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Geriatric prescribing patterns: a beers 2023 criteria pharmacoepidemiologic analysis, Alexandria, Egypt
Abstract
Background: In the geriatric population, the appropriateness of medication requires meeting multiple criteria, such as having a clear evidence-based indication, being well-tolerated by the majority, and being sufficiently cost-effective. In African countries, standardized Potentially Inappropriate Medication use criteria are rarely used.
Aim: We aimed in this study to estimate the prevalence of inappropriate medication prescribing patterns among geriatric patients aged 65 years or more in Alexandria, Egypt, and to determine the characteristics and risk factors for such patterns.
Methods: Cluster sampling was used as the sampling technique, and the sample size reached 1,000 prescriptions representing all districts of the Alexandria governorate. The updated 2023 Beers Criteria were utilized to identify potentially inappropriate prescribing. Inappropriate prescribing was considered if at least one inappropriate medication fell into at least one of the mentioned categories stated in the 2023 Beers Criteria.
Results: About 64.1% of prescriptions included three or more medications. Notably, 31.8% of prescriptions contained three medications, while 25.5% included four medications. A total of 463 (46.3) prescriptions were potentially inappropriate. The full logistic regression model, which included all predictors, was statistically significant, χ² (20, N=1147) = 372.825, p < .001. Several independent variables made a unique statistically significant contribution to the model, including district, physician grade, and the number of medications prescribed.
Conclusion: It is advisable to standardize prescribing systems, particularly for the older population.
Received: 22 May 2025
Accepted: 09 July 2025
Published on, 18 August 2025
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O’Mahony D, Gallagher PF. Inappropriate prescribing in the older population: Need for new criteria. Vol. 37, Age and Ageing. 2008.
Dovjak P. Polypharmacy in elderly people. Wiener Medizinische Wochenschrift. 2022;172(5–6).
Beezer J, Al Hatrushi M, Husband A, Kurdi A, Forsyth P. Polypharmacy definition and prevalence in heart failure: a systematic review. Vol. 27, Heart Failure Reviews. 2022.
Lavan AH, Gallagher PF, O’Mahony D. Methods to reduce prescribing errors in elderly patients with multimorbidity. Vol. 11, Clinical Interventions in Aging. 2016.
Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Vol. 13, Expert Opinion on Drug Safety. 2014.
Fick DM, Semla TP, Steinman M, Beizer J, Brandt N, Dombrowski R, et al. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4).
Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly an update. Arch Intern Med. 1997;157(14).
American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7).
Tian F, Chen Z, Zeng Y, Feng Q, Chen X. Prevalence of Use of Potentially Inappropriate Medications among Older Adults Worldwide: A Systematic Review and Meta-Analysis. Vol. 6, JAMA Network Open. 2023.
World B. Population ages 65 and above (% of total population) – Egypt. Federal Reserve Economic Data (FRED) [Internet]. 2023. Available from: https://fred.stlouisfed.org/series/SPPOP65UPTOZSEGY
Pasina L, Astuto S, Cortesi L, Tettamanti M, Franchi C, Marengoni A, et al. Therapeutic Duplicates in a Cohort of Hospitalized Elderly Patients: Results from the REPOSI Study. Drugs Aging. 2016;33(9).
Daniel WW. Biostatistics: A Foundation for Analysis in the Health Sciences. Biometrics. 1995;51(1).
Lachenbruch PA, Lwanga SK, Lemeshow S. Sample Size Determination in Health Studies: A Practical Manual. J Am Stat Assoc. 1991 Dec;86(416):1149.
Cohen J. Statistical Power Analysis for the Behavioral Sciences. Statistical Power Analysis for the Behavioral Sciences. 2013.
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstem AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12).
Willcox SM, Himmelstein DU, Woolhandler S. Inappropriate Drug Prescribing for the Community-Dwelling Elderly. JAMA: The Journal of the American Medical Association. 1994;272(4).
Levy PS, Lemeshow S. Sampling of Populations: Methods and Applications. John Wiley & Sons; 2013.
