Comparison of three criteria for potentially inappropriate medications in Chinese older adults

Figures & data

Table 1 Demographic and clinical characteristics of the aged Chinese people and prevalence of PIMs (n=863)

Characteristics	Total	Beers criteria		P-value	STOPP criteria		P-value	Chinese criteria		P-value
	863	PIM	Non-PIM		PIM	Non-PIM		PIM	Non-PIM
		501 (58.1%)	362		380 (44.0%)	483		692 (80.2%)	171
Number of PIMs per person (IQR)		1 (1–2)			1 (1–1)			1 (1–2)
Age, years (mean ± SD)	75.4±7.4	76.3±7.3	74.2±7.3	P<0.001	76.1±7.1	74.8±7.6	0.011	75.3±7.3	75.9±7.7	0.312
Gender				0.444						0.568
Male (%)	466 (54.0)	265 (56.9)	201 (43.1)		196 (42.1)	270 (57.9)		377 (80.9)	89 (19.1)
Female (%)	397 (46.0)	236 (59.5)	161 (40.6)		184 (46.4)	213 (53.7)	0.206	315 (79.4)	82 (20.7)
Barthel index				P<0.001			P<0.001			P<0.001
Barthel score ≤60 (%)	207 (24.0)	154 (74.4)	53 (25.6)		109 (52.7)	98 (47.3)		163 (78.7)	44 (21.3)
Barthel score >60 (%)	656 (76.0)	347 (52.9)	309 (47.1)		271 (41.3)	385 (58.7)		529 (80.6)	127 (19.4)
CCI (IQR)	2 (1–3)	3 (2–4)	2 (1–3)	P<0.001	2 (1–4)	2 (1–3)	0.264	2 (1–3)	2 (1–3)	0.061
No prescribed medications (IQR)	10 (8–12.5)	11 (9–14)	8 (6–11)	P<0.001	11 (9–13)	9 (7–12)	P<0.001	10 (8–13)	8 (6–11)	P<0.001
Length of stay, days (IQR)	7 (5–9)	7 (5–10)	6 (4–7)	P<0.001	7 (5–9)	6 (4–8)	0.023	6.5 (5–9)	7 (5–9)	0.234

Abbreviations: CCI, Charlson Comorbidity Index; PIM, potentially inappropriate medication; STOPP, Screening Tool of Older Persons’ Prescriptions.

Table 2 Concordance between the three criteria

STOPP-listed PIM	Beers-listed PIM		κ	P-value
	Yes	No
Yes No	347 154	33 329	0.575	P<0.001a P<0.001b
Chinese-listed PIM	Beers-listed PIM
	Yes	No
Yes No	424 77	268 94	0.114	P<0.001a P<0.001b
Chinese-listed PIM	STOPP-listed PIM	STOPP-listed non-PIM
	Yes	No
Yes No	323 57	369 114	0.079	P<0.001a P<0.001b

a Notes: Based on kappa test;

b Based on chi-squared test.

Abbreviations: PIM, potentially inappropriate medication; STOPP, Screening Tool of Older Persons’ Prescriptions.

Table 3 Top ten PIMs based on the three sets of PIM criteria

Beers criteria (N=763)		STOPP criteria (N=477)		Chinese criteria (N=945)
Drugs and items	N (%)	Drugs and items	N (%)	Drugs and items	N (%)
PPIs	260 (34.1)	PPIs	260 (54.5)	Clopidogrel	526 (55.7)
Diuretics	208 (27.3)	Beta-blocker for bradycardia, type II atrioventricular block or complete atrioventricular block	40 (8.4)	Benzodiazepines, nonbenzodiazepine, benzodiazepine receptor agonist hypnotics	121 (12.8)
Benzodiazepines, nonbenzodiazepine, benzodiazepine receptor agonist hypnotics	133 (17.4)	Benzodiazepines for ≥4 weeks	32 (6.7)	Insulin	47 (5.0)
Insulin	47 (6.2)	Aspirin, dipyridamole, Vitamin K antagonist, direct thrombin inhibitor or factor Xa inhibitors for patients with hemorrhagic diseases	20 (4.2)	Warfarin	46 (4.9)
Peripheral alpha-1 blockers	28 (3.7)	Benzodiazepines with history of falls	16 (3.4)	Amiodarone	40 (4.2)
NSAIDs, nondihydropyridine CCBs and thiazolidinediones with heart failure	14 (1.8)	Beta-blocker in combination with verapamil or diltiazem	14 (2.9)	Spirolactone (>25 mg/day)	26 (2.8)
Digoxin	13 (1.7)	Amiodarone for supraventricular arrhythmia as the first line drug	13 (2.7)	First-generation antihistamines	29 (3.1)
Amiodarone	13 (1.7)	NSAIDs with severe hypertension or severe heart failure	13 (2.7)	NSAIDs with cruor disorder, hypertension, renal insufficiency or heart failure	22 (2.3)
Antipsychotics, first (conventional) and second (atypical) generation	8 (1.1)	Verapamil or diltiazem with NYHA class III or IV heart failure	12 (2.5)	Narcotic and adjuvant drugs	14 (1.5)

Abbreviations: NYHA, New York Heart Association; PIM, potentially inappropriate medication; PPIs, proton-pump inhibitors.

Table 4 Multivariate analysis of risk factors associated with PIM use

Characteristics	Beers criteria		STOPP criteria		Chinese criteria
	OR (95% CI)	P-value	OR (95% CI)	P-value	OR (95% CI)	P-value
Age	1.013 (0.991–1.036)	0.245	1.014 (0.994–1.035)	0.174	0.974 (0.949–0.999)	0.039
Sex	1.257 (0.929–1.699)	0.138	1.232 (0.931–1.630)	0.144	1.050 (0.740–1.491)	0.784
Barthel score ≤60	1.624 (1.094–2.410)	0.016	1.320 (0.935–1.862)	0.115	0.509 (0.309–0.840)	0.008
CCI	0.900 (0.808–1.001)	0.053	0.913 (0.828–1.007)	0.069	1.165 (1.016–1.335)	0.028
No prescribed medications	1.249 (1.185–1.317)	<0.001	1.117 (1.070–1.165)	<0.001	1.200 (1.137–1.268)	<0.001
Length of stay	1.070 (1.022–1.121)	0.004	0.989 (0.954–1.026)	0.555	0.972 (0.935–1.011)	0.153

Abbreviations: CCI, Charlson Comorbidity Index; PIM, potentially inappropriate medication; STOPP, Screening Tool of Older Persons’ Prescriptions.