Potentially inappropriate prescribing in older patients admitted to psychiatric hospital

The objectives of this study are to determine the prevalence of potentially inappropriate prescribing including potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs) and to assess related risk factors in older people with major psychiatric illness.

This was a cross-sectional study of older patients hospitalized in a psychiatric hospital (n = 164; mean age 74.9 ± 7.3 years; 62% female). The primary endpoint was the prevalence of participants receiving PIMs and PPOs, which was assessed by using the Beers criteria 2012 and the screening tool of older person's potentially inappropriate prescriptions (STOPP) and screening tool of alert doctors to the right treatment (START) criteria. Univariate and multivariate logistic regression was used to assess significant risk factors for PIMs in this population.

A total of 1269 drugs were prescribed to included patients (range: 0-19 drugs/day). PIMs were identified in 47% and 79% of participants, based on the Beers 2012 and STOPP criteria, respectively. Most PIMs (70%) concerned psychotropic drugs. The STOPP criteria identified more PIMs (331) than the Beers criteria 2012 (199). According to the START criteria, 59% of participants had PPOs. The number of prescribed medications was significantly associated with the occurrence of PIMs according to the Beers 2012 [OR 1.2 (95% CI 1.1-1.3)] and STOPP [OR 1.5 (95% CI 1.3-1.8)] criteria.

Potentially inappropriate prescribing, as identified by the Beers and STOPP/START criteria, is highly prevalent among older patients hospitalized with major psychiatric illness. However, the focus on psychotropic drugs prescription without taking into account the benefit of these drugs to individual patients may limit the application of the Beers and STOPP criteria in psychiatric hospitals.