Potentially inappropriate medication and associated factors such as depression and dementia: An analysis of middle-aged and elderly people

Keywords: potentially inappropriate medication list, middle aged, aged, depression, dementia, public health


AIMS: To establish the frequency potentially inappropriate medications use and the associated factors, such as signs and symptoms of depression and cognitive deficit among middle-aged and elderly people.
METHODS: A cross-sectional population study was performed with 2,350 people, aged between 55-103 years, registered in the primary health care. Potentially inappropriate medications were defined by updated 2019 Beers criteria. Studied variables were sociodemographic, lifestyle and health, and signs and symptoms of depression and cognitive deficit. Multinomial regression analysis was executed.
RESULTS: The frequency of potentially inappropriate medications use was 65.4%. Former and current smokers, regular self-perception of health, polypharmacy, and individuals with signs and symptoms of depression and cognitive deficit were significantly associated with potentially inappropriate medications use. Antiarrhythmics, antihistamines and antiadrenergic agents were the highest potentially inappropriate medications classes used for individuals with signs and symptoms of depression and cognitive deficit.
CONCLUSIONS: The frequency of use of potentially inappropriate medications is high among middle-aged people, a population that was previously under-researched, as well as among elderly people. Cognitive impairment alone or together with depression symptoms were associated factor for a potentially inappropriate medications use. Knowledge of the pharmacoepidemiology of potentially inappropriate medications is an important for the promotion of the rational use of drugs in public health.


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Author Biographies

Vanessa Sgnaolin, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Graduate Program in Biomedical Gerontology. Porto Alegre, RS

Pharmacist, Specialist in Health with emphasis on Clinical and Toxicological Analysis, MD in Health Sciences and PhD in Biomedical Gerontology. Postdoctoral student of the Graduate Program in Biomedical Gerontology at Pontifical Catholic University of Rio Grande do Sul (PUCRS).

Paula Engroff, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Institute of Geriatrics and Gerontology. Porto Alegre, RS

Pharmacist, Specialist in Teaching in Higher Education and PhD in Biomedical Gerontology. Pharmacist at the Biochemistry and Molecular Genetics Laboratory of the Institute of Geriatrics and Gerontology at Pontifical Catholic University of Rio Grande do Sul (PUCRS).

Natascha Melo Linkievicz, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), School of Health and Life Sciences. Porto Alegre, RS

Pharmacy Student at Pontifical Catholic University of Rio Grande do Sul (PUCRS). Scientific Initiation Scholarship at the Biochemistry and Molecular Genetics Laboratory of the Graduate Program in Biomedical Gerontology at PUCRS.

Irenio Gomes, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Graduate Program in Biomedical Gerontology. Porto Alegre, RS

Physician, MD in Cellular and Molecular Biology, PhD in Medicine and Postdoctoral at Hôpital de Bicêtre in Paris.

Alfredo Cataldo Neto, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), School of Medicine and Graduate Program in Biomedical Gerontology. Porto Alegre, RS

Physician, Specialist in Psychiatry, Psychoanalyst and PhD in Clinical Medicine. Professor of School of Medicine at Pontifical Catholic University of Rio Grande do Sul (PUCRS) and researcher at the PUCRS Institute of Geriatrics and Gerontology.


World Health Organization (WHO). Ageing and health [Internet]. Fact sheet N°404. Geneva: WHO; 2015 [cited 2018 Oct 6]. Available from: http://www.who.int/mediacentre/factsheets/fs404/en/

Cooper JA, Ryan C, Smith SM, Wallace E, Bennett K, Cahir C, Williams D, Teeling M, Fahey T, Hughes CM, (The PROMPT Steering Group). The development of the PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) criteria. BMC Health Serv Res. 2014;14:484. https://doi.org/10.1186/s12913-014-0484-6.

Cojutti P, Arnoldo L, Cattani G, Brusaferro S, Pea F. Polytherapy and the risk of potentially inappropriate prescriptions (PIPs) among elderly and very elderly patients in three different settings (hospital, community, long-term care facilities) of the Friuli Venezia Giulia region, Italy: are the very elderly at higher risk of PIPs? Pharmacoepidemiol Drug Saf. 2016;25(9):1070-8. https://doi.org/10.1002/pds.4026.

