Karki Subash, Thapa Rahi Bikram, Shrestha Rajeev
Department of Pharmacy Purbanchal University School of Health Science Sundar Haraicha Gothgaun Nepal.
NIHR Newcastle Patient Safety Research Collaboration Newcastle University Newcastle-upon-Tyne UK.
Aging Med (Milton). 2025 Jun 15;8(3):238-248. doi: 10.1002/agm2.70025. eCollection 2025 Jun.
Potentially inappropriate medication (PIM) use is a significant concern among the elderly, a vulnerable population, due to physiological changes, and the risk of multiple comorbidities and polypharmacy. This study aimed to assess the use of PIM among elderly inpatients in tertiary care hospital in eastern Nepal.
A three-month prospective observational study was conducted, involving 200 eligible elderly patients admitted to general medicine ward. Relevant data were collected from patient case sheets, nursing and doctor cardex, discharge summaries, and via patient interviews. PIMs were identified based on the latest 2023 AGS Beers Criteria.
Among the 200 eligible patients, 108 (54.0%) were prescribed at least one PIM. Medications that should be avoided in older patients accounted for 32.2%, where prazosin and hyoscine were the most common. Additionally, 52.8% of the medications required cautious use, with diuretics being the most frequent one. Multivariate analysis revealed that patients with chronic kidney disease (CKD) and the number of prescribed medicines significantly influenced the likelihood of PIMs with an adjusted odd ratio of 6.730 (2.111-21.456) and 2.764 (1.448-5.276), respectively, at < 0.05.
PIMs are more common among the elderly, with CKD and polypharmacy contributing significantly to their prevalence. To reduce PIM use, healthcare professionals, including clinical pharmacists, should implement targeted interventions, particularly for older adults with CKD who are managing with multiple medications.
潜在不适当用药（PIM）在老年人（一个弱势群体）中是一个重大问题，这是由于生理变化以及多种合并症和多重用药的风险所致。本研究旨在评估尼泊尔东部一家三级护理医院老年住院患者中PIM的使用情况。
进行了一项为期三个月的前瞻性观察研究，纳入了200名入住普通内科病房的符合条件的老年患者。从患者病历、护理和医生卡片索引、出院小结以及通过患者访谈收集相关数据。根据最新的2023年美国老年医学会（AGS）Beers标准确定PIM。
在200名符合条件的患者中；108名（54.0%）至少开具了一种PIM。老年患者应避免使用的药物占32.2%，其中哌唑嗪和东莨菪碱最为常见。此外，52.8%的药物需要谨慎使用，利尿剂最为常见。多变量分析显示，慢性肾脏病（CKD）患者和开具药物的数量显著影响PIM的发生可能性，调整后的比值比分别为6.730（2.111 - 21.456）和2.764（1.448 - 5.276），P < 0.05。
PIM在老年人中更为常见，CKD和多重用药对其患病率有显著影响。为减少PIM的使用，包括临床药师在内的医疗保健专业人员应实施有针对性的干预措施，特别是对于正在使用多种药物治疗的CKD老年患者。
