Evaluation of inappropriate drug use in geriatric patients using the TIME-to-STOP/TIME-to-START criteria in a tertiary hospital
Yıl 2023,
Cilt: 27 Sayı: 2, 687 - 695, 27.06.2025
Ajla Hodzıc
,
Berna Terzioğlu Bebitoğlu
,
Elif Oğuz
,
Banu Mesci
,
Nurgül Bulut
Öz
This study aimed to determine the frequency and factors affecting inappropriate drug use and
polypharmacy in geriatric patients. The data on 318 geriatric patients hospitalized between January 1, 2020, and July 1,
2020, in the internal medicine clinic of a tertiary hospital were analyzed retrospectively. Inappropriate drug use was
evaluated according to the Turkish Inappropriate Medication Use in the Elderly (TIME) TIME-to-STOP/ TIME-to-
START criteria. Of the 318 patients, 157 (49.4%) used at least one potentially inappropriate drug. The most frequently
used inappropriate drugs according to TIME-to-START criteria were related to (B) the central nervous system (n = 28;
53.89%), (A) the cardiovascular system (n = 26; 33.33%), and (I) supplements (n = 24; 30.77%). The most frequently used
inappropriate drugs according to TIME-to-STOP criteria were related to (B) the central nervous system (n = 258; 45.18%),
(C) the gastrointestinal system (n = 224; 39.23%), and (D) the respiratory system (n = 44; 7.71%). A total of 225 (70.8%)
patients engaged in polypharmacy at least once. Conclusion: There is a high rate of potentially inappropriate drug use
and polypharmacy among Turkish geriatric patients. The use of published guidelines should be expanded in Turkey.
Kaynakça
- Kerry Z. Rational drug use in elderly. Ege Journal of Medicine 2015;54:62-72. (Article in Turkish)
[https://doi.org/10.19161/etd.344151]
- Trifiro G, Spina E. Age-related Changes in Pharmacodynamics: Focus on Drugs Acting on Central Nervous and
Cardiovascular Systems. Curr Drug Metab. 2011;12:611. [https://doi.org/10.2174/138920011796504473]
- Mand P, Roth K, Biertz F, Kersting M, Kruschinski C, Schmiemann G, Hummers-Pradier E. Drug-disease interaction in
elderly patients in family practice. Int J Clin Pharmacol Ther 2014;52(5):337-45. [https://doi.org/ 10.5414/CP202003]
- Rattan SIS. Molecular and Cellular Basis of Aging. In: Malavolta M, Mocchegiani E. (Eds). Molecular basis of nutrition
and aging. Academic Press., London, 2016, pp. 73-107. [https://doi.org/10.1016/B978-0-12-801816-3.00001-7]
- Leporini C, De Sarro G, Russo E. Adherence to therapy and adverse drug reactions: is there a link? Expert Opin Drug
Saf 2014;13(1):41-55. [https://doi.org/ 10.1517/14740338.2014.947260]
- Bozkurt E, Parlar A, Arslan S. Investigation of Inappropriate Drug Use in Elderly Patients and Polifarmacy Presence.
ADYÜ Sağlık Bilimleri Derg 2019;5(1):1254-1266. (Article in Turkish) [https://doi.org/10.30569/adiyamansaglik.513045
- Beers MH, Ouslander JG, Rollingher I, et al. Explicit criteria for determining inappropriate medication use in nursing
home residents. Arch Intern Med 1991;151:1825–1832. [https://doi.org/10.1001/archinte.1991.00400090107019]
- Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch
Intern Med. 1997;157:1531–1536. [https://doi.org/ 10.1001/archinte.1997.00440350031003]
- Pérez-Jover V, Mira JJ, Carratala-Munuera C. Inappropriate Use of Medication by Elderly, Polymedicated, or
Multipathological Patients with Chronic Diseases. Int J Environ Res Public Health 2018;15(2):310.
[https://doi.org/10.3390/ijerph15020310]
- De Oliveira Alves C, Schuelter-Trevisol F, Trevisol DJ. Beers criteria-based assessment of medication use in
hospitalized elderly patients in southern Brazil. J Family Med Prim Care 2014;3(3):260-265. [https://doi.org/10.4103/2249-
4863.141628]
- Galli TB, Reis WC, Andrzejevski VM. Potentially inappropriate prescribing and the risk of adverse drug reactions in
critically ill older adults. Pharmacy Practice 2016; 14(4):818. [https://doi.org/10.18549/PharmPract.2016.04.818]
- Moreira FSM, Jerez-Roig J, Ferreira LMBM, Dantas APQM, Lima KC, Ferreira MAF. Use of potentially inappropriate
medications in institutionalized elderly: prevalence and associated factors. Cien Saude Colet. 2020;25(6):2073-2082.
