Polypharmacy leads to increased prevalence of potentially inappropriate medication in the Indonesian geriatric population visiting primary care facilities

Figures & data

Table 1 Criteria used to identify PIM based on Beers and McLeod et al criteria

Drugs	Beers	McLeod	Beers and McLeod
Anticholinergics
Brompheniramine	✓
Carbinoxamine	✓
Chlorpheniramine	✓
Clemastine	✓
Cyproheptadine	✓
Dexbrompheniramine	✓
Dexchlorpheniramine	✓
Diphenhydramine	✓
Doxylamine	✓
Hydroxyzine	✓
Promethazine	✓
Triprolidine	✓
Antidiarrheal
Diphenoxylate		✓
Antiparkinson
Benztropine (oral)	✓
Trihexyphenidyl	✓
Vasodilator
Nylidrin		✓
Pentoxifylline		✓
Antispasmodic
Belladonna alkaloids	✓
Clidinium–chlordiazepoxide	✓
Dicyclomine	✓
Hyoscyamine	✓
Propantheline	✓
Scopolamine 20	✓
Stimulant
Methylpenidate		✓
Antithrombotics
Dipyridamole, oral short acting	✓	✓	✓
Ticlopidin	✓
Analgesic & anti-inflammatory
Meperidine	✓	✓	✓
Aspirin >325 mg/d	✓
Diclofenac	✓
Diflunisal	✓
Etodolac	✓
Fenoprofen	✓
Ibuprofen	✓
Ketoprofen	✓
Meclofenamate	✓
Mefenamic acid	✓	✓	✓
Meloxicam	✓
Nabumetone	✓
Naproxen	✓	✓	✓
Oxaprozin	✓	✓	✓
Piroxicam	✓	✓	✓
Sulindac	✓
Tolmetin	✓
Indomethacin	✓	✓	✓
Ketorolac, includes parenteral	✓	✓	✓
Pentazocine	✓	✓	✓
Anti-infective
Nitrofurantoin	✓
Cardiovascular
α1blockers
Doxazosin	✓
Prazosin	✓
Terazosin	✓
α agonists, central
Clonidine	✓
Guanabenz	✓
Guanfacine	✓
Methyldopa	✓
Reserpine (>0.1 mg/d)	✓	✓	✓
Antiarrhythmic
Amiodarone	✓
Dofetilide	✓
Dronedarone	✓
Flecainide 35	✓
Ibutilide	✓
Procainamide	✓
Propafenone	✓
Quinidine	✓
Sotalol	✓
Disopyramide	✓	✓	✓
Dronedarone	✓
Digoxin >0.125 mg/d	✓
Nifedipine, immediate release	✓
Spironolactone >25 mg/d	✓
Central nervous system
Tertiary tricyclic antidepressant
Amitriptyline	✓	✓	✓
Chlordiazepoxide–amitriptyline	✓
Clomipramine	✓
Doxepin >6 mg/d	✓
Imipramine	✓	✓	✓
Perphenazine–amitriptyline	✓
Trimipramine	✓
Antipsychotics
Thioridazine	✓
Mesoridazine	✓
Barbiturates	✓	✓	✓
Amobarbital	✓
Butabarbital	✓
Butalbital	✓
Mephobarbital	✓
Pentobarbital	✓
Phenobarbital	✓
Secobarbital	✓
Benzodiazepines	✓
Alprazolam	✓
Estazolam	✓
Lorazepam	✓
Oxazepam	✓
Temazepam	✓
Triazolam	✓	✓	✓
Clorazepate	✓
Chlordiazepoxide	✓	✓	✓
Chlordiazepoxide–amitriptyline	✓
Clidinium–chlordiazepoxide	✓
Clonazepam	✓
Diazepam	✓	✓	✓
Flurazepam	✓	✓	✓
Quazepam	✓
Chloral hydrate	✓
Meprobamate	✓
Eszopiclone	✓
Zolpidem	✓
Zaleplon	✓
Ergot mesylates	✓
Isoxsuprine	✓
Skeletal muscle relaxants
Carisoprodol	✓	✓	✓
Chlorzoxazone	✓	✓	✓
Cyclobenzaprine	✓	✓	✓
Metaxalone	✓	✓	✓
Methocarbamol	✓	✓	✓
Orphenadrine	✓	✓	✓
Endocrine
Methyltestosterone	✓
Testosterone	✓
Desiccated thyroid	✓
Estrogens with or without progestins	✓
Growth hormone	✓
Insulin, sliding scale	✓
Megestrol	✓
Chlorpropamide	✓
Glyburide	✓
Gastrointestinal
Metoclopramide	✓
Mineral oil, oral	✓
Trimethobenzamide	✓

Note: American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–631, with permission from John Wiley and Sons.¹⁷ Reproduced with permission from McLeod PJ, Huang AR, Tamblyn RM, Gayton DC. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ. 1997;156(3):385–391.¹⁸

Abbreviation: PIM, potentially inappropriate medication.

Table 2 General characteristics of subjects

Characteristics	Distribution (%)
Age (years)
60–69	2,710 (71)
70–79	958 (25)
≥80	151 (4)
Sex
Male	1,632 (43)
Female	2,187 (57)
Number of diseases
1	3,025 (79)
2	744 (19)
≥3	50 (1)
Number of medications
1–2	507 (13)
3–4	3,104 (81)
≥5	208 (5)

Table 3 Prevalence of PIM in Beers¹⁷ and McLeod¹⁸ criteria

Criteria	Number of PIM (%)
Beers	1,505 (39.4)
McLeod	17 (0.4)
Beers and McLeod	472 (12.4)
Total	1,944 (52.2)

Abbreviation: PIM, potentially inappropriate medication.

Table 4 Results of logistic regression analysis

Characteristics	OR (CI)	P-value
Age (years)
60–69	0.9 (0.8, 1.1)	0.661
70–79	1.0 (0.9, 1.2)	0.578
≥80	0.9 (0.6, 1.3)	0.829
Sex
Male	0.9 (0.8, 1.0)	0.159
Female		Ref
Number of diseases
1	0.9 (0.8, 1.1)	0.668
2	1.0 (0.8, 1.2)	0.778
≥3	1.1 (0.6, 2.0)	0.620
Number of medication
0–4 medications	0.9 (0.7, 1.3)	0.927
≥5 medications	1.6 (1.2, 2.1)	0.001

Abbreviations: OR, odds ratio; Ref, reference.

Table 5 Relationship between number of drugs and prevalence of PIM

Number of medication	n	PIM (%)
1–2	507	223 (44)
3–4	3,104	1,651 (53.2)
≥5	208	132 (63.5)
Total	3,819	2,006 (52.5)

Abbreviation: PIM, potentially inappropriate medication.

American Geriatrics Society 2012 Beers Criteria Update Expert PanelAmerican Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adultsJ Am Geriatr Soc201260461663122376048

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McLeodPJHuangARTamblynRMGaytonDCDefining inappropriate practices in prescribing for elderly people: a national consensus panelCMAJ199715633853919033421

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