PIM among Chinese elderly patients
The problem of PIMs is an important healthcare issue. We discovered through this study that the prevalence of PIMs was 40.1% in our investigated population. To our knowledge, no study has yet investigated the prevalence of PIM in the whole Chinese elderly population. The results of our study demonstrated and confirmed our proposal that inappropriate medications were frequently being prescribed to senior patients in China, and the prevalence of PIM was slightly higher than what was found based on the 2012 Beers Criteria in Japan (37.5%),19 in the United States (34.1%),20 in Turkey (33.3%),21 in Hong Kong (38.6%),22 and in Albania (34.5%).23 A 2011 Taiwan study revealed a PIM prevalence of 36.2% based on STOPP/START criteria.24
The 2019 updated Beers Criteria retained the five categories of criteria in the previous version. The first category includes inappropriate medications for elderly patients. The second and fourth categories are compiled based on drug-disease interactions and drug-drug interactions. The third category comprises medications to be administered with caution on certain situations. The last category takes into account the renal functions of elderly population and suggests an substitute or a dosage reduce of an medication.5 Notably, glimepiride has been included to the lists of drug to avoid in elderly patients considering the increased likelihood of prolonged hypoglycemia.5 The serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine, duloxetine and more, have been advised to be avoided in patients with a history of falls or fractures, where the use of the group of medications could result in future additional falls.5 H2-receptor antagonists, e.g. ranitidine, were removed from the “avoid” list in elderly patients with cognitive impairment or dementia.5
Beers Criteria are designed for the purpose of warning practitioners of some absolute contraindications for elderly patients, but to be used as an approach to prescribe and monitor adverse effects. The information about the risks of each specific medication should serve to raise practitioners’ awareness on the potential problems that may arise with the prescription, but it should be noted that the use of a Beers-Criteria-list drug may still be necessary under some circumstances. Therefore, clinicians should carefully weigh the potential risks and benefits when tailoring medication therapies.