Potentially Inappropriate Medications Prescribed to Geriatric Patients in Single Institution

Abstract

OBJECTIVES: The primary objective of this investigation was to determine the types and frequency of PIMs prescribed to geriatric patients at the Dental College of Georgia at Augusta University (DCG) while considering patients’ age groups and American Society of Anesthesiologists (ASA) physical status. The secondary objective was to determine the source of PIMs prescriptions based on the prescribers’ specialty and professional status. METHODS: The most recent Beers List and STOPP/START criteria were studied, and PIMs identified. A retrospective electronic chart review of patients at DCG aged 65 and above was performed for calendar years 2018, 2019, 2020, 2021 and 2022. Search queries were also generated for the patients’ medical history, along with PIMs prescribers’ specialty and professional status. RESULTS: Of 10675 geriatric patients identified, 6.2% (n=662) received PIMs prescriptions. Of those, 73.7% had an ASA III status. 77% received one PIM prescription, while others received between two to six. NSAIDs were the most commonly prescribed PIM (60.1% of patients), followed by opioids (32.5% of patients). A dramatic drop in prescribing NSAIDs was detected in recent years. Surprisingly, a similar pattern was not observed with opioids. Both NSAIDs and opioids were largely provided by oral-maxillofacial surgery (OMFS) followed by restorative dentistry and periodontics. Benzodiazepines were mostly prescribed by endodontics, while tricyclic antidepressants (TCAs), muscle relaxants and anticonvulsants were most commonly prescribed by oral medicine. Residents prescribed opioids at similar rates to faculty (p=0.78), but exceeded faculty in prescribing benzodiazepines (p<0.001). CONCLUSIONS: PIMs are prescribed at low percentages to geriatric patients. However, many of the geriatric patients receiving such prescriptions have an ASA III status. Prescription of PIMs, especially opioids and NSAIDs, is not uncommon, and many patients received more than two PIMs. Further work should be devoted, at both institutional and national levels, to monitor/limit PIMs provided to geriatric patients. IMPLICATIONS: In geriatric care, it is important to be cognizant of the unique characteristics of this population. Studies like this are important to analyze prescription trends in different populations and dental specialties. We can draw attention to areas which can be improved, while also highlighting what is being done well, for future care.