Prevalence of potentially inappropriate medications in Iranian elderly hospitalized patients

Abstract

Abstract Background: Population aging is a health challenge in the world and Iran. Potentially inappropriate medications (PIMs) should not be prescribed to the elderly due to low effectiveness and adverse drug reactions. There are various tools for screening PIMs including Zhan's criteria. This study was conducted to determine the frequency of PIMs in the elderly admitted to teaching hospitals in Kerman, in 2023. Methods: This cross-sectional descriptive study was conducted on 1500 elderly patients hospitalized in educational hospitals in Kerman, Iran, 2023. The inclusion criteria were determined as age> 60 years. Patients with incomplete electronic information were excluded from the study. Patients were selected using stratified multistage sampling method. The data collection forms were completed according to the Health Information System (HIS) of the hospital, which includes the patient's age and gender, drug information, and the name of the hospital and ward. PIMs prescriptions were assessed according to Zhan's criteria. Statistical analyses were performed using SPSS version 20.0. The results were presented as mean ± standard deviation (SD) for quantitative data and frequencies (percents) for qualitative data. Results: Nearly 17.79% of patients were treated with at least one PIMs included in the Zhan criteria. Among them, one PIMs was found in 76.02%, two PIMs were detected in 19.86%, and three or more PIMs were found in 4.12% of patient’s records. Patients who were admitted to the surgical ward (47.5%), Critical Care Unit (34.2%), and infectious diseases ward (25.3) had the most percent of prescribing PIMs. Totally, 331 PIMs were used for patients. Considering the classification of Zhan, 43.51%, 23.26%, and 33.23% of drugs were classified as always avoid, rarely appropriate, and some indication, respectively. Considering pharmaceutical categories, sedative-hypnotics, opioids, and antihistamines were the most prevalent PIMs. Among inappropriate drugs, pethidine, chlordiazepoxide, Hyoscine, Chlorpheniramine, and Indomethacin were the most prevalent PIMs, respectively. Conclusions: PIMs are still frequently experienced by elderly patients in Iranian hospitals. Specifically, physicians in the surgical ward, Critical Care Unit, and infectious diseases ward need to be more aware of PIMs. More attention should be paid to sedative-hypnotics, opioids, and antihistamines as the most frequently prescribed PIMs.