الفهرس 
GERIATRICSOnly 14 pages are availabe for public view
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Abstract
Drug use is widespread in elderly patients. It is also complicated by agerelated changes which increase the response to many drugs. These changes with
the extensive use of drugs and high prevalence of co -morbidities increase the risk
of inconvenient effects of drugs in elderly patients. Inappropriate drug use (IDU) is
an imperative health care problem in elderly and it is linked with adverse drug
reactions, hospitalization, and mortality.
Potentially inappropriate medications (PIMs) use is a chief problem among
older people, and may be committed to increase risk of adverse drug effects and to
develop drug-drug and drug-disease interactions. Appropriate prescribing can be
evaluated by using explicit and implicit criteria. The most commonly used explicit
criteria are the Beers criteria and STOPP & START criteria. Although the most
commonly used implicit criteria are medication appropriateness index (MAI).
These tools include a list of inappropriate drugs that should be avoided in older
patients. All of the above stress on the role of the clinical pharmacist in detection
of the potentially inappropriate medication through the application of the above
tools.
This study was conducted to minimize drug related problems in elderly
patients after evaluating their occurrence and causes. This was done through four
phases: evaluation of the medications related problems in the control group (150
patients) that will be occurred and analysis of them, construction of pharmaceutical
care plan to solve these problems, educational intervention for pharmacists,
patients, nurses and physicians and finally application of this plan on the
intervention group (150 patients).
The primary objective of this study is to determine whether the complex
intervention would change the quality of medication therapy determined by the explicit criteria by using Beers criteria and STOPP & START criteria in
comparison to control group. The intervention focuses on multi-morbid patients
receiving polypharmacy. Moreover, medication appropriateness index was done as
a secondary measure.
In the current study it was found that:
The age of participants was in harmony with the general life expectancy of
elderly, with relative predominance of female patients.
The main cause of morbidity found in our study was hypertension followed
by diabetes and ischemic heart diseases. The most frequently used drugs
were aspirin, omeprazole and ACE Inhibitors.
The number of patients suffered from inappropriate prescribing was
significantly higher in control group than in intervention groups according to
STOPP & START criteria and Beers criteria. Furthermore, pharmacist
intervention significantly improved the prescribing procedure.
According to medication appropriateness index (MAI), before the
intervention 99.0% of medications and 99.3% of patients met at least 1
criterion of inappropriateness, while after the intervention only 22.8% of
medications and 70.6% of patients showed at least 1 criterion of
inappropriateness.
Average MAI score per patient decreased from 17 in the control group to 4
in the intervention group.
Polypharmacy and number of morbidities are associated with the risk of
inappropriateness of indicated medicines.
All of the above re-highlights the important role of pharmaceutical
intervention in the setting of geriatric care.