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Variability in prevalence of inappropriate medications use among older adults: a review highlighting the importance of screening methods and database types
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  • * RLéguillon,
  • * JGrosjean,
  • * FRoca,
  • * EBarat,
  • Remi VARIN,
  • * ELejeune,
  • * GKerdelhué,
  • * SJDarmoni,
  • * JCharlet,
  • Marie-Laure Laroche
* RLéguillon
Rouen University Hospital

Corresponding Author:[email protected]

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* JGrosjean
Rouen University Hospital
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* FRoca
Normandy University
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* EBarat
Rouen University Hospital
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Remi VARIN
Rouen University Hospital
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* ELejeune
Rouen University Hospital
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* GKerdelhué
Rouen University Hospital
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* SJDarmoni
Rouen University Hospital
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* JCharlet
U1142 INSERM Sorbonne Université
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Marie-Laure Laroche
Laboratoire VieSanté - UR 24134 (Vieillissement Fragilité Prévention e-Santé) Institut Omega Health Université de Limoges
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Abstract

Purpose The global older population is growing rapidly, and the rise in polypharmacy has increased potentially inappropriate medication (PIM) encounters. PIMs pose health risks, but detecting them automatically in large medical databases is complex. This review aims to uncover PIM prevalence in people aged over 65 using health databases and emphasize the risk of underestimating PIM prevalence due to underutilization of detection tools. Methods This study conducted a broad search on the Medline database to identify articles about the prevalence of PIMs in older adults using various databases. Articles published between January 2010 and June 2023 were included, and specific criteria were applied for study selection. Two literature reviews conducted before our study period were integrated in order to obtain a perspective from the 1990s to the present day. The selected papers were analysed for variables including database type, screening method, adaptations, and PIM prevalence. The study categorized databases and screening methods for clarity, examined adaptations, and assessed concordance among different screening methods. Results This study encompassed 48 manuscripts, covering 58 sample evaluations. The mean prevalence of PIMs within the general population aged over 65 was 29.3% (95%CI: 18.7%- 37.5%). Significant heterogeneity emerged in both the utilized databases and the detection methods. Adaptation of original methods was observed in 86.2% (50/58) of cases. Half of the methods used for assessing PIMs belonged to the “List of drugs” category. About a third of the studies employed less than half of the original criteria after adaptation. Only three studies used over 75% of the original criteria and more than 50 criteria. Conclusion This extensive review highlights PIM prevalence among the older adults, emphasizing method intricacies and the potential for underestimation due to data limitations and algorithm adjustments. The findings call for enhanced methodologies, transparent algorithms, and a deeper understanding of intricate rules’ impact on public health implications