Appropriate use of essential medicines in the elderly: a comparison of the WHO essential medicines list and PIM criteria
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REVIEW
Appropriate use of essential medicines in the elderly: a comparison of the WHO essential medicines list and PIM criteria Xin Ma 1 & Xuxu Yin 1 & Meng Li 1 & Yanwen Wang 1 & Hongxia Xin 2 & Wei Liu 1 Received: 20 September 2020 / Accepted: 31 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The elderly are not only threatened by bad medicines (overtreatment) but also by undertreatment with “good” medicines. Symmetry is required in any patient-centred approach to properly treat older people. The purpose of this study was to perfect the development of an EML and criteria according to the advantages of each and promote the appropriate use of essential medicines in the elderly. Method We compared the EML with four PIM criteria and calculated the proportion of essential medicines included in the criteria. We also summarized the rationale for including medicines in each criterion and analysed higher risk drugs and drug risks. Results Of essential medicines, 26% are included in at least one criterion as PIM. In 11 drug categories of the EML, more than 50% of drugs of each category are included in at least one criterion, and in four categories, all drugs are included. The potentially inappropriate essential medicines (PIEMs) for the elderly focus on cardiovascular drugs and central nervous system drugs. Fiftynine drugs have been explicitly identified as increasing the risk of falls, increasing mortality and/or having inappropriate longterm use, and the main risk of PIEMs is falls (30.3% of PIEMs). Additionally, 17.9% of essential medicines are labelled as positive drugs in START and/or FORTA (A/B). Conclusion Improving medication information for the elderly in the EML and establishing an essential medicines list for the elderly will promote appropriate drug use in older people worldwide. Keywords Essential medicines list . Potentially inappropriate medication . Potentially inappropriate medication criterion . Elderly
Introduction With the improvement of people’s quality of life and medical conditions, human life expectancy continues to increase, and the proportion of the elderly is increasing steadily [1]. Most elderly people have age-related organ and system function decline, which will lead to changes in pharmacokinetics and pharmacodynamics [2]. Meanwhile, the elderly often suffer from multiple chronic diseases and require using multiple drugs long term [3]. Therefore, compared with other age groups, the elderly require
* Wei Liu [email protected] Xin Ma [email protected] 1
College of Pharmacy, Zhengzhou University, No.100 Science Avenue, Zhengzhou, Henan Province, China
2
Henan Provincial People’s Hospital, Zhengzhou, Henan, China
more drugs and are more vulnerable to drugs [4]. Because the elderly are the main group of medication users, their medication use has received increasing attention. Increasingly explicit potentially inappropriate medication (PIM) criteria have been published and updated constantly to monitor drug therapy and avoid PIM use in the eld
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