Assessment of Potentially Inappropriate Medications Using the EU (7)-PIM List, in a Sample of Portuguese Older Adults’ Residents in Nursing Homes

Figures & data

Table 1 Characteristics of Older Adult Patients

N = 210	% (N)
Female	75.20 (158)
Age (mean: 85.1±6.98)
65–70	5.2 (11)
71–75	3.8 (8)
76–80	12.8 (27)
81–85	22.8 (48)
86–90	36.8 (77)
91–95	14.8 (31)
96–100	3.3 (7)
≥ 101	0.5 (1)
Health problems per patient
0–3	65.70 (138)
4–6	29.00 (61)
≥7	5.20 (11)
Health problems (ICD-10)
Diseases of the circulatory system	62.40 (131)
Mental and behavioral disorders	50.00 (105)
Endocrine, nutritional, and metabolic diseases	33.80 (71)
Diseases of the digestive system	25.20 (53)
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	21.90 (46)
Diseases of the musculoskeletal system and connective tissue	11.90 (25)
Diseases of the genitourinary system	10.50 (22)
Diseases of the respiratory system	10.00 (21)
Diseases of the nervous system	9.50 (20)
Diseases of the ear and mastoid process	4.30 (9)
Diseases of the eye and adnexa	2.40 (5)
Diseases of the skin and subcutaneous tissue	1.00 (2)
Prescribed medicines (n = 1458) (mean: 7.1±0.21)
<5	17.60 (37)
5–10	60.50 (127)
≥10	21.90 (46)

Figure 1 Most frequent pharmacological subgroups (third level), according to the ATC classification system of prescribed.

Table 2 Most Frequent PIM According to the EU (7)-PIM List

PIM (N = 469) Patients with PIM N = 190	N (%)	% of Patients	Main Reason
A02BC Proton pump inhibitors	121 (25.80)	63.68	Duration of treatment
N05BA06 Lorazepam	61 (13.00)	32.11	Duration of treatment
N05BA12 Alprazolam	35 (7.46)	18.42	Risk of falling with hip fracture; prolonged reaction times; psychiatric reactions (can also be paradoxical, eg agitation, irritability, hallucinations, psychosis); cognitive impairment; depression
B03AA Iron bivalent, oral preparations	29 (6.18)	15.26	Dose too high (>325 mg/d)
B01AF01 Rivaroxaban	19 (4. 05)	10.00	Limited information on use for older adults; risk of bleeding events; no reversal agent available in case of overdose; risk of bleeding may be higher in cases of severe renal failure
N05BB01 hydroxyzine	19 (4. 05)	10.00	Anticholinergic side effects (eg constipation, dry mouth); impaired cognitive performance, confusion, sedation; electrocardiographic changes
C01EB15 Trimetazidine	14 (2.99)	7.37	Can cause or worsen parkinsonian symptoms (tremor, akinesia, hypertonia)
A06AB02 Bisacodyl	10 (2.13)	5.26	Adverse events include abdominal pain, fluid and electrolyte imbalance and hypoalbuminemia. May exacerbate bowel dysfunction
C01AA05 Digoxin	10 (2.13)	5.26	Dose too high

Figure 2 Directed acyclic graphs. Proposed relationship between the different variables (A) and the relationship between the different variables after the appropriate adjustment (B).

Table 3 Factors Influencing the Presence of PIM

Dependent Variable	PIM
Negative Binomial Regression
Variable*	Bivariate Model		Adjusted Model
	RR (CI 95%)	p-value	(CI 95%) RR	p-value
Sex			-	-
Male	1 (-)		-	-
Female	1.10 (0.89–1.37)	0.3783	-	-
Diseases of the respiratory system	1.00 (0.93–1.07)	0.9327	-	-
Diseases of the musculoskeletal system and connective tissue	1.01 (0.90–1.12)	0.9005	-	-
Diseases of the genitourinary system	0.94 (0.79–1.09)	0.4542	-	-
Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism	1.11 (0.88–1.37)	0.3645	-	-
Diseases of the circulatory system	1.03 (1.00–1.05)	0.0244	1.01 (0.98–1.03)	0.6099
Mental and behavioural disorders	1.03 (0.98–1.09)	0.1777	-	-
Diseases of the nervous system	1.08 (0.99–1.16)	0.0714	0.99 (0.91–1.07)	0.7801
Diseases of the eye and adnexa	1.08 (0.85–1.3)	0.4921	-	-
Diseases of the ear and mastoid process	1.27 (0.84–1.85)	0.2307	-	-
Endocrine, nutritional and metabolic diseases	1.02 (1.00–1.05)	0.0334	0.98 (0.96–1.01)	0.1790
Diseases of the skin and subcutaneous tissue	1.09 (0.58–1.74)	0.7414	-	-
Other pathologies	0.99 (0.93–1.06)	0.8636	-	-
Diseases of the digestive system	1.05 (1.00–1.09)	0.0257	1.05 (1.00–1.09)	0.0214
Age	0.99 (0.97–1.00)	0.0342	0.99 (0.97–1.0)	0.0474
Number of prescribed medicines per patient	1.14 (1.10–1.17)	<0.0001	1.15 (1.10–1.19)	<0.0001

Note: *To select the variables, we performed a bivariate analysis and then selected all independent variables having a p-value lower than 0.2 for multivariate analysis purposes.