Evaluation of inappropriate drug use in geriatric patients using the TIME-to-STOP/TIME-to-START criteria in a tertiary hospital

Year 2023, Volume: 27 Issue: 2, 687 - 695, 27.06.2025

Ajla Hodzıc , Berna Terzioğlu Bebitoğlu , Elif Oğuz , Banu Mesci , Nurgül Bulut

https://izlik.org/JA27RJ25YP

Abstract

This study aimed to determine the frequency and factors affecting inappropriate drug use and
polypharmacy in geriatric patients. The data on 318 geriatric patients hospitalized between January 1, 2020, and July 1,
2020, in the internal medicine clinic of a tertiary hospital were analyzed retrospectively. Inappropriate drug use was
evaluated according to the Turkish Inappropriate Medication Use in the Elderly (TIME) TIME-to-STOP/ TIME-to-
START criteria. Of the 318 patients, 157 (49.4%) used at least one potentially inappropriate drug. The most frequently
used inappropriate drugs according to TIME-to-START criteria were related to (B) the central nervous system (n = 28;
53.89%), (A) the cardiovascular system (n = 26; 33.33%), and (I) supplements (n = 24; 30.77%). The most frequently used
inappropriate drugs according to TIME-to-STOP criteria were related to (B) the central nervous system (n = 258; 45.18%),
(C) the gastrointestinal system (n = 224; 39.23%), and (D) the respiratory system (n = 44; 7.71%). A total of 225 (70.8%)
patients engaged in polypharmacy at least once. Conclusion: There is a high rate of potentially inappropriate drug use
and polypharmacy among Turkish geriatric patients. The use of published guidelines should be expanded in Turkey.

