Study: 63 Percent of Older Adults Take Inappropriate Medications

A cross-sectional study reveals that despite low medication complexity, nearly two-thirds of older adults use potentially harmful drugs

For Doctors in a Hurry

This study investigated the prevalence of polypharmacy and potentially inappropriate medications in older adults.
Researchers conducted a cross-sectional study of 200 patients over age 65 at a community pharmacy in Turkey.
Potentially inappropriate medications were found in 63.5% of patients, significantly correlating with polypharmacy and mental disorders (p<0.05).
The authors concluded that these elderly patients exhibited high rates of inappropriate medication use despite low medication complexity scores.
Community pharmacists require targeted training to better identify and reduce potentially inappropriate medications in older clinical populations.

The Hidden Hazards of Polypharmacy in Older Adults

As the global population ages, the management of multiple chronic conditions has made polypharmacy an increasingly common and dangerous clinical challenge. Across various populations, polypharmacy affects 41 percent to 48 percent of older adults and doubles the odds of a patient receiving potentially inappropriate medications [1, 2]. This prescribing cascade is not merely an academic concern, as polypharmacy is directly linked to a 62 percent increase in all-cause mortality and a significantly higher likelihood of drug-related adverse events [2, 3]. While pharmacist-led medication reviews have proven effective at reducing inappropriate prescriptions by nearly 14 percent and lowering drug costs, these interventions are not yet universally integrated into routine outpatient care [4]. A new cross-sectional study now offers fresh insights into the real-world prevalence of inappropriate prescribing among ambulatory older adults, highlighting a critical missed opportunity for intervention at the pharmacy counter.

Study Design and Patient Demographics

To better understand the risks inherent in complex geriatric drug regimens, researchers designed a cross-sectional study evaluating the prevalence of polypharmacy and potentially inappropriate medications. The investigators utilized the 2019 Beers Criteria, a widely recognized clinical guideline that flags medications with unfavorable risk profiles in older adults, such as certain anticholinergics or sedatives that increase fall risk. They also calculated the Medication Regimen Complexity Index, a standardized metric that quantifies the logistical burden of a patient's daily drug routine by factoring in dosage frequency and specific administration instructions. The study was conducted at a community pharmacy in Turkey between early 2023 and May 5, 2023. To capture a broad snapshot of ambulatory care, the researchers enrolled patients over 65 years of age who used at least one medication and visited the pharmacy for any reason. The final cohort included 200 patients, of which 59.5 percent were female. Reflecting a typical geriatric outpatient population, the median age of the participants was 70 years, with an interquartile range of 66 to 74.75. By combining these validated tools, the researchers assessed both the pharmacological safety of the prescribed drugs and the practical burden placed on elderly patients.

High Rates of Inappropriate Prescribing

When analyzing the daily drug regimens of the cohort, the researchers uncovered concerning patterns of hazardous prescribing. Polypharmacy was detected in 33 percent of the patients, a finding that aligns with the known challenges of managing multiple chronic conditions in geriatric care. However, the safety profile of these regimens proved even more alarming. The use of potentially inappropriate medications was identified in 63.5 percent of the patients, meaning nearly two-thirds of the evaluated older adults were taking at least one drug flagged by the 2019 Beers Criteria as having risks that likely outweigh the clinical benefits. For practicing physicians, this high prevalence underscores a critical need for routine medication reconciliation to identify and deprescribe hazardous agents before they cause adverse events like cognitive decline or falls. Interestingly, this high rate of hazardous prescribing did not correlate with overly complicated daily routines. In this cohort, the median Medication Regimen Complexity Index score was 11, with an interquartile range of 7 to 15, indicating a relatively straightforward daily schedule for most individuals. Ultimately, the study concluded that elderly patients visiting the pharmacy had low medication complexity scores but a high use of potentially inappropriate medications. This juxtaposition highlights a crucial clinical takeaway: a simple medication regimen is not necessarily a safe one, and clinicians must remain vigilant about the specific pharmacological risks of each prescribed drug regardless of how easily the patient can manage their daily doses.

Clinical Drivers of Prescribing Risks

To better understand the clinical profile of older adults at risk for hazardous prescribing, the researchers analyzed the demographic and medical factors driving these patterns. They found that patients taking potentially inappropriate medications had a significantly higher number of chronic diseases and total prescribed drugs compared to those without such prescriptions (p < 0.05). Consequently, the presence of polypharmacy and higher Medication Regimen Complexity Index scores were both significantly elevated in the group taking inappropriate medications (p < 0.05). Furthermore, specific clinical conditions elevated the risk of hazardous prescribing. Notably, the presence of mental disorders was significantly higher in patients with potentially inappropriate medications (p < 0.05), suggesting that psychiatric comorbidities may complicate prescribing decisions and increase the likelihood of utilizing high-risk pharmacological agents in older adults. The researchers also investigated the specific factors driving higher scores on the Medication Regimen Complexity Index. Social determinants of health played a measurable role, as having less than eight years of education was associated with significantly higher complexity scores (p < 0.05). From a clinical standpoint, the sheer volume of prescriptions was a primary driver, with polypharmacy strongly linked to higher complexity (p < 0.05). Additionally, the specific nature of a patient's underlying health conditions heavily influenced the logistical difficulty of their daily regimen. The presence of specific comorbidities, including diabetes mellitus, cardiovascular disease, thyroid disease, chronic obstructive pulmonary disease, asthma, and mental disorders, was associated with significantly higher Medication Regimen Complexity Index scores (p < 0.05). For practicing physicians, these findings highlight the necessity of targeted medication reviews, particularly for older patients with limited educational backgrounds or those managing multiple chronic conditions that inherently require complex, multi-drug regimens.

The Pharmacist's Role in Deprescribing

The high prevalence of hazardous prescribing among ambulatory older adults highlights a critical gap in outpatient medication management. Because elderly patients frequently visit pharmacies to fill prescriptions from multiple different specialists, the authors suggest that community pharmacists have an important role in identifying inappropriate drug use. Positioned at the final step before a patient takes a medication home, these professionals can serve as a vital safety net to intercept prescriptions that conflict with geriatric safety guidelines. For practicing physicians, collaborating closely with pharmacists offers a practical strategy to catch overlapping or high-risk prescriptions that might otherwise go unnoticed during routine, time-constrained clinic visits. However, recognizing complex pharmacological risks requires specialized clinical knowledge, particularly when balancing multiple comorbidities and polypharmacy. To effectively bridge this gap in patient safety, the authors recommend that community pharmacists be trained to develop skills in identifying and reducing potentially inappropriate medications in older patients. By implementing targeted educational programs focused on tools like the Beers Criteria, healthcare systems can empower pharmacists to actively initiate medication reviews. This proactive approach facilitates safe deprescribing practices, reduces the risk of adverse drug events, and ensures that older adults receive pharmacological care that maximizes clinical benefit while minimizing harm.

Study Info

Evaluation of potentially inappropriate medications use and medication complexity in elderly patients applying to community pharmacy in Turkey

Aslınur Albayrak, Halil Demirbaş

Journal BMC Geriatrics

Published October 13, 2023