Potentially Inappropriate Prescribing for Prostatic Hyperplasia in Older Persons
In the context of improved medication management of older patients, we wished to evaluate the overprescription of potentially inappropriate drugs [α1-blockers and 5α-reductase inhibitors (5-ARI)] for benign prostate hyperplasia (BPH). These drugs are considered by geriatricians to increase the risk...
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| Veröffentlicht in: | Journal of the American Medical Directors Association 2022-06, Vol.23 (6), p.992-997 |
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| creator | Renoncourt, Thomas Saint, Fabien Bennis, Youssef Mondet, Lisa Bloch, Frédéric |
| description | In the context of improved medication management of older patients, we wished to evaluate the overprescription of potentially inappropriate drugs [α1-blockers and 5α-reductase inhibitors (5-ARI)] for benign prostate hyperplasia (BPH). These drugs are considered by geriatricians to increase the risk of falls and pharmacodynamic interactions, but these properties have not yet been proven.
This was a descriptive study of drug prescriptions in a geriatric academic center.
We included all patients older than 75 years who received a prescription for α1-blockers or 5-ARIs for 2 weeks in our hospital.
We evaluated the prevalence of the potentially inappropriate prescription of α1-blockers and 5-ARI in older people during hospitalization using a new tool consisting of an 8-item list of explicit indicators developed using the most recent summary of product characteristics (SmPC) and latest European Association of Urology (EAU) guidelines. Results: A population of 117 patients (≥75 years) was included in the study. The median age was 84.5 (±6.3) years. The average time since urological medication prescription was 1.2 ± 1.6 years. According to explicit criteria, 84 patients (71.8%) received at least 1 potentially inappropriate urologic medication, 77 (91.7%) related to α1-blockers. Patients with a potentially inappropriate prescription for α1-blockers and/or 5-ARIs more frequently had urological assessments (P = .026), more frequently showed pharmacological interactions, with the risk of orthostatic hypotension (P = .005) or arrhythmia (P = .028), and experienced more falls in their history (P = .043). The misuse group was associated with an increased risk of falls, with an odds ratio of 3.22 (P = .039, 95% confidence interval 1.08–10.2).
In our study, potentially inappropriate prescriptions for older individuals for BPH was close to 72% and mainly involved α1-blockers. Potentially inappropriate prescriptions for BPH were associated with a threefold higher frequency of falls. |
| doi_str_mv | 10.1016/j.jamda.2021.09.023 |
| format | Article |
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This was a descriptive study of drug prescriptions in a geriatric academic center.
We included all patients older than 75 years who received a prescription for α1-blockers or 5-ARIs for 2 weeks in our hospital.
We evaluated the prevalence of the potentially inappropriate prescription of α1-blockers and 5-ARI in older people during hospitalization using a new tool consisting of an 8-item list of explicit indicators developed using the most recent summary of product characteristics (SmPC) and latest European Association of Urology (EAU) guidelines. Results: A population of 117 patients (≥75 years) was included in the study. The median age was 84.5 (±6.3) years. The average time since urological medication prescription was 1.2 ± 1.6 years. According to explicit criteria, 84 patients (71.8%) received at least 1 potentially inappropriate urologic medication, 77 (91.7%) related to α1-blockers. Patients with a potentially inappropriate prescription for α1-blockers and/or 5-ARIs more frequently had urological assessments (P = .026), more frequently showed pharmacological interactions, with the risk of orthostatic hypotension (P = .005) or arrhythmia (P = .028), and experienced more falls in their history (P = .043). The misuse group was associated with an increased risk of falls, with an odds ratio of 3.22 (P = .039, 95% confidence interval 1.08–10.2).