Keywords

inappropriate drug use , geriatrics , polypharmacy , prescribing

References

• Kerry Z. Rational drug use in elderly. Ege Journal of Medicine 2015;54:62-72. (Article in Turkish) [https://doi.org/10.19161/etd.344151]
• Trifiro G, Spina E. Age-related Changes in Pharmacodynamics: Focus on Drugs Acting on Central Nervous and Cardiovascular Systems. Curr Drug Metab. 2011;12:611. [https://doi.org/10.2174/138920011796504473]
• Mand P, Roth K, Biertz F, Kersting M, Kruschinski C, Schmiemann G, Hummers-Pradier E. Drug-disease interaction in elderly patients in family practice. Int J Clin Pharmacol Ther 2014;52(5):337-45. [https://doi.org/ 10.5414/CP202003]
• Rattan SIS. Molecular and Cellular Basis of Aging. In: Malavolta M, Mocchegiani E. (Eds). Molecular basis of nutrition and aging. Academic Press., London, 2016, pp. 73-107. [https://doi.org/10.1016/B978-0-12-801816-3.00001-7]
• Leporini C, De Sarro G, Russo E. Adherence to therapy and adverse drug reactions: is there a link? Expert Opin Drug Saf 2014;13(1):41-55. [https://doi.org/ 10.1517/14740338.2014.947260]
• Bozkurt E, Parlar A, Arslan S. Investigation of Inappropriate Drug Use in Elderly Patients and Polifarmacy Presence. ADYÜ Sağlık Bilimleri Derg 2019;5(1):1254-1266. (Article in Turkish) [https://doi.org/10.30569/adiyamansaglik.513045
• Beers MH, Ouslander JG, Rollingher I, et al. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 1991;151:1825–1832. [https://doi.org/10.1001/archinte.1991.00400090107019]
• Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med. 1997;157:1531–1536. [https://doi.org/ 10.1001/archinte.1997.00440350031003]
• Pérez-Jover V, Mira JJ, Carratala-Munuera C. Inappropriate Use of Medication by Elderly, Polymedicated, or Multipathological Patients with Chronic Diseases. Int J Environ Res Public Health 2018;15(2):310. [https://doi.org/10.3390/ijerph15020310]
• De Oliveira Alves C, Schuelter-Trevisol F, Trevisol DJ. Beers criteria-based assessment of medication use in hospitalized elderly patients in southern Brazil. J Family Med Prim Care 2014;3(3):260-265. [https://doi.org/10.4103/2249- 4863.141628]
• Galli TB, Reis WC, Andrzejevski VM. Potentially inappropriate prescribing and the risk of adverse drug reactions in critically ill older adults. Pharmacy Practice 2016; 14(4):818. [https://doi.org/10.18549/PharmPract.2016.04.818]
• Moreira FSM, Jerez-Roig J, Ferreira LMBM, Dantas APQM, Lima KC, Ferreira MAF. Use of potentially inappropriate medications in institutionalized elderly: prevalence and associated factors. Cien Saude Colet. 2020;25(6):2073-2082. [https://doi.org/10.1590/1413-81232020256.26752018]
• Grina D, Briedis V. The use of potentially inappropriate medications among the Lithuanian elderly according to Beers and EU (7)-PIM list -a nationwide cross-sectional studyon reimbursement claims data. J Clin Pharm Ther. 2017;42(2):195- 200. [https://doi.org/10.1111/jcpt.12494]
• Lopez-Rodriguez JA, Rogero-Blanco E, Aza-Pascual-Salcedo M, LopezVerde F, Pico-Soler V, Leiva-Fernandez F, Prados-Torres JD, PradosTorres A, Cura-González I; MULTIPAP group. Potentially inappropriate prescriptions according to explicit and implicit criteria in patients with multimorbidity and polypharmacy. MULTIPAP: A cross- sectional study. PLoS One. 2020;15(8): e0237186. [https://doi.org/10.1371/journal.pone.0237186]
• Tosato M, Landi F, Martone AM, Cherubini A, Corsonello A, Volpato S, Bernabei R, Onder G; Investigators of the CRIME Study. Potentially inappropriate drug use among hospitalised older adults: results from the CRIME study. Age Aging. 2014;43(6):767-73. [https://doi.org/10.1093/ageing/afu029]
• Ertem Ö, Kasım İ, Özkara A, Koç EM, Kahveci R, Şencan İ. Inappropriate Drug Use in Hospitalized Elderly Patients. Euras J Fam Med 2015;4(3):117-25. (Article in Turkish). [https://doi.org/10.30569/adiyamansaglik.513045]
• Bahat G, Ilhan B, Erdogan T, Savas S, Ulger Z. Turkish inappropriate medication use in the elderly (TIME) criteria to improve prescribing in older adults: TIME-to-STOP/TIME-to-START. Eur Geriatr Med 2020;11(3):491-498. [https://doi.org/10.1007/s41999-020-00297-z]
• Küçükdağılı P. Polypharmacy and Related Factors in Geriatric Outpatients Eur J Geriatr Gerontol 2019;1(2):56-60. [https://doi.org/10.4274/ejgg.galenos.2019.144]
