Assessment of Drug Therapy in Psychiatric Elderly Patients Based on the Beers Criteria of the American Geriatrics Societ
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ssment of Drug Therapy in Psychiatric Elderly Patients Based on the Beers Criteria of the American Geriatrics Society O. O. Kirilochev* Astrakhan State Medical University, Astrakhan, 414000 Russia *e-mail: [email protected] Received September 8, 2019; revised December 11, 2019; accepted December 16, 2019
Abstract—The study objective was to analyze the frequency of the prescription of potentially inappropriate medications (PIMs) to elderly patients treated in a psychiatric, inpatient setting. This study was carried out with the Beers criteria, an antipolypharmacy tool developed under the auspices of the American Geriatrics Society. The study indicates a high frequency of use of PIMs from the following pharmacological groups: benzodiazepine derivatives, nonsteroidal anti-inflammatory drugs (long-term use), and drugs with significant anticholinergic potential. The AGS Beers criteria can help optimize treatment for older psychiatric patients and increase the safety of pharmacotherapy. Keywords: elderly, mental disorders, polypharmacy, Beers criteria, potentially inappropriate medications, adverse drug reactions DOI: 10.1134/S2079057020040098
INTRODUCTION Questions related to the efficacy and safety of drug therapy in elderly patients remain open, and this aspect has been particularly insufficiently studied with respect to patients with mental disorders. Multimorbidity, physiologic changes associated with aging, and polypharmacy are risk factors for the emergence of adverse drug reactions in this group of patients. Such reactions can occur in the elderly four times more frequently than in young people [9]. Somatic and mental comorbidity is a factor that complicates the pharmacotherapy of patients in the older age group [7]. Therefore, accurate monitoring of drug therapy is recommended for this age cohort in order to improve the quality of life and to reduce the frequency of adverse drug reactions and, indirectly, financial costs [15, 30]. An important tool in the optimization of pharmacotherapy in patients over 65 years of age are the restrictive lists of potentially inappropriate medications (PIMs), which were developed by lead specialists in the field of gerontology and pharmacotherapy according to the principles of evidence-based medicine. The Beers criteria developed under the auspices of the American Geriatrics Society are the most credible tool among such lists. This recommendation document was first developed in 1991. It has been updated several times [6]; the last update was in 2019 [10]. Research on the frequency of PIM use in elderly psychiatric patients is important for several reasons. Chronic mental diseases are a risk factor for polypharmacy and, hence, may be accompanied by an
increased frequency of unintended, adverse drug reactions [15]. Features of the functioning of the body of an elderly person, including the central nervous system, can also contribute to the pharmacodynamics and pharmacokinetics of drugs. The excessive permeability of the blood–brain barrier [25] and quantitative changes in brai
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