PIM Usage in Older Adults: An Overview

Understanding Potentially Inappropriate Medications

Potentially inappropriate medication (PIM) usage is linked to various adverse effects in the older adult population. A recent study examined the costs associated with PIMs and highlighted the differences between cases in residential care facilities compared to traditional aged care settings.

The Challenge of Polypharmacy

Polypharmacy refers to the concurrent use of multiple medications to manage a single health condition. There is a concerning trend of individuals in residential care facilities being prescribed more than five different pharmaceuticals. Research from 2015 revealed that around 50% of residents were exposed to PIMs, resulting in complications such as increased disability, hospitalization, and mortality rates. This reliance on medications is particularly troubling as older adults often face multiple health issues.

Research Study on PIM Costs

Study Background and Methodology

Previous studies have indicated a high prevalence of PIMs in care homes, but they have not differentiated the incidence rates across various residential care models. An Australian study published in BMC Geriatrics sought to analyze the costs linked to PIMs, specifically comparing home-like residential care models with traditional aged facilities. The researchers conducted a cross-sectional, observational study involving participants from aged care facilities across Australia.

To qualify for the study, participants had to meet specific criteria: they needed to be permanent residents, not in palliative care, have minimal family issues that could hinder participation, and have a family member available to act as a proxy if necessary. A total of 901 older adults were invited to take part in the study, and researchers accessed their pharmacy dispensing records to review medication history from the previous year. The classification of medications as PIMs was determined using the Beers Criteria 2015, alongside input from certified pharmacists.

Cost Analysis of PIMs

The researchers employed the Dispensed Price for Maximum Quantity (DPMQ) methodology to calculate the costs associated with PIMs. The total annual cost for each participant’s PIM usage was expressed in Australian dollars (AUD). The home-like residential care models investigated were designed to create a more domestic and homely environment.

Key Findings

Medication Exposure and Cost Outcomes

Results indicated that the average number of medications taken by participants over the 12-month period was 14.5, with an average cost of AUD 1991.86. Notably, the study found that the likelihood of PIM usage was 52% lower among residents in home-like care models compared to those in traditional residential care facilities.

Implications for Future Care

These findings underscore the significant exposure of older adults to PIMs. However, the research indicates that residing in a home-like care model can markedly decrease the use of PIMs, although the reasons for this trend require further exploration. With approximately AUD 9 billion spent annually on aged care services in Australia, reducing PIM usage could yield savings of about AUD 38 million.

Future research should encourage healthcare providers to consider de-prescribing unnecessary medications to mitigate both direct and indirect costs. Additionally, physicians are urged to explore non-pharmacological alternatives, while remaining mindful of the potential risks associated with these options.

Reference

Harrison, S. L., O’Donnell, L. K., Milte, R., Dyer, S. M., Gnanamanickam, E. S., Bradley, E. L., Hilmer, S. N., & Crotty, M. (2018). Costs of potentially inappropriate medication use in residential aged care facilities. BMC Geriatrics, 18(9), 1-10. https://dx.doi.org/10.1186/s12877-0.18-0704-8

Related Topics of Interest

– Do Herbal Remedies Interact with Prescribed Medications in Pregnancy?
– Are Older Adults Inappropriately Prescribed Medications in Residential Care?
– How Common is Polypharmacy in Older Adults?
– Polypharmacy in Primary Care: Are Medications Being Appropriately Prescribed?