gms | German Medical Science

Background: According to experience the amount of medication grows with increasing age. In addition to that the risk of adverse drug events increases as well. Because of their pharmacological effects certain drugs are regarded as „potentially inappropriate“ for the elderly. This poses a challenge to the attending doctors regarding pharmaceutical drug safety. With the publication of the PRISCUS List in 2010 Holt et al. made an important contribution to this field in Germany.

Objective: In our study we tried to optimize the drug therapy of elderly patients in the geriatric institution of the university hospital in Jena. For that matter we wanted to find out to which extent it is possible to abstain from PIM and how adverse drug events (ADE) affected the patients. In addition to the 83 PRISCUS drugs we turned our attention to the 46 drugs that were left with no clear decision after the Delphi process (called „Nearly-PRISCUS“ drugs in the following paragraphs) to approach the problem from a wider angle.

Materials and Methods: With regard to the PRISCUS List we analyzed the medication (admission and discharge) of 312 acute geriatric patients [of the geriatric institution of the university hospital in Jena] from August 2012 to January 2013. To find possible factors that affected PIM intake we collected socio-demographic data, basic geriatric assessments and multimorbidity data.

Results: At the time of admission the mean age amounted to 82,4 years (SD 6,7) and the mean intake of drugs per patient was 9,3 (SD 3,7). 21,2% of the patients received at least one PRISCUS medication and 31,7% took at least one Nearly-PRISCUS drug. The highest PRISCUS prevalence was observed for psycoleptics (6,4%). On the top of the Nearly-Priscus prevalence we found antihypertensives (10,3%). The most prescribed drugs among PRISCUS were digoxin, etoricoxib and amitriptyllin. Among Nearly-PRISCUS the most frequently taken drugs were moxonidin, ciprofloxacin and diclofenac. From admission to discharge both general drugs and PIM (PRISCUS and Nearly-PRISCUS) were significantly (p < 0,001) reduced. Regarding polypharmacy we found a significantly higher risk for receiving a PRISCUS (OR 2,1; 95% CI: 1,15-3,73; p=0,016) or Nearly-PRISCUS drug (OR 2,2, 95% CI: 1,33-3,69; p=0,002). At the point of admission at least one ADE was observed in 180 patients (57,7%). Almost 8% (n=24) of the patients suffered from at least one ADE (in total 29) caused by a PRISCUS (n=9, esp. digoxin and doxazocin) or a Nearly-PRISCUS drug (n=20, esp. moxonidin). Most frequently ADEs that affect the cardiovascular system - such as hypotension and bradycardia - were observed. Patients with Nearly-PRISCUS drugs have to live with a 1,7 times heightened risk (OR 1,73; 95% CI: 1,057-2,855; p = 0,03) for the appearance of an ADE.

Conclusion: Polymedication is common and PIM (PRISCUS and Nearly-PRISCUS) are widely used in the observed study population. Furthermore polymedication poses a risk factor for PIM prescription. More than the half of the patients was affected by an ADE at the time of admission. We found out, that Nearly-Priscus drugs are a risk factor for ADEs. PRISCUS as well as Nearly-PRISCUS medication underwent a significant reduction during the hospital treatment. From that we can infer that physicians in a specialized geriatric institution are similarly sensitized to Nearly-PRISCUS as to PRISCUS.