[https://doi.org/10.1590/1413-81232020256.26752018]
- Grina D, Briedis V. The use of potentially inappropriate medications among the Lithuanian elderly according to Beers
and EU (7)-PIM list -a nationwide cross-sectional studyon reimbursement claims data. J Clin Pharm Ther. 2017;42(2):195-
200. [https://doi.org/10.1111/jcpt.12494]
- Lopez-Rodriguez JA, Rogero-Blanco E, Aza-Pascual-Salcedo M, LopezVerde F, Pico-Soler V, Leiva-Fernandez F,
Prados-Torres JD, PradosTorres A, Cura-González I; MULTIPAP group. Potentially inappropriate prescriptions according
to explicit and implicit criteria in patients with multimorbidity and polypharmacy. MULTIPAP: A cross- sectional study.
PLoS One. 2020;15(8): e0237186. [https://doi.org/10.1371/journal.pone.0237186]
- Tosato M, Landi F, Martone AM, Cherubini A, Corsonello A, Volpato S, Bernabei R, Onder G; Investigators of the
CRIME Study. Potentially inappropriate drug use among hospitalised older adults: results from the CRIME study. Age
Aging. 2014;43(6):767-73. [https://doi.org/10.1093/ageing/afu029]
- Ertem Ö, Kasım İ, Özkara A, Koç EM, Kahveci R, Şencan İ. Inappropriate Drug Use in Hospitalized Elderly Patients.
Euras J Fam Med 2015;4(3):117-25. (Article in Turkish). [https://doi.org/10.30569/adiyamansaglik.513045]
- Bahat G, Ilhan B, Erdogan T, Savas S, Ulger Z. Turkish inappropriate medication use in the elderly (TIME) criteria to
improve prescribing in older adults: TIME-to-STOP/TIME-to-START. Eur Geriatr Med 2020;11(3):491-498.
[https://doi.org/10.1007/s41999-020-00297-z]
- Küçükdağılı P. Polypharmacy and Related Factors in Geriatric Outpatients Eur J Geriatr Gerontol 2019;1(2):56-60.
[https://doi.org/10.4274/ejgg.galenos.2019.144]
- Masnoon, N., Shakib, S., Kalisch-Ellett, L. et al. What is polypharmacy? A systematic review of definitions. BMC
Geriatr 17, 230 (2017). [https://doi.org/10.1186/s12877-017-0621-2]
- Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults:
register-based prospective cohort study. Clin Epidemiol. 2018;10:289-298. [https://doi.org/10.2147/CLEP.S153458]
- Rawle MJ, Richards M, Davis D, Kuh D. The prevalence and determinants of polypharmacy at age 69: a British birth
cohort study. BMC Geriatr. 2018;18(1):118. [https://doi.org/10.1186/s12877-018-0795-2]
- Haider SI, Ansari Z, Vaughan L, Matters H, Emerson. Prevalence and factors associated with polypharmacy in
Victorian adults with intellectual disability. E Res Dev Disabil. 2014; 35(11):3071.
[https://doi.org/10.1016/j.ridd.2014.07.060]
- Midao L, Giardini A, Menditto E. Polypharmacy prevalence among older adults based on the survey of health,
Ageing and retirement in Europe. Arch Gerontol Geriatr 2018; 78:213–220.
[https://doi.org/10.1016/j.archger.2018.06.018].
- Cankara FN Aşcı H, Sönmez. Physicians' drug preferences and polypharmacy presence in inpatients of university
hospital. 2015;1–6. (Article in Turkish)
- Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications
For health care, research, and medical education: a cross-sectional study. Lancet. 2012;380:37–43.
[https://doi.org/10.1016/S0140-6736(12)60240-2].
- Parminder R, Gilsing A, Mayhew AJ, Sohel N, van den Heuvel E, Griffith LE. Individual and population level impact
of chronic conditions on functional disability in older adults. PloS One. 2020;15(2):e0229160.
[https://doi.org/10.1371/journal.pone.0229160].
- Brandao GR, Teixeira L, Araújo L, Paúl C, Ribeiro O. Self-medication in older European adults: Prevalence and
predictive factors. Arch Gerontol Geriatr. 2020;21;91:104189. Epub ahead of print.