AHFS Classification - Drug Assignments [Internet]. 2023. Available from: https://ahfsdruginformation.com/ahfs-classification-drug-assignments/
Barrons R. Evaluation of personal digital assistant software for drug interactions. American Journal of Health-System Pharmacy. 2004;61(4).
Stoltzfus JC. Logistic regression: A brief primer. Academic Emergency Medicine. 2011;18(10).
Tabachnick BG, Fidell LS, Ullman JB. Using multivariate statistics . Boston, MA: pearson. 2013;6:497–516.
Hosmer DW, Lemeshow S, Sturdivant RX. Applied Logistic Regression. Wiley; 2013.
Maxwell SRJ. Rational prescribing: The principles of drug selection. Clinical Medicine, Journal of the Royal College of Physicians of London. 2016;16(5).
Myers B, Mitchell C, Whitty JA, Donovan P, Coombes I. Prescribing and medication communication on the post-take ward round. Intern Med J. 2017;47(4).
Anderson K, Stowasser D, Freeman C, Scott I. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: A systematic review and thematic synthesis. BMJ Open. 2014;4(12).
Patel P, et al. Drug interactions with amiodarone: mechanisms and clinical management. American Journal of Cardiovascular Drugs. 2020;20(6):563–76.
The Mechanism and Drug Interaction - Amiodarone and Digoxin [Internet]. Available from: https://www.ebmconsult.com/articles/digoxin-amiodarone-cordarone-drug-interaction-mechanism
Whelton A. Nephrotoxicity of nonsteroidal anti-inflammatory drugs: Physiologic foundations and clinical implications. In: American Journal of Medicine. 1999.
Patsalos PN, Perucca E. Clinically important drug interactions in epilepsy: Interactions between antiepileptic drugs and other drugs. Vol. 2, Lancet Neurology. 2003.
Dalbeth N, Lauterio TJ, Wolfe HR. Colchicine toxicity and therapeutic use: a review. Rheumatology (Oxford). 2014;53(3):407–15.
Oplinger M, Andrews CO. Nitrofurantoin contraindication in patients with a creatinine clearance below 60 mL/min: Looking for the evidence. Annals of Pharmacotherapy. 2013;47(1).
Fox C, Richardson K, Maidment ID, Savva GM, Matthews FE, Smithard D, et al. Anticholinergic medication use and cognitive impairment in the older population: The medical research council cognitive function and ageing study. J Am Geriatr Soc. 2011;59(8).
Spinewine A, Swine C, Dhillon S, Franklin BD, Tulkens PM, Wilmotte L, et al. Appropriateness of use of medicines in elderly inpatients: Qualitative study. Br Med J. 2005;331(7522).
Roux B, Sirois C, Simard M, Gagnon ME, Laroche ML. One-year persistence of potentially inappropriate medication use in older adults: A population-based study. Br J Clin Pharmacol. 2020;86(6).
Zhang H, Wong ELY, Wong SYS, Chau PYK, Yip BHK, Chung RYN, et al. Prevalence and determinants of potentially inappropriate medication use in Hong Kong older patients: A cross-sectional study. BMJ Open. 2021;11(7).
Roux B, Sirois C, Simard M, Gagnon ME, Laroche ML. Potentially inappropriate medications in older adults: a population-based cohort study. Fam Pract. 2020;37(2).
Garcia RM. Five ways you can reduce inappropriate prescribing in the elderly: A systematic review. Vol. 55, Journal of Family Practice. 2006.
Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Vol. 370, Lancet. 2007.
Monteiro L, Maricoto T, Solha I, Ribeiro-Vaz I, Martins C, Monteiro-Soares M. Reducing potentially inappropriate prescriptions for older patients using computerized decision support tools: Systematic review. Vol. 21, Journal of Medical Internet Research. 2019.
DOI: https://dx.doi.org/10.21622/AMPDR.2025.05.2.1365
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Copyright (c) 2025 Mohamed Metwally Mosly, Hesham Metwalli Mousli
Advances in Medical, Pharmaceutical and Dental Research
E-ISSN: 2812-4898
P-ISSN: 2812-488X
Published by:
Academy Publishing Center (APC)
Arab Academy for Science, Technology and Maritime Transport (AASTMT)
Alexandria, Egypt