Guaraldo L, Cano FG, Damasceno GS, Rozenfeld S. Inappropriate medication use among the elderly: a systematic review of administrative databases. BMC Geriatr. 2011;11:79. https://doi.org/10.1186/1471-2318-11-79.

Lucchetti G, Lucchetti AL. Inappropriate prescribing in older persons: A systematic review of medications available in different criteria. Arch Gerontol Geriatr. 2017;68:55-61. https://doi.org/10.1016/j.archger.2016.09.003.

American Geriatrics Society 2019 Beers Criteria Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67:674–94. https://doi.org/10.1111/jgs.15767.

Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107(31-32):543-51. https://doi.org/10.3238/arztebl.2010.0543.

Kuhn-Thiel AM, Weiß C, Wehling M, FORTA authors/ expert panel members. Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging. 2014;31(2):131-40. https://doi.org/10.1007/s40266-013-0146-0.

Renom-Guiteras A, Meyer G, Thürmann PA. The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. 2015;71(7):861-75. https://doi.org/10.1007/s00228-015-1860-9.

O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213-8. https://doi.org/10.1093/ageing/afu145.

Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380:37-43. https://doi.org/10.1016/S0140-6736(12)60240-2.

Gutzmann H, Qazi A. Depression associated with dementia. Z Gerontol Geriatr. 2015;48(4):305-11. https://doi.org/10.1007/s00391-015-0898-8.

Alic A, Pranjic N, Ramic E. Polypharmacy and decreased cognitive abilities in elderly patients. Med Arh. 2011;65(2):102-5.

Lee D, Martini N, Moyes S, Hayman K, Zolezzi M, Kerse N. Potentially inappropriate medication use: the Beers’ Criteria used among older adults with depressive symptoms. J Prim Health Care. 2013;5(3):182-90. https://doi.org/10.1071/HC13182.

Disalvo D, Luckett T, Agar M, Bennett A, Davidson PM. Systems to identify potentially inappropriate prescribing in people with advanced dementia: a systematic review. BMC Geriatr. 2016;16:114. https://doi.org/10.1186/s12877-016-0289-z.

American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American geriatrics society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227-46. https://doi.org/10.1111/jgs.13702.

World Health Organization (WHO). WHO Collaborating Centre for Drug Statistics Methodology [Internet]. Guidelines for ATC classification and DDD assignment 2017. Geneva: WHO; 2017 [cited 2018 Oct 10]. Available from: https://www.whocc.no/filearchive/publications/2017_guidelines_web.pdf

Lesher EL, Berryhill JS. Validation of the Geriatric Depression Scale–Short Form among inpatients. J Clin Psychol. 1994;50:256-60.

Stanley R, Kuruvilla A, Kumar S, Gayathri K, Mathews P, Abraham V, Rajkumar A, Jacob KS. The Vellore screening instruments and strategies for the diagnosis of dementia in the community. Int Psychogeriatr. 2009;21(3):539-47. https://doi.org/10.1017/S104161020900903X.

Opondo D, Eslami S, Visscher S, de Rooij SE, Verheij R, Korevaar JC, Abu-Hanna A. Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review. PLoS One. 2012;7(8):e43617. https://doi.org/10.1371/journal.pone.0043617.

Cassoni TCJ, Corona LP, Romano-Lieber NS, Secoli SR, Duarte YAO, Lebrao ML. Uso de medicamentos potencialmente inapropriados por idosos do Município de São Paulo, Brasil: Estudo SABE. Cad Saude Publica. 2014;30(8):1708-20. https://doi.org/10.1371/journal.pone.0043617.

Lopes LM, Figueiredo TP, Costa SC, Reis AM. Use of potentially inappropriate medications by the elderly at home. Cien Saude Colet. 2016;21(11):3429-38. https://doi.org/10.1590/1413-812320152111.14302015.

Cooper JA, Moriarty F, Ryan C, Smith SM, Bennett K, Fahey T, Wallace E, Cahir C, Williams D, Teeling M, Hughes CM. Potentially inappropriate prescribing in two populations with differing socio-economic profiles: a cross-sectional database study using the PROMPT criteria. Eur J Clin Pharmacol. 2016;72(5):583-91. https://doi.org/10.1007/s00228-015-2003-z.

