Determinants of Potentially Inappropriate Medication Use in Long-Term and Acute Care Settings: A Systematic Review.
Stephanie K Nothelle, Ritu Sharma, Allison H Oakes and 2 others
PMID 28764876WHAT IT FOUND
Potentially inappropriate medication use in older adults is consistently linked to younger age, female sex, and polypharmacy.
Geographic region also matters, with higher risk in the West, Midwest, and South compared to the Northeast. Clinician factors were rarely studied.
Key findings
01Across nursing homes, emergency departments, and hospitals, the most consistent determinants of potentially inappropriate medication use were younger age, female sex, polypharmacy, and geographic region.
02In nursing home residents, younger age, depression, and diabetes were the most common determinants of potentially inappropriate medication use.
03Very few studies examined clinician determinants, but in hospitals, care delivered by geriatricians was associated with lower potentially inappropriate medication use compared to other specialists.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review defines 'potentially inappropriate' medication, which may still be clinically appropriate for some individual patients. Most included studies were observational, so they identify associations rather than causal drivers. The search was limited to US studies, so findings may not apply to other healthcare systems. Very few studies examined clinician-level factors, leaving gaps in understanding how provider behavior influences prescribing. Definitions of PIM varied across studies, though most used the Beers criteria.
Declared interests
None declared. The funding source had no role in the project.
The easy way to misread this
Do not assume that a 'younger' older adult is safe from inappropriate prescribing. The review consistently found that younger age (within the 60+ range) was associated with higher rates of potentially inappropriate medication use, likely because these patients are more active in the healthcare system and may be prescribed medications that become inappropriate as they age.