University of Hertfordshire

By the same authors

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Original languageEnglish
Pages (from-to)183-210
JournalDrug, Healthcare and Patient Safety
Publication statusPublished - 3 Nov 2021


Potentially inappropriate medication (PIM) is a primary health concern affecting
the quality of life of patients over 65. PIM is associated with adverse drug reactions
including falls, increased healthcare costs, health services utilization and hospital admissions.
Various strategies, clinical guidelines and tools (explicit and implicit) have been developed to
tackle this health concern. Despite these efforts, evidence still indicates a high prevalence of
PIM in the older adult population. This systematic review explored the practice of using
explicit tools to review PIM in hospitalized patients and examined the outcomes of PIM
reduction. A literature search was conducted in several databases from their inception to
2019. Original studies that had an interventional element using explicit criteria detecting PIM
in hospitalized patients over 65 were included. Descriptive narrative synthesis was used to
analyze the included studies. The literature search yielded 6116 articles; 25 quantitative
studies were included in this systematic literature review. Twenty were prospective studies
and five were retrospective. Approximately, 15,500 patients were included in the review.
Various healthcare professionals were involved in reviewing PIM including physicians and
hospital pharmacists. Several tools were used to review PIM for hospitalized patients over
65, most frequently Beer’s criteria and the STOPP/START tool. The reduction of PIM ranged
from 3.5% up to 87%. The most common PIM were benzodiazepines and antipsychotics.
This systematic review showed promising outcomes in terms of improving patient outcomes.
However, the reduction of PIM varied in the studies, raising the question of the variance
between hospitals in the explicit tools used for review. Additional studies need to be
conducted to further investigate the outcomes of reviewing PIM at different levels, as well
as assessing the cost-effectiveness of using explicit tools in reducing PIM.
Keywords: older population, adverse drug effects, drug review tools, PIM

ID: 27149421