Willems S, De Maesschalck S, Deveugele M, Derese A, De Maeseneer J. Socio-economic status of the patient and doctor-patient communication: does it make a difference? Patient Educ Couns. 2005;56(2):139-46. https://doi.org/10.1016/j.pec.2004.02.011.

Smith SK, Dixon A, Trevena L, Nutbeam D, McCaffery KJ. Exploring patient involvement in healthcare decision making across different education and functional health literacy groups. Soc Sci Med. 2009;69(12):1805- 12. https://doi.org/10.1016/j.socscimed.2009.09.056.

Mercer SW, Watt GC. The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland. Ann Fam Med. 2007;5:503-10. https://doi.org/10.1370/afm.778.

Charlton J, Rudisill C, Bhattarai N, Gulliford M. Impact of deprivation on occurrence, outcomes and health care costs of people with multiple morbidity. J Health Serv Res Policy. 2013;18:215-23. https://doi.org/10.1177/1355819613493772.

Payne RA, Avery AJ, Duerden M, Saunders CL, Simpson CR, Abel GA. Prevalence of polypharmacy in a Scottish primary care population. Eur J Clin Pharmacol. 2014;70(5):575-81. https://doi.org/10.1007/s00228-013-1639-9.

McLean G, Gunn J, Wyke S, Guthrie B, Watt GC, Blane DN, Mercer SW. The influence of socioeconomic deprivation on multimorbidity at different ages: a cross- sectional study. Br J Gen Pract. 2014;64(624):e440-7. https://doi.org/10.3399/bjgp14X680545.

Bongue B, Naudin F, Laroche ML, Galteau MM, Guy C, Guéguen R, Convers JP, Colvez A, Maarouf N. Trends of the potentially inappropriate medication consumption over 10 years in older adults in the East of France. Pharmacoepidemiol Drug Saf. 2009;18(12):1125-33. https://doi.org/10.1002/pds.1762.

Brekke M, Hunskaar S, Straand J. Self-reported drug utilization, health, and lifestyle factors among 70-74 year old community dwelling individuals in Western Norway. The Hordaland Health Study (HUSK). BMC Public Health. 2006;6:121. https://doi.org/10.1186/1471-2458-6-121.

Richardson K, Kenny RA, Bennett K. The effect of free health care on polypharmacy: a comparison of propensity score methods and multivariable regression to account for confounding. Pharmacoepidemiol Drug Saf. 2014;23(6):656-65. https://doi.org/10.1002/pds.3590.

Bradley MC, Fahey T, Cahir C, Bennett K, O’Reilly D, Parsons C, Hughes CM. Potentially inappropriate prescribing and cost outcomes for older people: a cross-sectional study using the Northern Ireland Enhanced Prescribing Database. Eur J Clin Pharmacol. 2012;68(10):1425-33. https://doi.org/10.1007/s00228-012-1249-y.

Patterson SM, Hughes C, Kerse N, Cardwell CR, Bradley MC, Ryan C, Hughes C. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2014;(10):CD008165. https://doi.org/10.1002/14651858.CD008165.pub3.

Cadogan CA, Ryan C, Hughes CM. Appropriate Polypharmacy and Medicine Safety: When Many is not Too Many. Drug Saf. 2016;39(2):109-16. https://doi.org/10.1007/s40264-015-0378-5.

Koyama A, Steinman M, Ensrud K, Hillier TA, Yaffe K. Ten-year trajectory of potentially inappropriate medications in very old women: importance of cognitive status. J Am Geriatr Soc. 2013;61(2):258-63. https://doi.org/10.1111/jgs.12093.

Weston AL, Weinstein AM, Barton C, Yaffe K. Potentially inappropriate medication use in older adults with mild cognitive impairment. J Gerontol A Biol Sci Med Sci. 2010; 65:318-21. https://doi.org/10.1093/gerona/glp158.

Toscani F, Di Giulio P, Villani D, Giunco F, Brunelli C, Gentile S, Finetti S, Charrier L, Monti M, van der Steen JT, End of Life Observatory-Prospective Study on Dementia Patients Care Research Group. Treatments and prescriptions in advanced dementia patients residing in long-term care institutions and at home. J Palliat Med. 2013;16(1):31-7. https://doi.org/10.1089/jpm.2012.0165.

