Department of Digital Health, Rouen University Hospital, Rouen, France.
Department of Pharmacy, Rouen University Hospital, Rouen, France.
Br J Clin Pharmacol. 2024 Jul;90(7):1559-1575. doi: 10.1111/bcp.16092. Epub 2024 May 16.
The global older population is growing rapidly, and the rise in polypharmacy has increased potentially inappropriate medication (PIM) encounters. PIMs pose health risks, but detecting them automatically in large medical databases is complex. This review aimed to uncover PIM prevalence in individuals aged 65 years or older using health databases and emphasized the risk of underestimating PIM prevalence due to underutilization of detection tools.
This study conducted a broad search on the Medline database to identify articles about the prevalence of PIMs in older adults using various databases. Articles published between January 2010 and June 2023 were included, and specific criteria were applied for study selection. Two literature reviews conducted before our study period were integrated to obtain a perspective from the 1990s to the present day. The selected papers were analysed for variables including database type, screening method, adaptations and PIM prevalence. The study categorized databases and original screening tools for clarity, examined adaptations and assessed concordance among different screening methods.
This study encompassed 48 manuscripts, covering 58 sample evaluations. The mean prevalence of PIMs within the general population aged over 65 years was 27.8%. Relevant heterogeneity emerged in both the utilized databases and the detection methods. Adaptation of original screening tools was observed in 86.2% (50/58) of cases. Half of the original screening tools used for assessing PIMs belonged to the simple category. About a third of the studies employed less than half of the original criteria after adaptation. Only three studies used over 75% of the original criteria and more than 50 criteria.
This extensive review highlights PIM prevalence among the older adults, emphasizing method intricacies and the potential for underestimation due to data limitations and algorithm adjustments. The findings call for enhanced methodologies, transparent algorithms and a deeper understanding of intricate rules' impact on public health implications.
全球老年人口迅速增长，同时多药治疗的增加增加了潜在不适当药物（PIM）的发生。PIM 会带来健康风险，但在大型医疗数据库中自动检测它们非常复杂。本综述旨在通过健康数据库揭示 65 岁及以上人群中 PIM 的流行率，并强调由于检测工具利用不足，可能低估 PIM 流行率的风险。
本研究在 Medline 数据库上进行了广泛搜索，以确定使用各种数据库评估老年人 PIM 流行率的文章。纳入了 2010 年 1 月至 2023 年 6 月期间发表的文章，并应用了具体的标准进行研究选择。整合了我们研究之前进行的两项文献综述，以获得从 90 年代至今的视角。对所选论文进行了分析，包括数据库类型、筛选方法、改编和 PIM 流行率。为了清晰起见，本研究对数据库和原始筛选工具进行了分类，检查了改编，并评估了不同筛选方法之间的一致性。
本研究包括 48 篇论文，涵盖了 58 项样本评估。65 岁以上一般人群中 PIM 的平均流行率为 27.8%。在所使用的数据库和检测方法中都出现了显著的异质性。在 86.2%（50/58）的情况下观察到了原始筛选工具的改编。用于评估 PIM 的原始筛选工具中有一半属于简单类别。大约三分之一的研究在改编后仅使用了原始标准的一半以下。只有三项研究使用了超过 75%的原始标准和 50 多个标准。
本综述强调了老年人中 PIM 的流行率，强调了方法的复杂性以及由于数据限制和算法调整而低估的可能性。这些发现呼吁采用更先进的方法、透明的算法，并深入了解复杂规则对公共卫生影响。
