The relationship between common geriatric syndromes and potentially inappropriate medication use among older adults

  • Pinar KucukdagliEmail author
  • Gulistan Bahat
  • Ilker Bay
  • Cihan Kilic
  • Meryem Merve Oren
  • Banu Ozulu Turkmen
  • Mehmet Akif Karan
Original Article



Polypharmacy and inappropriate medication use in older adults is a major public health problem associated with morbidity and mortality. Aging is associated with metabolic changes and decreased drug clearance, increased drug–drug interactions, prescribing cascades, and potentially inappropriate medication (PIM) use. The purpose of this study was to evaluate the association between a common geriatric syndromes and PIM use among older adults.


Study participants were recruited among patients admitted to Istanbul Medical School Geriatrics outpatient clinic between June 2000 and June 2014 and were evaluated retrospectively by a geriatrician using the patients’ records according to Beers 2012 criteria.


Among the 667 enrolled patients, 421 (63.1%) were women and 246 (36.9%) were men. The use of PIM was not associated with age or sex. Polypharmacy (OR 4.86, 95% CI 3.25–7.27, p < 0.001), malnutrition (OR 2.69, 95% CI 1.52–4.76, p = 0.001), depression (OR 2.61, 95% CI 1.7–3.95, p < 0.001), presence of fall in the previous year (OR 2.24, 95% CI 1.51–3.32, p < 0.001), and dementia (OR 1.69, 95% CI 1.08–2.65, p = 0.021) were independently associated with the use of PIM.


The results of our study suggest that PIM use is independently associated with presence of polypharmacy, malnutrition, depression, falls and dementia in older outpatients. Identifying the association of inappropriate medication use with common geriatric syndromes in older people can help to prevent, delay, and reduce PIM use and related adverse health outcomes.


Inappropriate medication use Geriatric syndromes Beers criteria 


Compliance with ethical standards

Conlict of interest

The authors report no conflict of interest.

Ethical approval

The study protocol was approved by the ethics committee of Istanbul Medical School, Istanbul University.

Informed consent

Informed consent was obtained from all participants included in the study.