Sönnerstam E, Sjölander M, Gustafsson M. An evaluation of the prevalence of potentially inappropriate medications in older people with cognitive impairment living in Northern Sweden using the EU(7)-PIM list. Eur J Clin Pharmacol. 2017;73(6):735-42. https://doi.org/10.1007/s00228-017-2218-2.

Zhong G, Wang Y, Zhang Y, Zhao Y2. Association between benzodiazepine use and dementia: a meta-analysis. PLoS One. 2014;10(5):e0127836. https://doi.org/10.1371/journal.pone.0127836.

Wijarnpreecha K, Thongprayoon C, Panjawatanan P, Ungprasert P. Proton pump inhibitors and risk of dementia. Ann Transl Med. 2016;4(12):240. https://doi.org/10.21037/atm.2016.06.14.

Rojo LE, Alzate-Morales J, Saavedra IN, Davies P, Maccioni RB. Selective interaction of lansoprazole and astemizole with tau polymers: potential new clinical use in diagnosis of Alzheimer’s disease. J Alzheimers Dis. 2010;19(2):573-89. https://doi.org/10.3233/JAD-2010-1262.

Badiola N, Alcalde V, Pujol A, Münter LM, Multhaup G, Lleó A, Coma M, Soler-López M, Aloy P. The proton-pump inhibitor lansoprazole enhances amyloid beta production. PLoS One. 2013;8(3):e58837. https://doi.org/10.1371/journal.pone.0058837.

Fallahzadeh MK, Borhani Haghighi A, Namazi MR. Proton pump inhibitors: predisposers to Alzheimer disease? J Clin Pharm Ther. 2010;35(2):125-6. https://doi.org/10.1111/j.1365-2710.2009.01100.x.

Lam JR, Schneider JL, Zhao W, Corley DA. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA. 2013;310(22):2435-42. https://doi.org/10.1001/jama.2013.280490.

Schubert I, Küpper-Nybelen J, Ihle P, Thürmann P. Prescribing potentially inappropriate medication (PIM) in Germany’s elderly as indicated by the PRISCUS list. An analysis based on regional claims data. Pharmacoepidemiol Drug Saf. 2013;22(7):719-27. https://doi.org/10.1002/pds.3429.

Johnell K. Inappropriate drug use in people with cognitive impairment and dementia: A systematic review. Curr Clin Pharmacol. 2015;10:178-84. https://doi.org/10.2174/1574884710666150609154741.

Cross AJ, George J, Woodward MC, Ames D, Brodaty H, Ilomäki J, Elliott RA. Potentially inappropriate medications and anticholinergic burden in older people attending memory clinics in Australia. Drugs Aging. 2016;33:37-44. https://doi.org/10.1007/s40266-015-0332-3.

Vitry AI, Hoile AP, Gilbert AL, Esterman A, Luszcz MA. The risk of falls and fractures associated with persistent use of psychotropic medications in elderly people. Arch Gerontol Geriatr. 2010;50(3):e1-e4. https://doi.org/10.1016/j.archger.2009.04.004.

Tampi RR, Tampi DJ. Efficacy and tolerability of benzodiazepines for the treatment of behavioral and psychological symptoms of dementia: A systematic review of randomized controlled trials. Am J Alzheimers Dis Other Demen. 2014;29:565-74. https://doi.org/10.1177/1533317514524813.

Thorpe JM, Thorpe CT, Kennelty KA, Gellad WF, Schulz R. The impact of family caregivers on potentially inappropriate medication use in noninstitutionalized older adults with dementia. Am J Geriatr Pharmacother. 2012;10(4):230-41. https://doi.org/10.1016/j.amjopharm.2012.05.001.

How to Cite
Sgnaolin, V., Engroff, P., Melo Linkievicz, N., Gomes, I., & Cataldo Neto, A. (2020). Potentially inappropriate medication and associated factors such as depression and dementia: An analysis of middle-aged and elderly people. Scientia Medica, 30(1), e34478. https://doi.org/10.15448/1980-6108.2020.1.34478
Original Articles