Publication:

COVID-19 impact on the prevalence of PIMS in elderly patients according to STOPP/ START criteria: a record base study

Background Polypharmacy, contribute to an increased risk of adverse drug reaction morbidity, and mortality, and increases the length of hospital stay, hospital revisits and readmissions. We aimed to evaluate the prevalence and trends of polypharmacy and potentially inappropriate medications in elderly patients with version 2. STOPP/START criteria, and assess the severity of adverse drug events in patients with PIMs.

Methods This is a retrospective, record-based study of over-the-counter, and potentially inappropriate medications in the prescriptions of patients (>60 years). PIMs have been identified and further investigated to determine any adverse effects. If harm occurred, the severity of an adverse effect was rated using a modified Hartwig and Siegel scale. The causality of the events was assessed by using Naranjo's scale.

Results Out of 583 patients polypharmacy and excessive polypharmacy were found in 36.0%, and 42.8% of pre-admission medications. The most common over-the-counter (OTC) drugs were hydrocortisone (39.86%), ranitidine (21.62%), bisacodyl (14.86%), and diphenhydramine (12.84%). A statistically significant positive correlation was seen between age and the number of drugs prescribed (r2=0.16), while a non-significant positive correlation was found between sex, length of stay (LOS), and the number of drugs prescribed (r2 =0.0002, r2 =0.001). Common PIMs related incidence reported include Insulin (regular) 31.25% (N=20), Trihexyphenidyl (THP) 18.75%, zolpidem 12.5%, acetylsalicylic acid 9.3%, pantoprazole 52 7.81%, furosemide 7.8%, hydrocortisone 6.25%, and glimepiride 6.25%. Total of 130 ADRs 50% were mild, 28.4% were moderate, and 21.5% were severe. Out of 130 incidents, 64.6% were preventable, 22.3% were probably preventable, and 13.0% were not preventable. A total of 50.0% recovered completely from the ADRs, 33.0% had been recovering, 12.3% recovered with a squeal, 2.3% could not recover and 2.3% had been fatal.

Conclusions The study shows high uses of OTC and PIMs and PGx in elderly patients; which encourage intent need to develop awareness and action plans.