Evaluation of potential inappropriate medication in elderly patients admitted to Muhimbili national hospital using the stopp/start criteria

Abstract

Background: Prescribing in elderly is a challenging and complex process due to age and physiological related changes which compromise drug handling and response. The process is further complicated by presence of co morbidity and co medication. Elderly population is increasing worldwide including Tanzania, Thus with an increase in this elderly population, quality and safety of medication becomes more important for improving health and drug use. Aim of the study: We have conducted a study on potential inappropriate in medication elderly patients using the STOPP/START criteria and in addition the study assessed the magnitude of reduced renal function requiring dose adjustment. Methodology: This was a descriptive study conducted using medical records from MNH, involving 297 elderly patients admitted at Muhimbili national hospital between September 2013 and February 2014. Data was analyzed by STATA software Version 12. (Stata Corp. College Station, Texas, USA) and summarized using appropriate standard statistics. Statistical tests i.e. chi square, T –test and fisher exact was used to measure associations. A P value of <0.05 was considered to be statistically significant. Results: sixty one patient out of 297 (20.5%) had at least one potential inappropriate medication (PIM).Many patients with at least one inappropriate medication were admitted through emergency medicine department (22.5%).Majority of PIM were related to Glibenclamide use in patient with type two diabetics (21.3%). A total of 58 (19.5%) medications were omitted and majority (67.2 %) of the patient to whom medication were omitted came from emergency admission. A significant reduction in renal function was very common in our cohort; about 200 (68%) out of 297 had an eGFR of less than 60 ml min−1per 1.73 m−2. Of the 200 patients with significantly reduced renal functions, 117 (58.5%) were females; in the 297 elderly patients, 116 (39.3%) of them had a moderate reduction in eGFR and thirty-five patients out of 297 (11.8%) were in end stage renal diseases. Conclusion: Potential inappropriate medication, medication omission, and reduced renal function are common among elderly patients admitted at MNH.