Table 4: Screening Tools for Older Adults’ Prescriptions Source TOOL
Pertinent Information
American Geriatrics Society
Beers Criteria for Potentially Inappropriate Medication
Comprehensive list of medications for older adults; list focuses on medications that can be harmful to older adults
Europe
STOPP/START Criteria (O’Mahony et al., 2023)
Table 5: Medications Contributing to Polypharmacy for Older Adults Condition Medication Type Percentage Gastrointestinal medication Laxative 47.5% Stomach acid 43.3% Psychiatric medication Antidepressant 46.3% Antipsychotics/ antiemetics 25.9% Pain relief Nonnarcotic analgesics 46.3% Antipyretics 41.2% Antiarthritics 31.2% Diuretics 35% Replenishers or regulators of electrolytes or water 31.2% Angiotensin-converting enzyme inhibitors 23.6% Healthcare Consideration: If you had a loved one or neighbor whose physical health and well-being would benefit from the support provided by a skilled nursing facility or nursing home, how would you envision advocating for proper medication management to try to avoid the potential prescription cascade? Vulnerable older adults are frequently on medications that may have been started to achieve a therapeutic outcome but have not been followed, tracked, or monitored as they should. Over time, these patients may be taking multiple medications inappropriately, further exacerbating aspects of polypharmacy with a lower likelihood of discontinuation. Furthermore, many of the residents of nursing homes and skilled nursing facilities are likely to have dementia, with a high prevalence of Alzheimer’s disease. It is a societal imperative to ensure that these patients have their medications monitored, their well-being screened, Set of criteria to identify and support deprescribing medications that have been identified as harmful for older adults, as well as the introduction of beneficial medications for older adults Designed for identification of PIM based on disease: ● General PIM ● DDI-PIM: drug interaction ● Ds-PIM: specific disease and chronic conditions ● Dose-PIM: monitoring for appropriate dosing ● Omission-PIM: potential medication omissions tracking
Screening tool of older persons’ potentially inappropriate prescriptions (STOPP), screening tool to alert doctors to right treatment (START)
Korea
Korean MR tool - LTCF
(Chae et al., 2023)
▪ Infection ▪ Somnolence ▪ Incontinence ▪ Convulsions ▪ Increased fall risk ▪ Higher incidence of fracture ○ The Food and Drug Administration (as referenced by Rho et al., 2022) has issued a warning stating that dementia patients receiving antipsychotic medications have an increased risk of death. However, it should be noted that all older adults have an increased mortality risk with this class of medication ● Depression diagnoses are considered common in nursing homes and skilled nursing facilities. ○ Approximately 35% of residents are taking an antidepressant, typically an SSRI. ▪ Rates of antidepressant has increased from ● Constipation and other gastrointestinal issue medications are regularly given to nursing home residents due to: ○ Decreased hydration ○ Little to no functional mobility or physical exercise ○ Inability to perform activities of daily living ○ Medication side effects ○ Neurological and metabolic disorders ● Constipation as a side effect from other medications including: ○ Antidepressants ○ Opioids ○ Propionic acid derivatives or NSAIDS ○ Anticholinergics ○ Anti-Parkinson’s dopaminergic ○ Benzodiazepines ● Laxatives used to relieve constipation are thought to contribute to prescribing cascades when they are not discontinued once constipation is relieved See Table 5 for medications that contribute to polypharmacy for older adults, often in the nursing home or skilled nursing facility. 39.5% to 47.5% of residents and has been noted to correlate to time living in the nursing home environment ▪ There is also a notable co-prescribing of sedative or hypnotic medication for this population in the nursing home environment
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