[https://doi.org/10.1016/j.archger.2020.104189]
- Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people.BMJ.1997; 25;315(7115):1096-9
[https://doi.org/10.1136/bmj.315.7115.1096]
- Ahmed B, Nanji K, Mujeeb R, Patel MJ. Effects of polypharmacy on adverse drug reactions among geriatric outpatients
at a tertiary care hospital in Karachi a prospective cohort study. PLoS One. 2014;9(11):e112133.
[https://doi.org/10.1371/journal.pone.0112133]
- Dias BM, Santos FS dos, Reis, Ao MM. (2019). Potential drug interactions in drug therapy prescribed for older adultsat
hospital discharge: cross-sectional study. Sao Paul Medical Journal, 2019;137(4), 369-378. [https://doi.org/10.1590/1516-
3180.2019.013405072019]
- Prybys K, Melville K, Hanna J. Polypharmacy in the elderly: Clinical challenges in emergency practice: Part 1:
Overview, etiology, and drug interactions. Emerg Med Rep 2002;23:145–53.
- Unutmaz GD, Soysal P, Tuven B, Isik AT. Costs of medication in older patients: before and after comprehensive
geriatric assessment. Clin Interv Aging. 2018;13:607-613. [https://doi.org/10.2147/CIA.S159966]
- Park JW, Roh JL, Lee SW, Kim SB, Choi SH, Nam SY, Kim SY. Effect of polypharmacy and potentially inappropriate
medications on treatment and posttreatment courses in elderly patients with head and neck cancer. J Cancer Res Clin
Oncol. 2016;142(5):1031-40. [https://doi.org/10.1007/s00432-015-2108-x]
- Alic A., Pranjic N., Ramic E. Polypharmacy and decreased cognitive abilities in elderly patients. Med. Arch.
2011;65:102–105. https://www.tuik.gov.tr/media/announcements/istatistiklerle_yaslilar_2020.pdf
- Pereira, TFF, De Sa Soares A, Trevisol JD, Trevisol SF. Assessing the overall medication use by elderly people in
Brazilian hospital using the start/stopp criteria version 2. Brazilian Journal of Pharmaceutical Sciences 2019;55.
[https://doi.org/10.1590/s2175-97902019000117739]
- Fahrni ML, Azmy MT, Usir E, Aziz NA, Hassan Y. Inappropriate prescribing defined by STOPP and START criteria
and its association with adverse drug events among hospitalized older patients: A multicentre, prospective study. PLoS
One 2019;14(7): e0219898. [https://doi.org/10.1371/journal.pone.0219898]
- Aydos T, Emre Aydıngöz S, Lux K, Efe O, İşli F. Polypharmacy Prevalence Among Gerıatrıc Patıents In Prımary
Healthcare Settıngs Across Turkey: A Cross-Sectıonal Analysıs Through The Nationwide Prescrıptıon Informatıon
System. The Turkish Journal of Geriatrics 2020;23(2):169-179. [http://doi.org/10.31086/tjgeri.2020.151]
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Yıl 2023,
Cilt: 27 Sayı: 2, 687 - 695, 27.06.2025
Ajla Hodzıc
,
Berna Terzioğlu Bebitoğlu
,
Elif Oğuz
,
Banu Mesci
,
Nurgül Bulut
Kaynakça
- Kerry Z. Rational drug use in elderly. Ege Journal of Medicine 2015;54:62-72. (Article in Turkish)
[https://doi.org/10.19161/etd.344151]
- Trifiro G, Spina E. Age-related Changes in Pharmacodynamics: Focus on Drugs Acting on Central Nervous and
Cardiovascular Systems. Curr Drug Metab. 2011;12:611. [https://doi.org/10.2174/138920011796504473]
- Mand P, Roth K, Biertz F, Kersting M, Kruschinski C, Schmiemann G, Hummers-Pradier E. Drug-disease interaction in
elderly patients in family practice. Int J Clin Pharmacol Ther 2014;52(5):337-45. [https://doi.org/ 10.5414/CP202003]
- Rattan SIS. Molecular and Cellular Basis of Aging. In: Malavolta M, Mocchegiani E. (Eds). Molecular basis of nutrition
and aging. Academic Press., London, 2016, pp. 73-107. [https://doi.org/10.1016/B978-0-12-801816-3.00001-7]
- Leporini C, De Sarro G, Russo E. Adherence to therapy and adverse drug reactions: is there a link? Expert Opin Drug
Saf 2014;13(1):41-55. [https://doi.org/ 10.1517/14740338.2014.947260]
- Bozkurt E, Parlar A, Arslan S. Investigation of Inappropriate Drug Use in Elderly Patients and Polifarmacy Presence.
