of working closely with your healthcare provider if you have questions or concerns about the medications you take, or if you want to have a discussion about alternative therapies.
Moving forward, healthcare professionals and their patients may be able to use these data to explore options for further decreasing PIM use and understanding health outcomes with different forms of treatment. If you have questions about specific medications or treatment options for yourself or an older adult you care for, make a complete and current list of medicines (including supplements and vitamins) and bring it to your healthcare professional to discuss. A pharmacist may also be a helpful point-of-contact for reviewing your medication list and discussing potential concerns or alternatives. Some medications may be appropriate for specific patients in specific situations. Your healthcare provider is well situated to make these determinations and to answer any questions you may have, and can also work with you to evaluate an alternative regimen if you are concerned about a PIM.
This summary is from the full report titled “Prevalence of Potentially Inappropriate Medication Use in Older Adults Using the 2012 AGS Beers Criteria®.” It appears online ahead of print in the March 2015 issue of the Journal of the American Geriatrics Society. The report is authored by Amy J. Davidoff, PhD, G. Edward Miller, PhD, Eric M. Sarpong, PhD, Eunice Yang, MA, Nicole Brandt, PharmD, MBA, and Donna M. Fick, PhD, RN.