[Current State of Appropriate Medication Use in Older Adults and Future Prospects]

Medication is the most common strategy for addressing the healthcare needs of older adults. In order to treat disease, maintain health, prevent further declines in health, prolong survival, and improve quality of life, the proper use of medicine is of great importance in the care of older patients (de Oliveira Alves, Schuelter-Trevisol, & Trevisol, 2014). Since the physician Dr. Beers put forward the concept of potentially inappropriate medication (PIM) almost thirty years ago in 1991 (Beers et al., 1991), scholars around the world have issued explicit criteria related to PIM for clinical and research purposes. It is necessary for the first-line medical personnel who are involved in caring for older patients to increase their knowledge and understanding of the medication status of their older patients, clarify the indications of medicines taken by these patients, and become familiar with the tools used to assess the appropriateness of medications in order to assist the medical team to identify PIM and to serve as a channel between older patients and the medical team. A systematic literature review found prevalences of PIM among older individuals ranging from 3.6% to 92.0% (Nothelle, Sharma, Oakes, Jackson, & Segal, 2017; Redston, Hilmer, McLachlan, Clough, & Gnjidic, 2018; Storms, Marquet, Aertgeerts, & Claes, 2017), subject to different research samples, study sites, and assessment tools. The prevalence of PIM among older patients in Taiwan has been estimated at 9.8%-91.2% (Chang et al., 2011; Huang, Yeh, Hung, Hsieh, & Tsai, 2011; Lin, Peng, Chen, Lin, & Hwang, 2011; Shen, 2008), which indicates that the problem of PIM among older patients in Taiwan is no less serious than in Europe or the United States. A survey of medication used by older adult inpatients at a medical center in northern Taiwan found the incidences of PIM in the sample to be 76.3%, 80.9%, 70.0%, 69.1%, and 75.2%, respectively, at hospital admission, during hospitalization, at discharge, at the first return visit, and 3 months after discharge (Ho, 2017). This not only revealed a high prevalence of PIM among older people in Taiwan but also suggests that PIM may initially decrease and subsequently increase over time after hospital discharge. This possible trend deserves further assessment and attention. Nurses, especially homecare nurses, are frontline personnel in medical care who play an important role in reviewing medication safety. Lou (2016) used focus group research to explore the challenges of medication safety faced by older patients under the care of homecare nurses. The study found that homecare nurses lack the self-confidence necessary to review of the appropriateness of medication due to several factors, including medication complexity, lack of clinical experience, the regular introduction of new drugs, and the fact that homecare nurses are not medical experts. Lou further used PIM-Taiwan criteria (version 1) to design and develop an application software program (app) that reviews automatically the appropriateness of medications given to older patients. This app is a supplemental assistance device for non-drug experts and facilitates the timely reporting of medication review results to prescribing physicians. The app was further shown to have a positive and significant impact in a demonstration trial. The administration of medication is a key part of the routine work of nurses. In addition to administering correct dosages, nurses should have a better understanding of the appropriateness of medications. Nurses should not only be familiar with the medicines that they give to their older patients but should also be able to identify their appropriateness. They should make good use of explicit criteria to identify the appropriateness of medications and apply related technological products in clinical situations in order to improve quality of care in terms of medication safety for older patients.