ADYÜ Sağlık Bilimleri Derg 2019;5(1):1254-1266. (Article in Turkish) [https://doi.org/10.30569/adiyamansaglik.513045
- Beers MH, Ouslander JG, Rollingher I, et al. Explicit criteria for determining inappropriate medication use in nursing
home residents. Arch Intern Med 1991;151:1825–1832. [https://doi.org/10.1001/archinte.1991.00400090107019]
- Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch
Intern Med. 1997;157:1531–1536. [https://doi.org/ 10.1001/archinte.1997.00440350031003]
- Pérez-Jover V, Mira JJ, Carratala-Munuera C. Inappropriate Use of Medication by Elderly, Polymedicated, or
Multipathological Patients with Chronic Diseases. Int J Environ Res Public Health 2018;15(2):310.
[https://doi.org/10.3390/ijerph15020310]
- De Oliveira Alves C, Schuelter-Trevisol F, Trevisol DJ. Beers criteria-based assessment of medication use in
hospitalized elderly patients in southern Brazil. J Family Med Prim Care 2014;3(3):260-265. [https://doi.org/10.4103/2249-
4863.141628]
- Galli TB, Reis WC, Andrzejevski VM. Potentially inappropriate prescribing and the risk of adverse drug reactions in
critically ill older adults. Pharmacy Practice 2016; 14(4):818. [https://doi.org/10.18549/PharmPract.2016.04.818]
- Moreira FSM, Jerez-Roig J, Ferreira LMBM, Dantas APQM, Lima KC, Ferreira MAF. Use of potentially inappropriate
medications in institutionalized elderly: prevalence and associated factors. Cien Saude Colet. 2020;25(6):2073-2082.
[https://doi.org/10.1590/1413-81232020256.26752018]
- Grina D, Briedis V. The use of potentially inappropriate medications among the Lithuanian elderly according to Beers
and EU (7)-PIM list -a nationwide cross-sectional studyon reimbursement claims data. J Clin Pharm Ther. 2017;42(2):195-
200. [https://doi.org/10.1111/jcpt.12494]
- Lopez-Rodriguez JA, Rogero-Blanco E, Aza-Pascual-Salcedo M, LopezVerde F, Pico-Soler V, Leiva-Fernandez F,
Prados-Torres JD, PradosTorres A, Cura-González I; MULTIPAP group. Potentially inappropriate prescriptions according
to explicit and implicit criteria in patients with multimorbidity and polypharmacy. MULTIPAP: A cross- sectional study.
PLoS One. 2020;15(8): e0237186. [https://doi.org/10.1371/journal.pone.0237186]
- Tosato M, Landi F, Martone AM, Cherubini A, Corsonello A, Volpato S, Bernabei R, Onder G; Investigators of the
CRIME Study. Potentially inappropriate drug use among hospitalised older adults: results from the CRIME study. Age
Aging. 2014;43(6):767-73. [https://doi.org/10.1093/ageing/afu029]
- Ertem Ö, Kasım İ, Özkara A, Koç EM, Kahveci R, Şencan İ. Inappropriate Drug Use in Hospitalized Elderly Patients.
Euras J Fam Med 2015;4(3):117-25. (Article in Turkish). [https://doi.org/10.30569/adiyamansaglik.513045]
- Bahat G, Ilhan B, Erdogan T, Savas S, Ulger Z. Turkish inappropriate medication use in the elderly (TIME) criteria to
improve prescribing in older adults: TIME-to-STOP/TIME-to-START. Eur Geriatr Med 2020;11(3):491-498.
[https://doi.org/10.1007/s41999-020-00297-z]
- Küçükdağılı P. Polypharmacy and Related Factors in Geriatric Outpatients Eur J Geriatr Gerontol 2019;1(2):56-60.
[https://doi.org/10.4274/ejgg.galenos.2019.144]
- Masnoon, N., Shakib, S., Kalisch-Ellett, L. et al. What is polypharmacy? A systematic review of definitions. BMC
Geriatr 17, 230 (2017). [https://doi.org/10.1186/s12877-017-0621-2]
- Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults:
register-based prospective cohort study. Clin Epidemiol. 2018;10:289-298. [https://doi.org/10.2147/CLEP.S153458]
- Rawle MJ, Richards M, Davis D, Kuh D. The prevalence and determinants of polypharmacy at age 69: a British birth
cohort study. BMC Geriatr. 2018;18(1):118. [https://doi.org/10.1186/s12877-018-0795-2]
- Haider SI, Ansari Z, Vaughan L, Matters H, Emerson. Prevalence and factors associated with polypharmacy in
Victorian adults with intellectual disability. E Res Dev Disabil. 2014; 35(11):3071.
