Abstract
Purpose
Potentially inappropriate medication (PIM) is suggested to give rise to adverse drug events. To study this suggestion for elderly psychiatric patients, an observational analysis related prescription of PRISCUS PIMs and drug-induced side effects in old aged (≥65 years) psychiatric inpatients and outpatients under conditions of everyday pharmacotherapy.
Methods
Request forms from a therapeutic drug monitoring (TDM) survey and medical files were screened for medication to identify PIMs of the PRISCUS list and assessed using the Udvalg for Kliniske Undersøgelser (UKU) side effect rating scale.
Results
From 914 TDM request forms, data were available for 168 patients (64.3 % female). Patients (mean ± SD age 73.0 ± 5.5 years) received by mean 6.4 ± 3.9 drugs per day. More than half of them (53.0 %, n = 89) had at least one PIM, inpatients 0.9 ± 0.8 and outpatients 0.5 ± 0.7. Predominant PIMs were hypnotic drugs (69 %) in inpatients and antipsychotic drugs (35.6 %) in outpatients. The number of PIMs correlated with the total number of drugs administered per day (Spearman correlation coefficient 0.225, p < 0.01, CI 95 %). Side effects were documented for 106 patients (63 %). Severity of side effects did not correlate significantly (p > 0.05) with number of PIMs. However, only 6 of 77 patients who took no PRISCUS PIMs but 2 of 3 patients who took 3 PRISCUS PIMs exhibited severe side effects.
Conclusions
Though the prevalence for PIMs and side effects was high in old aged psychiatric inpatients and outpatients, PIMs could not be identified as major determinants of overall unwanted side effects. Nevertheless, prescription of PIMs should be minimized, especially of hypnotic drugs, to improve safety.
Similar content being viewed by others
References
Fulton MM, Allen ER (2005) Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract 17(4):123–132. doi:10.111/j.1041-2972.2005.0020.×
McLean AJ, Le Couteur DG (2004) Aging biology and geriatric clinical pharmacology. Pharmacol Rev 56(2):163–184. doi:10.1124/pr.56.2.4
Turnheim K (2003) When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol 38(8):843–853
Aymanns C, Keller F, Maus S, Hartmann B, Czock D (2010) Review on pharmacokinetics and pharmacodynamics and the aging kidney. Clin J Am Soc Nephrol 5(2):314–327. doi:10.2215/cjn.03960609
Goldberg RM, Mabee J, Chan L, Wong S (1996) Drug-drug and drug-disease interactions in the ED: analysis of a high-risk population. Am J Emerg Med 14(5):447–450. doi:10.1016/s0735-6757(96)90147-3
Leon C, Gerretsen P, Uchida H, Suzuki T, Rajji T, Mamo DC (2010) Sensitivity to antipsychotic drugs in older adults. Curr Psychiatry Rep 12(1):28–33. doi:10.1007/s11920-009-0080-3
Trifiro G, Spina E (2011) Age-related changes in pharmacodynamics: focus on drugs acting on central nervous and cardiovascular systems. Curr Drug Metab 12(7):611–620
Ahmed N, Mandel R, Fain MJ (2007) Frailty: an emerging geriatric syndrome. Am J Med 120(9):748–753. doi:10.1016/j.amjmed.2006.10.018
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research G (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156
Onder G, Pedone C, Landi F, Cesari M, Della Vedova C, Bernabei R, Gambassi G (2002) Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA). J Am Geriatr Soc 50(12):1962–1968
Mallet L, Spinewine A, Huang A (2007) The challenge of managing drug interactions in elderly people. Lancet 370(9582):185–191. doi:10.1016/s0140-6736(07)61092-7
Mittal V, Muralee S, Williamson D, McEnerney N, Thomas J, Cash M, Tampi RR (2011) Review: delirium in the elderly: a comprehensive review. Am J Alzheimers Dis Other Demen 26(2):97–109. doi:10.1177/1533317510397331
Mintzer J, Burns A (2000) Anticholinergic side-effects of drugs in elderly people. J R Soc Med 93(9):457–462
Field TS, Gurwitz JH, Avorn J, McCormick D, Jain S, Eckler M, Benser M, Bates DW (2001) Risk factors for adverse drug events among nursing home residents. Arch Intern Med 161(13):1629–1634
Dormann H, Sonst A, Muller F, Vogler R, Patapovas A, Pfistermeister B, Plank-Kiegele B, Kirchner M, Hartmann N, Burkle T, Maas R (2013) Adverse drug events in older patients admitted as an emergency: the role of potentially inappropriate medication in elderly people (PRISCUS). Dtsch Arztebl Int 110(13):213–219. doi:10.3238/arztebl.2013.0213
Holt S, Schmiedl S, Thurmann PA (2010) Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int 107(31–32):543–551. doi:10.3238/arztebl.2010.0543
Hamilton HJ, Gallagher PF, O’Mahony D (2009) Inappropriate prescribing and adverse drug events in older people. BMC Geriatr 9:5. doi:10.1186/1471-2318-9-5
American Geriatrics Society Beers Criteria Update Expert P (2012) American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60(4):616–631. doi:10.1111/j.1532-5415.2012.03923.×
Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH (2003) Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 163(22):2716–2724. doi:10.1001/archinte.163.22.2716
Gallagher P, O’Mahony D (2008) STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing 37(6):673–679. doi:10.1093/ageing/afn197
Laroche ML, Charmes JP, Merle L (2007) Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol 63(8):725–731. doi:10.1007/s00228-007-0324-2
Thiem U (2012) Potentially inappropriate medication: the quality of pharmacotherapy in the elderly. Internist Berl 53(9):1125–1130. doi:10.1007/s00108-012-3087-5
Thiem U, Theile G, Junius-Walker U, Holt S, Thurmann P, Hinrichs T, Platen P, Diederichs C, Berger K, Hodek JM, Greiner W, Berkemeyer S, Pientka L, Trampisch HJ (2011) Prerequisites for a new health care model for elderly people with multimorbidity: the PRISCUS research consortium. Z Gerontol Geriatr 44(2):115–120. doi:10.1007/s00391-010-0156-z
Schubert I, Kupper-Nybelen J, Ihle P, Thurmann P (2013) Prescribing potentially inappropriate medication (PIM) in Germany’s elderly as indicated by the PRISCUS list. An analysis based on regional claims data. Pharmacoepidemiol Drug Saf 22(7):719–727. doi:10.1002/pds.3429
Zimmermann T, Kaduszkiewicz H, van den Bussche H, Schon G, Brettschneider C, Konig HH, Wiese B, Bickel H, Mosch E, Luppa M, Riedel-Heller S, Werle J, Weyerer S, Fuchs A, Pentzek M, Hanisch B, Maier W, Scherer M, Jessen F, AgeCoDe-Study G (2013) Potentially inappropriate medication in elderly primary care patients: a retrospective, longitudinal analysis. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56(7):941–949. doi:10.1007/s00103-013-1767-5
Fiss T, Thyrian JR, Fendrich K, van den Berg N, Hoffmann W (2013) Cognitive impairment in primary ambulatory health care: pharmacotherapy and the use of potentially inappropriate medicine. Int J Geriatr Psychiatry 28(2):173–181. doi:10.1002/gps.3806
Amann U, Schmedt N, Garbe E (2012) Prescribing of potentially inappropriate medications for the elderly: an analysis based on the PRISCUS list. Dtsch Arztebl Int 109(5):69–75. doi:10.3238/arztebl.2012.0069
Hiemke C, Baumann P, Bergemann N, Conca A, Dietmaier O, Egberts K, Fric M, Gerlach M, Greiner C, Grunder G, Haen E, Havemann-Reinecke U, Jaquenoud Sirot E, Kirchherr H, Laux G, Lutz UC, Messer T, Muller MJ, Pfuhlmann B, Rambeck B, Riederer P, Schoppek B, Stingl J, Uhr M, Ulrich S, Waschgler R, Zernig G (2011) AGNP consensus guidelines for therapeutic drug monitoring in psychiatry: update 2011. Pharmacopsychiatry 44(6):195–235
Lingjaerde O, Ahlfors UG, Bech P, Dencker SJ, Elgen K (1987) The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatr Scand Suppl 334:1–100
Bauer TK, Lindenbaum K, Stroka MA, Engel S, Linder R, Verheyen F (2012) Fall risk increasing drugs and injuries of the frail elderly—evidence from administrative data. Pharmacoepidemiol Drug Saf 21(12):1321–1327. doi:10.1002/pds.3357
Siebert S, Elkeles B, Hempel G, Kruse J, Smollich M (2013) The PRISCUS list in clinical routine. Practicability and comparison to international PIM lists. Z Gerontol Geriatr 46(1):35–47. doi:10.1007/s00391-012-0324-4
Berger A, Mychaskiw M, Dukes E, Edelsberg J, Oster G (2009) Magnitude of potentially inappropriate prescribing in Germany among older patients with generalized anxiety disorder. BMC Geriatr 9:31. doi:10.1186/1471-2318-9-31
Onder G, Petrovic M, Tangiisuran B, Meinardi MC, Markito-Notenboom WP, Somers A, Rajkumar C, Bernabei R, van der Cammen TJ (2010) Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years or older: the GerontoNet ADR risk score. Arch Intern Med 170(13):1142–1148. doi:10.1001/archinternmed.2010.153
Bates DW, Miller EB, Cullen DJ, Burdick L, Williams L, Laird N, Petersen LA, Small SD, Sweitzer BJ, Vander Vliet M, Leape LL (1999) Patient risk factors for adverse drug events in hospitalized patients. ADE Prevention Study Group. Arch Intern Med 159(21):2553–2560
Dolder CR, McKinsey J (2011) Antipsychotic polypharmacy among patients admitted to a geriatric psychiatry unit. J Psychiatr Pract 17(5):368–374. doi:10.1097/01.pra.0000405368.20538.cd
Lesen E, Petzold M, Andersson K, Carlsten A (2009) To what extent does the indicator “concurrent use of three or more psychotropic drugs” capture use of potentially inappropriate psychotropics among the elderly? Eur J Clin Pharmacol 65(6):635–642. doi:10.1007/s00228-009-0623-×
Hamilton H, Gallagher P, Ryan C, Byrne S, O’Mahony D (2011) Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med 171(11):1013–1019. doi:10.1001/archinternmed.2011.215
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hefner, G., Stieffenhofer, V., Gabriel, S. et al. Side effects related to potentially inappropriate medications in elderly psychiatric patients under everyday pharmacotherapy. Eur J Clin Pharmacol 71, 165–172 (2015). https://doi.org/10.1007/s00228-014-1796-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00228-014-1796-5