  1. 1.
    Ferner RE, Aronson JK (2006) Communicating information about drug safety. BMJ 333:143. CrossRefGoogle Scholar
  2. 2.
    Weng MC, Tsai CF, Sheu KL et al (2013) The impact of number of drugs prescribed on the risk of potentially inappropriate medication among outpatient older adults with chronic diseases. QJM 106:1009–1015. CrossRefGoogle Scholar
  3. 3.
    Lai SW, Liao KF, Liao CC et al (2010) Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study. Medicine (Baltimore) 89:295–299. CrossRefGoogle Scholar
  4. 4.
    Jylhä V, Saranto K, Bates DW (2011) Preventable adverse drug events and their causes and contributing factors: the analysis of register data. Int J Qual Health Care 23:187–197. CrossRefGoogle Scholar
  5. 5.
    McLeod PJ, Huang AR, Tamblyn RM et al (1997) Defining inappropriate practices in prescribing for elderly people: a national consensus panel.  CMAJ 156:385–391Google Scholar
  6. 6.
    Beers MH, Ouslander JG, Rollingher I et al (1991) Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med. 151:1825. CrossRefGoogle Scholar
  7. 7.
    Beers MH (1997) Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 157:1531. CrossRefGoogle Scholar
  8. 8.
    Chew ML, Mulsant BH, Pollock BG et al (2008) Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc 56:1333. CrossRefGoogle Scholar
  9. 9.
    American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society (2015) Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2015:2227–2246. CrossRefGoogle Scholar
  10. 10.
    Onder G, Giovannini S, Sganga F et al (2018) Interactions between drugs and geriatric syndromes in nursing home and home care: results from Shelter and IBenC projects. Aging Clin Exp Res 30:1015–1021. CrossRefGoogle Scholar
  11. 11.
    Bor A, Matuz M, Csatordai M et al (2017) Medication use and risk of falls among nursing home residents: a retrospective cohort study. Int J Clin Pharm 39:408–415. CrossRefGoogle Scholar
  12. 12.
    Masumoto S, Sato M, Maeno T et al (2018) Potentially inappropriate medications with polypharmacy increase the risk of falls in older Japanese patients: 1-year prospective cohort study. Geriatr Gerontol Int. 18:1064–1070. CrossRefGoogle Scholar
  13. 13.
    Narayan SW, Nishtala PS (2015) Associations of potentially inappropriate medicine use with fall-related hospitalisations and primary care visits in older New Zealanders: a population-level study using the updated 2012 beers criteria. Drugs Real World Outcomes 2:137–141. CrossRefGoogle Scholar
  14. 14.
    Wastesson JW, Morin L, Laroche ML et al (2019) How chronic is polypharmacy in old age? A longitudinal nationwide cohort study. J Am Geriatr Soc 67:455–462. CrossRefGoogle Scholar
  15. 15.
    Midão L, Giardini A, Menditto E et al (2018) Polypharmacy prevalence among older adults based on the survey of health, ageing and retirement in Europe. Arch Gerontol Geriatr. 78:213–220. CrossRefGoogle Scholar
  16. 16.
    Craftman ÅG, Johnell K, Fastbom J et al (2016) Time trends in 20 years of medication use in older adults: findings from three elderly cohorts in Stockholm, Sweden. Arch Gerontol Geriatr 63:28–35. CrossRefGoogle Scholar
  17. 17.
    Haider S, Johnell K, Thorslund M et al (2007) Trends in polypharmacy and potential drug-drug interactions across educational groups in elderly patients in Sweden for the period 1992–2002. Int J Clin Pharmacol Ther 45:643–653CrossRefGoogle Scholar
  18. 18.
    Jhaveri BN, Patel TK, Barvaliya MJ et al (2014) Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India. Perspect Clin Res 5:184–189. CrossRefGoogle Scholar
  19. 19.
    Narayan SW, Nishtala PS (2015) Prevalence of potentially inappropriate medicine use in older New Zealanders: a population-level study using the updated 2012 Beers criteria. J Eval Clin Pract 21:633–641. CrossRefGoogle Scholar
  20. 20.
    Zhang X, Zhou S, Pan K, Li X, Zhao X, Zhou Y, Cui Y, Liu X (2017) Potentially inappropriate medications in hospitalized older patients: a cross-sectional study using the Beers 2015 criteria versus the 2012 criteria. Clin Interv Aging. 12:1697–1703. CrossRefGoogle Scholar
  21. 21.
    Morin L, Fastbom J, Laroche ML, Johnell K (2015) Potentially inappropriate drug use in older people: a nationwide comparison of different explicit criteria for population-based estimates. J Clin Pharmacol 80:315–324. CrossRefGoogle Scholar
  22. 22.
    Bahat G, Bay I, Tufan A et al (2017) Prevalence of potentially inappropriate prescribing among older adults: a comparison of the Beers 2012 and Screening Tool of Older Person’s Prescriptions criteria version 2. Geriatr Gerontol Int 17:1245–1251. CrossRefGoogle Scholar
  23. 23.
    Abrams P, Andersson KE, Birder L et al (2010) Fourth international consultation on incontinence recommendations of the international scientific committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn 29:213–240. CrossRefGoogle Scholar
  24. 24.
    Almeida OP, Almeida SA (1999) Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSMIV. Int J Geriatr Psychiatry 14:858–865CrossRefGoogle Scholar
  25. 25.
    Rubenstein LZ, Harker JO, Salvà A et al (2001) Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol: Ser A. 56:366–372. CrossRefGoogle Scholar
  26. 26.