[https://doi.org/10.1016/j.ridd.2014.07.060]
- Midao L, Giardini A, Menditto E. Polypharmacy prevalence among older adults based on the survey of health,
Ageing and retirement in Europe. Arch Gerontol Geriatr 2018; 78:213–220.
[https://doi.org/10.1016/j.archger.2018.06.018].
- Cankara FN Aşcı H, Sönmez. Physicians' drug preferences and polypharmacy presence in inpatients of university
hospital. 2015;1–6. (Article in Turkish)
- Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications
For health care, research, and medical education: a cross-sectional study. Lancet. 2012;380:37–43.
[https://doi.org/10.1016/S0140-6736(12)60240-2].
- Parminder R, Gilsing A, Mayhew AJ, Sohel N, van den Heuvel E, Griffith LE. Individual and population level impact
of chronic conditions on functional disability in older adults. PloS One. 2020;15(2):e0229160.
[https://doi.org/10.1371/journal.pone.0229160].
- Brandao GR, Teixeira L, Araújo L, Paúl C, Ribeiro O. Self-medication in older European adults: Prevalence and
predictive factors. Arch Gerontol Geriatr. 2020;21;91:104189. Epub ahead of print.
[https://doi.org/10.1016/j.archger.2020.104189]
- Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people.BMJ.1997; 25;315(7115):1096-9
[https://doi.org/10.1136/bmj.315.7115.1096]
- Ahmed B, Nanji K, Mujeeb R, Patel MJ. Effects of polypharmacy on adverse drug reactions among geriatric outpatients
at a tertiary care hospital in Karachi a prospective cohort study. PLoS One. 2014;9(11):e112133.
[https://doi.org/10.1371/journal.pone.0112133]
- Dias BM, Santos FS dos, Reis, Ao MM. (2019). Potential drug interactions in drug therapy prescribed for older adultsat
hospital discharge: cross-sectional study. Sao Paul Medical Journal, 2019;137(4), 369-378. [https://doi.org/10.1590/1516-
3180.2019.013405072019]
- Prybys K, Melville K, Hanna J. Polypharmacy in the elderly: Clinical challenges in emergency practice: Part 1:
Overview, etiology, and drug interactions. Emerg Med Rep 2002;23:145–53.
- Unutmaz GD, Soysal P, Tuven B, Isik AT. Costs of medication in older patients: before and after comprehensive
geriatric assessment. Clin Interv Aging. 2018;13:607-613. [https://doi.org/10.2147/CIA.S159966]
- Park JW, Roh JL, Lee SW, Kim SB, Choi SH, Nam SY, Kim SY. Effect of polypharmacy and potentially inappropriate
medications on treatment and posttreatment courses in elderly patients with head and neck cancer. J Cancer Res Clin
Oncol. 2016;142(5):1031-40. [https://doi.org/10.1007/s00432-015-2108-x]
- Alic A., Pranjic N., Ramic E. Polypharmacy and decreased cognitive abilities in elderly patients. Med. Arch.
2011;65:102–105. https://www.tuik.gov.tr/media/announcements/istatistiklerle_yaslilar_2020.pdf
- Pereira, TFF, De Sa Soares A, Trevisol JD, Trevisol SF. Assessing the overall medication use by elderly people in
Brazilian hospital using the start/stopp criteria version 2. Brazilian Journal of Pharmaceutical Sciences 2019;55.
[https://doi.org/10.1590/s2175-97902019000117739]
- Fahrni ML, Azmy MT, Usir E, Aziz NA, Hassan Y. Inappropriate prescribing defined by STOPP and START criteria
and its association with adverse drug events among hospitalized older patients: A multicentre, prospective study. PLoS
One 2019;14(7): e0219898. [https://doi.org/10.1371/journal.pone.0219898]
- Aydos T, Emre Aydıngöz S, Lux K, Efe O, İşli F. Polypharmacy Prevalence Among Gerıatrıc Patıents In Prımary
Healthcare Settıngs Across Turkey: A Cross-Sectıonal Analysıs Through The Nationwide Prescrıptıon Informatıon
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