In our study, potentially inappropriate prescriptions for older individuals for BPH was close to 72% and mainly involved α1-blockers. Potentially inappropriate prescriptions for BPH were associated with a threefold higher frequency of falls.</description><identifier>ISSN: 1525-8610</identifier><identifier>EISSN: 1538-9375</identifier><identifier>DOI: 10.1016/j.jamda.2021.09.023</identifier><identifier>PMID: 34653381</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>5α-reductase inhibitors ; Aged ; Aged, 80 and over ; Aging ; benign prostatic hyperplasia ; deprescribing ; Drug Prescriptions ; elderly ; Hospitalization ; Humans ; Inappropriate Prescribing ; Life Sciences ; Male ; Potentially Inappropriate Medication List ; Prostatic Hyperplasia - drug therapy ; Prostatic Hyperplasia - epidemiology ; α1-blockers</subject><ispartof>Journal of the American Medical Directors Association, 2022-06, Vol.23 (6), p.992-997</ispartof><rights>2021 AMDA — The Society for Post-Acute and Long-Term Care Medicine</rights><rights>Copyright © 2021 AMDA — The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.</rights><rights>Attribution - NonCommercial</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-ff4289386a9a5ace472607732d4833e84964943b870990ba46c7a52276bf7d8a3</citedby><cites>FETCH-LOGICAL-c438t-ff4289386a9a5ace472607732d4833e84964943b870990ba46c7a52276bf7d8a3</cites><orcidid>0000-0001-7432-9587 ; 0000-0002-4410-9572 ; 0000-0002-6046-7097 ; 0000-0002-0186-4797 ; 0000-0002-0255-6681</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jamda.2021.09.023$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34653381$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://u-picardie.hal.science/hal-03688454$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Renoncourt, Thomas</creatorcontrib><creatorcontrib>Saint, Fabien</creatorcontrib><creatorcontrib>Bennis, Youssef</creatorcontrib><creatorcontrib>Mondet, Lisa</creatorcontrib><creatorcontrib>Bloch, Frédéric</creatorcontrib><title>Potentially Inappropriate Prescribing for Prostatic Hyperplasia in Older Persons</title><title>Journal of the American Medical Directors Association</title><addtitle>J Am Med Dir Assoc</addtitle><description>In the context of improved medication management of older patients, we wished to evaluate the overprescription of potentially inappropriate drugs [α1-blockers and 5α-reductase inhibitors (5-ARI)] for benign prostate hyperplasia (BPH). These drugs are considered by geriatricians to increase the risk of falls and pharmacodynamic interactions, but these properties have not yet been proven.
This was a descriptive study of drug prescriptions in a geriatric academic center.
We included all patients older than 75 years who received a prescription for α1-blockers or 5-ARIs for 2 weeks in our hospital.
We evaluated the prevalence of the potentially inappropriate prescription of α1-blockers and 5-ARI in older people during hospitalization using a new tool consisting of an 8-item list of explicit indicators developed using the most recent summary of product characteristics (SmPC) and latest European Association of Urology (EAU) guidelines. Results: A population of 117 patients (≥75 years) was included in the study. The median age was 84.5 (±6.3) years. The average time since urological medication prescription was 1.2 ± 1.6 years. According to explicit criteria, 84 patients (71.8%) received at least 1 potentially inappropriate urologic medication, 77 (91.7%) related to α1-blockers. Patients with a potentially inappropriate prescription for α1-blockers and/or 5-ARIs more frequently had urological assessments (P = .026), more frequently showed pharmacological interactions, with the risk of orthostatic hypotension (P = .005) or arrhythmia (P = .028), and experienced more falls in their history (P = .043). The misuse group was associated with an increased risk of falls, with an odds ratio of 3.22 (P = .039, 95% confidence interval 1.08–10.2).
In our study, potentially inappropriate prescriptions for older individuals for BPH was close to 72% and mainly involved α1-blockers. Potentially inappropriate prescriptions for BPH were associated with a threefold higher frequency of falls.</description><subject>5α-reductase inhibitors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aging</subject><subject>benign prostatic hyperplasia</subject><subject>deprescribing</subject><subject>Drug Prescriptions</subject><subject>elderly</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Inappropriate Prescribing</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Potentially Inappropriate Medication List</subject><subject>Prostatic Hyperplasia - drug therapy</subject><subject>Prostatic Hyperplasia - epidemiology</subject><subject>α1-blockers</subject><issn>1525-8610</issn><issn>1538-9375</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kD1PwzAQhi0EoqXwC5BQVoYEf8WxB4YKAa1UqR1gti6OA67SJLJDpf57HAodmXy-e9_7eBC6JTgjmIiHbbaFXQUZxZRkWGWYsjM0JTmTqWJFfj7GNE-lIHiCrkLYYkwxUeISTRgXOWOSTNFm0w22HRw0zSFZttD3vuu9g8EmG2-D8a507UdSdz7-uzDA4EyyOPTW9w0EB4lrk3VT2Vi2PnRtuEYXNTTB3vy-M_T-8vz2tEhX69fl03yVGs7kkNY1p1IxKUBBDsbyggpcFIxWXDJmJVeCK85KWWClcAlcmAJySgtR1kUlgc3Q_bHvJzQ6brwDf9AdOL2Yr_SYw0xIyXO-J1HLjloTTwje1icDwXpkqbf6h6UeWWqsdGQZXXdHV_9V7mx18vzBi4LHo8DGO_fOeh2Ms62xlfPWDLrq3L8DvgF6yIVD</recordid><startdate>20220601</startdate><enddate>20220601</enddate><creator>Renoncourt, Thomas</creator><creator>Saint, Fabien</creator><creator>Bennis, Youssef</creator><creator>Mondet, Lisa</creator><creator>Bloch, Frédéric</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>1XC</scope><scope>VOOES</scope><orcidid>https://orcid.org/0000-0001-7432-9587</orcidid><orcidid>https://orcid.org/0000-0002-4410-9572</orcidid><orcidid>https://orcid.org/0000-0002-6046-7097</orcidid><orcidid>https://orcid.org/0000-0002-0186-4797</orcidid><orcidid>https://orcid.org/0000-0002-0255-6681</orcidid></search><sort><creationdate>20220601</creationdate><title>Potentially