The life expectancy in many communities is increasing, and the aged population is therefore growing. With advanced age come chronic diseases that require more drug usage in the age group. The people over 65 years are about 13% of the population but consume over 30% of the medications prescribed by physicians (Yayla, Bilge, Binen, & Keskin, 2013). Prescribing of drugs for the elderly patients is a complex and delicate process. Old age causes pharmacokinetic and pharmacodynamic changes in the body. Impairment of metabolic functions results in increased adverse drug reactions and drug sensitivity. In the elderly, drug absorption reduces due to gastrointestinal changes such as decreased intestinal motility and increased gastric Ph. Drugs distribution in the elderly patients is also affected because of the reduced lean body mass which is replaced by fat. Such changes cause the increased distribution of fat-soluble drugs but reduce distribution volume of water-soluble drugs. Also, drug metabolism is reduced due to changes in hepatic functioning and volume. With advancing age, glomerular and tubular function reduces which in turn affects drug excretion and clearance through the kidneys (Hughes, 1998). The elderly patients may also respond differently to certain drugs. Some have an abnormally increased or reduced response to the drugs.
The Beers criteria consist of an outline of potentially inappropriate medication (PIM) for the elderly patients. It contains various guidelines which assist healthcare providers in improving the quality and safety of medication prescription for the aged (American Geriatrics Society, 2015). The Beers criteria have outlined the drugs which are best avoided in elderly patients. It also lists the drugs which should be given in lower doses and carefully monitored. Such medications contained in the list have been associated with falls, confusion, mortality and other poor health outcomes. The latest beers criteria are divided into various sections. The first category describes those drugs that are potentially harmful to older patients due to increased adverse effects and ineffectiveness. The second group includes those drugs that are inappropriate for the older patient with certain diseases as the medication may worsen the conditions. The third category includes those drugs that elderly patients can use but with caution. The use of the Beers criteria has reduced the challenges of drug interactions, polypharmacy, and adverse drug interactions. However, the criteria have many gaps which are related to its reliability and applicability (Yayla et al., 2013). Some drugs such as nitrofurantoin and amitriptyline have been listed as inappropriate medication which has caused lots of disagreements. Also, most of the medications listed by Beers are not found in the drug index manuals.
Due to the doubts raised in the usage of Beers criteria, better criteria were suggested and approved for the various medications that are harmful to the aged patients. The criteria include the screening tool to alert to right treatment (START) and screening tool for older persons prescriptions (STOPP) (OMahony et al., 2015). The START criteria are a set of 22 rules observed to avoid omissions while prescribing medications for older patients. On the other hand, STOPP criteria consist of a list of 65 items which consist of drug-disease interactions, drug-drug interactions, drugs which cause falls and those that duplicate therapy. These criteria are divided according to the various body systems with an explanation of the cause of the inappropriateness for use. The medications listed in the STOPP criteria are associated with more with adverse effects than with those on Beers list (OMahony et al., 2015). The application of the START/STOPP criteria during hospitalization result in better medication appropriateness, reduction of ADRs and a shorter hospital stay for elderly patients.
The elderly patients are at increased susceptibility to drug interactions, prescribing cascades, and poor compliance. However, various criteria available should not be used to replace clinical judgment during prescriptions but should rather be used to improve quality of care for patients. The physician should be able to weigh the risk-benefit ratio when using a certain drug. Not all drugs would be considered inappropriate as some provide benefits that outweigh the risks. Healthcare providers should individualize prescription of medication depending on factors such as medical and social conditions (Pretorius, Gataric, Swedlund, & Miller, 2013). That would ensure safe prescription of medication for the aged population to avoid fatal adverse drug reactions.
American Geriatrics Society, A. G. (2015). American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of American Geriatrics Society, 22272246.
Hughes, S. G. (1998). Prescribing for the elderly patient: why do we need to exercise caution? British Journal of Clinical Pharmacology, 46(6), 531533. http://doi.org/10.1046/j.1365-2125.1998.00842.x
OMahony, D., OSullivan, D., Byrne, S., OConnor, M. N., Ryan, C., & Gallagher, P. (2015). STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age and Ageing, 44(2), 213218. http://doi.org/10.1093/ageing/afu145
Pretorius, R. W., Gataric, G., Swedlund, S. K., & Miller, J. R. (2013). Reducing the risk of adverse drug events in older adults. Am Fam Physician, 87(5), 331-336.
Yayla, M. E., Bilge, U., Binen, E., & Keskin, A. (2013). The Use of START/STOPP Criteria for Elderly Patients in Primary Care. The ScientificWorld Journal, 2013, 165873. http://doi.org/10.1155/2013/165873
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