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.