Inappropriate Prescribing for Prostatic Hyperplasia in Older Persons</title><author>Renoncourt, Thomas ; Saint, Fabien ; Bennis, Youssef ; Mondet, Lisa ; Bloch, Frédéric</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-ff4289386a9a5ace472607732d4833e84964943b870990ba46c7a52276bf7d8a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>5α-reductase inhibitors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aging</topic><topic>benign prostatic hyperplasia</topic><topic>deprescribing</topic><topic>Drug Prescriptions</topic><topic>elderly</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Inappropriate Prescribing</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Potentially Inappropriate Medication List</topic><topic>Prostatic Hyperplasia - drug therapy</topic><topic>Prostatic Hyperplasia - epidemiology</topic><topic>α1-blockers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Renoncourt, Thomas</creatorcontrib><creatorcontrib>Saint, Fabien</creatorcontrib><creatorcontrib>Bennis, Youssef</creatorcontrib><creatorcontrib>Mondet, Lisa</creatorcontrib><creatorcontrib>Bloch, Frédéric</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><jtitle>Journal of the American Medical Directors Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Renoncourt, Thomas</au><au>Saint, Fabien</au><au>Bennis, Youssef</au><au>Mondet, Lisa</au><au>Bloch, Frédéric</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Potentially Inappropriate Prescribing for Prostatic Hyperplasia in Older Persons</atitle><jtitle>Journal of the American Medical Directors Association</jtitle><addtitle>J Am Med Dir Assoc</addtitle><date>2022-06-01</date><risdate>2022</risdate><volume>23</volume><issue>6</issue><spage>992</spage><epage>997</epage><pages>992-997</pages><issn>1525-8610</issn><eissn>1538-9375</eissn><abstract>In the context of improved medication management of older patients, we wished to evaluate the overprescription of potentially inappropriate drugs [α1-blockers and 5α-reductase inhibitors (5-ARI)] for benign prostate hyperplasia (BPH). These drugs are considered by geriatricians to increase the risk of falls and pharmacodynamic interactions, but these properties have not yet been proven.
This was a descriptive study of drug prescriptions in a geriatric academic center.
We included all patients older than 75 years who received a prescription for α1-blockers or 5-ARIs for 2 weeks in our hospital.
We evaluated the prevalence of the potentially inappropriate prescription of α1-blockers and 5-ARI in older people during hospitalization using a new tool consisting of an 8-item list of explicit indicators developed using the most recent summary of product characteristics (SmPC) and latest European Association of Urology (EAU) guidelines. Results: A population of 117 patients (≥75 years) was included in the study. The median age was 84.5 (±6.3) years. The average time since urological medication prescription was 1.2 ± 1.6 years. According to explicit criteria, 84 patients (71.8%) received at least 1 potentially inappropriate urologic medication, 77 (91.7%) related to α1-blockers. Patients with a potentially inappropriate prescription for α1-blockers and/or 5-ARIs more frequently had urological assessments (P = .026), more frequently showed pharmacological interactions, with the risk of orthostatic hypotension (P = .005) or arrhythmia (P = .028), and experienced more falls in their history (P = .043). The misuse group was associated with an increased risk of falls, with an odds ratio of 3.22 (P = .039, 95% confidence interval 1.08–10.2).
In our study, potentially inappropriate prescriptions for older individuals for BPH was close to 72% and mainly involved α1-blockers. Potentially inappropriate prescriptions for BPH were associated with a threefold higher frequency of falls.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34653381</pmid><doi>10.1016/j.jamda.2021.09.023</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0001-7432-9587</orcidid><orcidid>https://orcid.org/0000-0002-4410-9572</orcidid><orcidid>https://orcid.org/0000-0002-6046-7097</orcidid><orcidid>https://orcid.org/0000-0002-0186-4797</orcidid><orcidid>https://orcid.org/0000-0002-0255-6681</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | 5α-reductase inhibitors Aged Aged, 80 and over Aging benign prostatic hyperplasia deprescribing Drug Prescriptions elderly Hospitalization Humans Inappropriate Prescribing Life Sciences Male Potentially Inappropriate Medication List Prostatic Hyperplasia - drug therapy Prostatic Hyperplasia - epidemiology α1-blockers |
| title | Potentially Inappropriate Prescribing for Prostatic Hyperplasia in Older Persons |
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