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Objective <p>To assess potentially inappropriate medication use (IMU), including both potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) according to the Turkish Inappropriate Medication Use in oldEr adults (TIME) criteria in older nursing home residents and to investigate its association with common geriatric syndromes.</p> Methods <p>This multi-center cross-sectional observational study was conducted from December 2023 to June 2024 across three nursing homes in Istanbul. Two geriatricians performed comprehensive geriatric assessments and used TIME criteria to identify IMU. The link between prevalent geriatric syndromes and IMU was examined.</p> Results <p>We included 165 residents with a mean age of 84.6 ± 7.9 years, 71.5% of whom were female. Of the participants, 81.6% (<i>n</i> = 134) had dementia. Respectively, 93% (<i>n</i> = 154) and 51% (n = 85) of the participants had polypharmacy and hyperpolypharmacy. The top three PIPs according to TIME-to-STOP criteria were tight blood pressure control with antihypertensives (51.5%), use of neuroleptics as hypnotics(50.3%), and proton pump inhibitors (PPIs) for multiple drug use indication (47.3%).Based on the TIME-to-START criteria, the three most common PPOs were the omission of acetylcholinesterase inhibitors for mild–moderate Alzheimer’s disease and memantine for moderate–severe Alzheimer’s disease and failure to initiate oral nutritional supplements in malnourished or at-risk individuals(47.9%).TIME-to-STOP PIPs were significantly associated with polypharmacy (<i>p</i> &lt; 0.001) in univariate analysis. In the logistic regression analyses of variables associated with TIME-to-START PPO, significant associations were observed with age (odds ratio (OR) = 1.14; 95% confidence interval (CI): 1.02–1.27; <i>p</i> = 0.015) and frailty (OR: 2.95; 95% CI: 1.209–7.201; <i>p</i> = 0.017), the latter conferring a roughly threefold increased risk.</p> Conclusion <p>Polypharmacy and IMU were highly prevalent among nursing home residents, and national/international prescribing tools like the TIME criteria are valuable in detecting both PIPs and PPOs. Frailty was significantly associated with prescribing omissions as identified by the TIME-to-START criteria, underscoring the need for targeted interventions in this vulnerable population.</p>

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Potentially inappropriate medication use by TIME criteria in nursing home residents and its relationship with common geriatric syndromes

  • 期刊论文

  • 发表日期：

    2025年11月1日

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  • Yasin Yildiz,
  • Nurdan Şentürk Durmuş,
  • Vildan Kandemir Bütün,
  • Berfin Dinsel Inan,
  • Banu Korkmaz Numanoğlu,
  • Muhammed Emin Çelenk,
  • Esra Dicle Kaya,
  • Zeynep Beşişik Yilmaz,
  • Çiğdem Alkaç,
  • Büşra Can,
  • Aslı Tufan,
  • Gulistan Bahat

摘要

Objective

To assess potentially inappropriate medication use (IMU), including both potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) according to the Turkish Inappropriate Medication Use in oldEr adults (TIME) criteria in older nursing home residents and to investigate its association with common geriatric syndromes.

Methods

This multi-center cross-sectional observational study was conducted from December 2023 to June 2024 across three nursing homes in Istanbul. Two geriatricians performed comprehensive geriatric assessments and used TIME criteria to identify IMU. The link between prevalent geriatric syndromes and IMU was examined.

Results

We included 165 residents with a mean age of 84.6 ± 7.9 years, 71.5% of whom were female. Of the participants, 81.6% (n = 134) had dementia. Respectively, 93% (n = 154) and 51% (n = 85) of the participants had polypharmacy and hyperpolypharmacy. The top three PIPs according to TIME-to-STOP criteria were tight blood pressure control with antihypertensives (51.5%), use of neuroleptics as hypnotics(50.3%), and proton pump inhibitors (PPIs) for multiple drug use indication (47.3%).Based on the TIME-to-START criteria, the three most common PPOs were the omission of acetylcholinesterase inhibitors for mild–moderate Alzheimer’s disease and memantine for moderate–severe Alzheimer’s disease and failure to initiate oral nutritional supplements in malnourished or at-risk individuals(47.9%).TIME-to-STOP PIPs were significantly associated with polypharmacy (p < 0.001) in univariate analysis. In the logistic regression analyses of variables associated with TIME-to-START PPO, significant associations were observed with age (odds ratio (OR) = 1.14; 95% confidence interval (CI): 1.02–1.27; p = 0.015) and frailty (OR: 2.95; 95% CI: 1.209–7.201; p = 0.017), the latter conferring a roughly threefold increased risk.

Conclusion

Polypharmacy and IMU were highly prevalent among nursing home residents, and national/international prescribing tools like the TIME criteria are valuable in detecting both PIPs and PPOs. Frailty was significantly associated with prescribing omissions as identified by the TIME-to-START criteria, underscoring the need for targeted interventions in this vulnerable population.