    Cho YC, Alessi CA, Cho M et al (1998) The association between chronic illness and functional change among participants in Comprehensive Geriatric Assessment program. J Am Geriatr Soc 46:667–682. Google Scholar
  27. 27.
    Blanco-Reina E, Ariza-Zafra G, Ocana-Riola R et al (2014) 2012 American Geriatrics Society Beers criteria: enhanced applicability for detecting potentially inappropriate medications in European older adults? A comparison with the Screening Tool of Older Person’s Potentially Inappropriate Prescriptions. J Am Geriatr Soc 62:1217–1223. CrossRefGoogle Scholar
  28. 28.
    Lam MP, Cheung BM, Wong IC (2015) Prevalence of potentially inappropriate prescribing among Hong Kong older adults: a comparison of the Beers 2003, beers 2012, and screening tool of older person’s prescriptions and screening tool to alert doctors to right treatment criteria. J Am Geriatr Soc 63:1471–1472. CrossRefGoogle Scholar
  29. 29.
    Chrischilles E, Rubenstein L, Van Gilder R et al (2007) Risk factors for adverse drug events in older adults with mobility limitations in the community setting. J Am Geriatr Soc 55:29–34. CrossRefGoogle Scholar
  30. 30.
    Blanco-Reina E, Ariza-Zafra G, Ocana-Riola R et al (2014) 2012 American Geriatrics Society Beers criteria: enhanced applicability for detecting potentially inappropriate medications in European older adults? A comparison with the Screening Tool of Older Person’s Potentially Inappropriate Prescriptions. J Am Geriatr Soc 62:1217–1223. CrossRefGoogle Scholar
  31. 31.
    Nguyen JK, Fouts MM, Kotabe SE et al (2006) Polypharmacy as a risk factor for adverse drug reactions in geriatric nursing home residents. Am J Geriatr Pharmacother. 4:36–41. CrossRefGoogle Scholar
  32. 32.
    Akazawa Manabu, Imai Hirohisa, Igarashi Ataru et al (2010) Potentially inappropriate medication use in elderly Japanese patients. Am J Geriatr Pharmacother. 8:146–160. CrossRefGoogle Scholar
  33. 33.
    Freeland KN, Thompson AN, Zhao Y et al (2012) Medication use and associated risk of falling in a geriatric outpatient population. Ann Pharmacother 46:1188–1192. CrossRefGoogle Scholar
  34. 34.
    Dalleur O et al (2012) Inappropriate prescribing and related hospital admissions in frail older persons according to the STOPP and START criteria. Drugs Aging 29:829–837. CrossRefGoogle Scholar
  35. 35.
    Bala SS, Jamieson HA, Nishtala PS (2018) Factors associated with inappropriate prescribing among older adults with complex care needs who have undergone the interRAI assessment. Curr Med Res Opin 31:1–16. Google Scholar
  36. 36.
    Fulone I, Lopes LC (2017) Potentially inappropriate prescriptions for elderly people taking antidepressant: comparative tools. BMC Geriatr 2:278. CrossRefGoogle Scholar
  37. 37.
    Sergi G, De Rui M, Sarti S et al (2011) Polypharmacy in the elderly: can comprehensive geriatric assessment reduce inappropriate medication use? Drugs Aging 28:509–518. CrossRefGoogle Scholar
  38. 38.
    Patel T, Slonim K, Lee L (2017) Use of potentially inappropriate medications among ambulatory home-dwelling elderly patients with dementia: a review of the literature. Can Pharm J 150:169–183. CrossRefGoogle Scholar
  39. 39.
    Hukins D, Macleod U, Boland JW (2019) Identifying potentially inappropriate prescribing in older people with dementia: a systematic review. Eur J Clin Pharmacol 75:467–481. CrossRefGoogle Scholar
  40. 40.
    Zeenny R, Wakim S, Kuyumjia YM (2012) Potentially inappropriate medications use in community-based aged patients: a cross-sectional study using beers criteria. Clin Interv Aging 2017:65–73. Google Scholar
  41. 41.
    Payette H, Coulombe C, Boutier V et al (2000) Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population. J Clin Epidemiol 53:579–587. CrossRefGoogle Scholar
  42. 42.
    Andel R, Hyer K, Slack A (2007) Risk factors for nursing home placement in older adults with and without dementia. J Aging Health 19:213–228. CrossRefGoogle Scholar
  43. 43.
    Agro-Torres H, von Strauss E, Viitanen M et al (2001) Institutionalization in the elderly: the role of chronic diseases and dementia cross- sectional and longitudinal data from a population-based study. J Clin Epidemiol 54:795–801. CrossRefGoogle Scholar
  44. 44.
    Griep MI, Mets TF, Collys K et al (2000) Risk of malnutrition in retirement homes elderly persons measured by the ‘‘mini-nutritional assessment’’. J Gerontol A Biol Sci Med Sci 55:57–63. CrossRefGoogle Scholar
  45. 45.
    Agostini JV, Han L, Tinetti ME et al (2004) The relationship between number of medications and weight loss or impaired balance in older adults. J Am Geriatr Soc 52:1719–1723. CrossRefGoogle Scholar
  46. 46.
    Ortolani E, Landi F, Martone AM et al (2013) Nutritional status and drug therapy in older adults. J Gerontol Geriat Res 2:123. CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Pinar Kucukdagli
    • 1
    Email author
  • Gulistan Bahat
    • 1
  • Ilker Bay
    • 1
  • Cihan Kilic
    • 1
  • Meryem Merve Oren
    • 2
  • Banu Ozulu Turkmen
    • 1
  • Mehmet Akif Karan
    • 1
  1. 1.Division of Geriatrics, Department of Internal Medicine, Istanbul Medical SchoolIstanbul UniversityIstanbulTurkey
  2. 2.Erzurum Provincial Health Directorate, Public Health Services PresidencyErzurumTurkey

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