Study on Potentially Inappropriate Medication Use Among Community-Dwelling Elderly Patients in Hubei Province

ZOU Jian¹, LI Wanping², GE Handa¹, JIN Zhe¹, RUFEINA·Tuerxun¹, LI Juan³, WEI Anhua³, FENG Da¹*

¹School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
²School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
³Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

Corresponding author: FENG Da, Associate Professor/Doctoral Supervisor; E-mail: fengda@hust.edu.cn

Abstract

Background As China's population ages, there is growing concern about the prevalence of polypharmacy among the elderly and the widespread phenomenon of potentially inappropriate medication (PIM) use in this demographic.

Objective To investigate PIM and potential prescription omissions among community-dwelling elderly patients using three different evaluation criteria, and to provide evidence for standardizing medication therapy management in older adults.

Methods From April 2021 to June 2021, this study employed cluster sampling to select Wuhan, Yichang, Qianjiang, and Zhijiang in Hubei Province as sample areas. A total of 12 communities (three streets or townships from each city) were randomly selected as research units. Community-dwelling elderly patients who met pre-established inclusion and exclusion criteria were enrolled. The Beers Criteria (2023 edition), the Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria (2014 edition), and the Chinese Criteria for Potentially Inappropriate Medication Use in Elderly People (2017 edition) were comprehensively applied to analyze PIM and potential prescription omissions among elderly patients in Hubei communities.

Results A total of 1,011 elderly patients were included, comprising 420 males (43.08%) and 591 females (57.92%). Statistically significant differences were observed in the number of medications taken among patients of different genders, ages, and chronic disease types (P<0.05). Using the Beers Criteria (2023 edition), PIM was detected in 294 patients (29.08%). The STOPP/START criteria (2014 edition) identified PIM in 189 patients (18.69%), with 229 instances of prescription omission. The Chinese criteria (2017 edition) detected PIM in 296 patients (29.28%). The most frequently identified PIM using the Beers Criteria (2023 edition) was immediate-release nifedipine. According to the STOPP/START criteria (2014 edition), non-steroidal anti-inflammatory drugs (NSAIDs) were the most common PIM, while the most frequent prescription omission was metformin non-use in type 2 diabetes. The Chinese criteria (2017 edition) most frequently identified nifedipine as PIM.

Conclusion PIM and prescription omission represent significant concerns in the treatment of community-dwelling elderly patients, necessitating strengthened medication therapy management. The three criteria complement each other to some extent, enabling more comprehensive screening of PIM and prescription omission issues.

Keywords Precision medicine; Medication review; Community elderly patients; Potentially inappropriate medication; Beers criteria; STOPP/START criteria; Chinese Criteria for Potentially Inappropriate Medication Use in Elderly People; Hubei province

Introduction

As physiological functions decline with age, elderly patients experience reduced drug metabolism capacity, progressively increasing their risk of adverse drug reactions due to drug accumulation [1]. Concurrently, older adults often suffer from multiple chronic conditions requiring polypharmacy, which elevates the risk of drug-drug interactions and further precipitates medication-related adverse events. Consequently, potentially inappropriate medication (PIM) use is prevalent among the elderly population [2]. The American Geriatrics Society Beers Criteria and the Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria represent the two most widely applied evaluation tools for assessing inappropriate medication use in older adults. Additionally, Chinese scholars have published the Chinese Criteria for Potentially Inappropriate Medication Use in Elderly People (2017 edition) [3-5]. These criteria, developed based on pharmacological risks, clinical indications, and patient comorbidities, have gradually transitioned from a drug-focused to a patient-centered approach [6]. Furthermore, studies have demonstrated that PIM is closely associated with falls, delirium, cognitive decline, and increased hospitalization rates among older adults [7]. Consequently, scholars have advocated for pharmaceutical interventions, comprehensive assessments, and prescription optimization to reduce PIM occurrence [8]. Overall, despite progress in PIM research and interventions in China, evaluation tools remain imperfect compared with those in developed countries, and practical application requires further promotion, particularly regarding standardized medication management in community healthcare settings [9]. This study aims to evaluate PIM status among 1,011 community-dwelling elderly patients in Hubei Province using the Beers Criteria (2023 edition), STOPP/START criteria (2014 edition), and Chinese criteria (2017 edition), providing a reference basis for medication therapy management and rational drug use in community elderly patients.

Methods

1.1 Study Subjects

From April 2021 to June 2021, this study employed cluster sampling to select Wuhan, Yichang, Qianjiang, and Zhijiang in Hubei Province as sample areas. From each city, three streets or townships were randomly selected, totaling 12 communities as research units. Community-dwelling elderly patients meeting pre-established inclusion and exclusion criteria were enrolled. Inclusion criteria: (1) clinical diagnosis of at least hypertension or diabetes; (2) chronic disease medication use for ≥3 months; (3) long-term residence within the jurisdiction of community health service stations; (4) age ≥60 years; (5) clear consciousness with ability to express thoughts correctly; and (6) informed consent and willingness to participate. Exclusion criteria: (1) inability to communicate effectively; (2) patients with acute complications; (3) severe illness preventing survey completion; and (4) unwillingness to cooperate [10]. This study was approved by the Medical Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, and all participants provided informed consent [Ethics approval number: 2020(S223)].

1.2 Research Tools and Procedures

1.2.1 Research Instruments
(1) General Information Questionnaire: Primarily includes age, gender, comorbidities, total number of medications taken, and medication information.