Analysis Of Potentially Inappropriate Medication Use In Elderly Hospitalized Patients

Background:China has a severely aging population,with senior elderly populations growing at the fastest pace.Elderly inpatients were chosen for PIM(Potentially Inappropriate Medication)evaluation to address the issue of irrational medication use in elderly inpatients because of the prevalence of multimorbidity,as well as the more serious problems of multidisciplinary treatment and polypharmacy in the elderly.Purposes:Combining the Beers criteria,STOPP/START criteria,and the "Chinese criteria for potentially inappropriate medication use in the elderly"(hereinafter,"Chinese criteria"),the incidence of potentially inappropriate therapeutic use in elderly inpatients was thoroughly investigated.The main influencing factors were discussed in order to lower the risk of medication use in elderly patients,provide a clinical basis for prudent medication use,and further improve the care for these patients.Methods:Senior patients who fulfilled the inclusion criteria and were admitted to the geriatric ward of the First Hospital of Jilin University between January 2020 and December 2021 were screened.Beers criteria,STOPP/START criteria,and Chinese criteria were used to check the PIM status of inpatient medication prescriptions for elderly patients,as well as to ascertain the incidence of PIM and its contributing factors.A thorough analysis of the incidence of PIM was then performed in conjunction with the most recent clinical recommendations for diseases that are related to PIM.The statistical program SPSS 25.0 was used for data processing.By building a logistic regression model,the major PIM influencing variables were examined,and the two-by-two consistency Kappa test was carried out using the three PIM criteria.Results:A total of 299 patients were eventually included in the study based on the inclusion and exclusion criteria,with a mean age of(86.6±3.6)years,a mean number of hospital days of(14±7.1),and a mean number of medication kinds of(9.2±3.4).Proton pump inhibitors,diuretics,and benzodiazepines had the highest frequency of PIM among the 215 individuals(71.9%)who were tested for PIM using the Beers criteria.277 patients(92.6%)were screened for the presence of PIM according to the STOPP/START criteria,and the drugs with the highest incidence of PIM were,in order,benzodiazepines,dexrazopiclone,and benzodiazepines.analogs,dexrazopiclone,and nonsteroidal anti-inflammatory drugs(NSAIDs);the START prescription omission screening tool had the highest proportion of patients with coronary artery disease who did not use ACEI analogs,followed by patients with ischemic cardiomyopathy who did not useβ-blockers and patients with chronic atrial fibrillation who did not use warfarin,direct thrombin inhibitors(DTIs),or factor Xa inhibitors.The treatment drugs with a high incidence of PIM were NSAIDs,clopidogrel,benzodiazepines,and insulin,in that order.Chinese criteria screened 159 patients(53.2%)with PIM.According to a multi-factor logistic regression analysis,the patient’s age and the number of diseases they had were the main factors influencing PIM under the Beers criterion(OR=1.365,95%CI1.204-1.547,P<0.001),the patient’s age(OR=1.152,95%CI1.008-1.316,P<0.05)and the number of diseases(OR=1.459,95%CI1.207-1.765,P<0.001)they had were the main factors influencing PIM under the STOPP/START criterion,and the factor influencing PIM under the Chinese criterion was the number of medication types(OR=1.207,95%CI1.107-1.315,P<0.001).the Kappa test indicated poor agreement between STOPP/START criteria and Chinese criteria(Kappa=0.066,P<0.05),Beers criteria and STOPP/START criteria(Kappa=0.146,P<0.001),and Chinese criteria and Beers criteria(Kappa=0.229,P<0.001).Conclusion:PIM is prevalent in elderly inpatients who meet all three requirements.The level of reasonable pharmaceutical use among senior people as a whole must be continually improved.Consider the disease experienced,the goal of the study,and the medications used in the department when choosing two to three assessment criteria for PIM.Concentrate on medication use in older patients,minimize medication use overall,take note of drug interactions and side effects,and lessen the harm caused by multi-drug combinations in elderly patients(especially elderly patients).