• Masnoon, N., Shakib, S., Kalisch-Ellett, L. et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr 17, 230 (2017). [https://doi.org/10.1186/s12877-017-0621-2]
• Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol. 2018;10:289-298. [https://doi.org/10.2147/CLEP.S153458]
• Rawle MJ, Richards M, Davis D, Kuh D. The prevalence and determinants of polypharmacy at age 69: a British birth cohort study. BMC Geriatr. 2018;18(1):118. [https://doi.org/10.1186/s12877-018-0795-2]
• Haider SI, Ansari Z, Vaughan L, Matters H, Emerson. Prevalence and factors associated with polypharmacy in Victorian adults with intellectual disability. E Res Dev Disabil. 2014; 35(11):3071. [https://doi.org/10.1016/j.ridd.2014.07.060]
• Midao L, Giardini A, Menditto E. Polypharmacy prevalence among older adults based on the survey of health, Ageing and retirement in Europe. Arch Gerontol Geriatr 2018; 78:213–220. [https://doi.org/10.1016/j.archger.2018.06.018].
• Cankara FN Aşcı H, Sönmez. Physicians' drug preferences and polypharmacy presence in inpatients of university hospital. 2015;1–6. (Article in Turkish)
• Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications For health care, research, and medical education: a cross-sectional study. Lancet. 2012;380:37–43. [https://doi.org/10.1016/S0140-6736(12)60240-2].
• Parminder R, Gilsing A, Mayhew AJ, Sohel N, van den Heuvel E, Griffith LE. Individual and population level impact of chronic conditions on functional disability in older adults. PloS One. 2020;15(2):e0229160. [https://doi.org/10.1371/journal.pone.0229160].
• Brandao GR, Teixeira L, Araújo L, Paúl C, Ribeiro O. Self-medication in older European adults: Prevalence and predictive factors. Arch Gerontol Geriatr. 2020;21;91:104189. Epub ahead of print. [https://doi.org/10.1016/j.archger.2020.104189]
• Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people.BMJ.1997; 25;315(7115):1096-9 [https://doi.org/10.1136/bmj.315.7115.1096]
• Ahmed B, Nanji K, Mujeeb R, Patel MJ. Effects of polypharmacy on adverse drug reactions among geriatric outpatients at a tertiary care hospital in Karachi a prospective cohort study. PLoS One. 2014;9(11):e112133. [https://doi.org/10.1371/journal.pone.0112133]
• Dias BM, Santos FS dos, Reis, Ao MM. (2019). Potential drug interactions in drug therapy prescribed for older adultsat hospital discharge: cross-sectional study. Sao Paul Medical Journal, 2019;137(4), 369-378. [https://doi.org/10.1590/1516- 3180.2019.013405072019]
• Prybys K, Melville K, Hanna J. Polypharmacy in the elderly: Clinical challenges in emergency practice: Part 1: Overview, etiology, and drug interactions. Emerg Med Rep 2002;23:145–53.
• Unutmaz GD, Soysal P, Tuven B, Isik AT. Costs of medication in older patients: before and after comprehensive geriatric assessment. Clin Interv Aging. 2018;13:607-613. [https://doi.org/10.2147/CIA.S159966]
• Park JW, Roh JL, Lee SW, Kim SB, Choi SH, Nam SY, Kim SY. Effect of polypharmacy and potentially inappropriate medications on treatment and posttreatment courses in elderly patients with head and neck cancer. J Cancer Res Clin Oncol. 2016;142(5):1031-40. [https://doi.org/10.1007/s00432-015-2108-x]
• Alic A., Pranjic N., Ramic E. Polypharmacy and decreased cognitive abilities in elderly patients. Med. Arch. 2011;65:102–105. https://www.tuik.gov.tr/media/announcements/istatistiklerle_yaslilar_2020.pdf
• Pereira, TFF, De Sa Soares A, Trevisol JD, Trevisol SF. Assessing the overall medication use by elderly people in Brazilian hospital using the start/stopp criteria version 2. Brazilian Journal of Pharmaceutical Sciences 2019;55. [https://doi.org/10.1590/s2175-97902019000117739]
• Fahrni ML, Azmy MT, Usir E, Aziz NA, Hassan Y. Inappropriate prescribing defined by STOPP and START criteria and its association with adverse drug events among hospitalized older patients: A multicentre, prospective study. PLoS One 2019;14(7): e0219898. [https://doi.org/10.1371/journal.pone.0219898]
• Aydos T, Emre Aydıngöz S, Lux K, Efe O, İşli F. Polypharmacy Prevalence Among Gerıatrıc Patıents In Prımary Healthcare Settıngs Across Turkey: A Cross-Sectıonal Analysıs Through The Nationwide Prescrıptıon Informatıon System. The Turkish Journal of Geriatrics 2020;23(2):169-179. [http://doi.org/10.31086/tjgeri.2020.151]
• Cojutti P, Arnoldo L, Cattani G, Brusaferro S. Pea F. Polytherapy and th risk of potentially inappropriate prescriptions (PIPs) among elderly and very elderly patients in three different settings (hospital, community, long-term care facilities) of the Friuli Venezia Giulia region, Italy: are the very elderly at higher risk of PIPs? Pharmacoepidemiol Drug Saf 2016; 25(9):1070-1078. [https://doi.org//10.1002/pds.4026]
• Bahat G, Bay I, Tufan A, Tufan F, Kilic C, Karan MA. Prevalence of potentially inappropriate prescribing among older adults: A comparison of the Beers 2012 and Screening Tool of Older Person's Prescriptions criteria version .Geriatr Gerontol Int 2017;17(9):1245-1251. [https://doi.org/10.1111/ggi.12850]
• Kara Ö, Arık G, Kızılarslanoglu MC, Kılıc MK, Varan HD, Sümer F, Esme M, Altıner S, Kuyumcu ME, Yesil Y,Yavuz BB, Cankurtaran M, Halil M. Potentially inappropriate prescribing according to the STOPP/START criteria for older adults. Aging Clin Exp Res 2016;28(4):761-768. [https://doi.org/ 10.1007/s40520-015-0475-4]
• Lamy PP. The elderly, undernutrition, and pharmacokinetics. J Am Geriatr Soc 1983 Sep;31(9):560-562. [https://doi.org/10.1111/j.1532-5415.1983.tb02202.x]
• Sayın Z, Sancar M, Özen Y, Okuyan B. Polypharmacy, potentially inappropriate prescribing and medication complexity in Turkish older patients in the community pharmacy setting. Acta Clin Belg 2020;8:1-7. [https://doi.org/ 10.1080/17843286.2020.1829251]
• Kyriazis I, Tatakis FP, Lappa T et al. Screening for Malnutrition in Older Hospitalised Patients in an Internal Medicine Departmentof a Greek Public Hospital. Archives of Diabetes & Obesity 2019;2(1). [https://doi.org/10.32474/ADO.2019.02.000128]
• Öztürk GZ, Ardic C, Toprak D. Frequency of polypharmacy and use of potentially inappropriate medications in the elderly. Turk Geriatri Dergisi 2017;20(4):296-305.
• Maarsingh OR, Schellevis FG, van der Horst HE. Looks vestibular: irrational prescribing of antivertiginous drugs for older dizzy patients in general practice. Br J Gen Pract 2012;62(603):518-520. [http://doi.org/ 10.3399/bjgp12X656757]
• Hsu WH. Hyoscine-N-Butyl-bromide-induced hypotension and myocardial ischemia. Case Rep Critical Care 2013;2013:1–3. [http://doi.org/ 10.1155/2013/414856]
• Patel, M.M., Mark, A.S, Patel, V. (2020). Identification of potentially inappropriate medications used in elder patients attending outpatient departments using Beers 2015 criteria and comparing the same with 2012 criteria. IP International Journal of Comprehensive and Advanced Pharmacology, 5, 95-99. [http://doi.org/ 10.18231/j.ijcaap.2020.021]
• Walckiers D, Van der Heyden J, Tafforeau J. Factors associated with excessive polypharmacy in older people. Arch Public Health. 2015;73:50. [http://doi.org/10.1186/s13690-015-0095-7]
• Nieder C, Mannsăker B, Pawinski A, Haukland E. Polypharmacy in Older Patients ≥70 Years Receiving Palliative Radiotherapy. Anticancer Res. 2017; 37(2):795-799. [http://doi.org/ 10.21873/anticanres.11379]
• Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol. 2018;10:289-298. [http://doi.org/ 10.2147/CLEP.S153458]
• Harugeri A, Joseph J, Parthasarathi G, Ramesh M, Guido S. Prescribing patterns and predictors of high-level polypharmacy in the elderly population: A prospective surveillance study from two teaching hospitals in India. Am J Geriatr Pharmacother. 2010;8(3):271-80. [http://doi.org/ 10.1016/j.amjopharm.2010.06.004]
• Dunlay SM, Eveleth JM, Shah ND, McNallan SM, Roger VL. Medication adherence among community-dwelling patients with heart failure. Mayo Clinic Proc. 2011;86(4):273–81. [http://doi.org/ 10.4065/mcp.2010.0732]
• Shrestha S, Shrestha S, Khanal S. Polypharmacy in elderly cancer patients: Challenges and the way clinical pharmacists can contribute in resource-limited settings. Aging Med (Milton). 2019; 14;2(1):42- 49.85. [http://doi.org/10.1002/agm2.12051]
• Murphy CC, Fullington HM, Alvarez CA, Betts AC, Lee SJC, Haggstrom DA, Halm EA. Polypharmacy and patterns of prescription medication üşe among cancer survivors. Cancer. 2018;1;124(13):2850-2857.2. [http://doi.org/10.1002/cncr.31389]
• Scharlach AE, Mor-Barak ME, Katz A, et al. Generation: a corporatesponsored retiree health care program. Gerontologist 1992;32: 265–269 [http://doi.org/ 10.1093/geront/32.2.265]