Background: The elderly are frequently exposed to drug related problems causing hospitalizations and increased\ncosts of care. Information about Romanian prescribing practices among the elderly and potential medication\nassociated- risks is lacking. The objective of this study was to identify and compare the most frequent potentially\ninappropriate medications (PIM) recommended to ambulatory and institutionalized Romanian elderly, through an\nobservational retrospective design.\nMethods: All reimbursed medications prescribed to a sample of ambulatory elderly accessing two community\npharmacies and all medications recommended to a group of institutionalized elderly (urban facilities, Romania,\nsame month) were analyzed. The STOPP/START criteria and the PRISCUS list were used for PIM identification and for\nclassification as misprescribed, underprescribed or overprescribed -subtypes.\nResults: The analysis involved 345 prescriptions recommended to ambulatory elderly and 91 medical files available\nfor the institutionalized patients. The ambulatory elderly had a mean age of 74.8 years old and were daily exposed\nto a median number of 3 prescribed medications. The institutionalized elderly were older (mean age 80.77)\nreceived 8 medications daily and 69 % of them were functionally dependent. Cardiovascular and neuropsychiatric\nindications were the most frequent: 64.34 % and 18.55 % of the ambulatory prescriptions, 93.40 % and 41.75 % of\nthe institutionalized patients� medical files. 159 PIM were identified on 34.49 % of the ambulatory prescriptions. 82.\n41 % of the institutionalized patients� medical files contained 140 PIM. The potential underprescribing of\ncardiovascular therapies was the most frequent PIM category on the ambulatory prescriptions (55.34 % of all PIM),\nwhile for the institutionalized patients� medical files, the misprescribed and overprescribed PIM were those\npredominantly represented (62.14 % and 27.14 % of all PIM). In both subgroups of data, NSAIDs (56.66 % of\nambulatory prescriptions and 35.63 % of institutionalized patients� data) and benzodiazepines (26.66 % of\nambulatory prescriptions and 24.13 % of institutionalized patient�s data) were predominantly misprescribed.\nAnticholinergics were rarely used (0.62 % of total PIM from ambulatory prescriptions, 2.14 % of total PIM from\ninstitutionalized patients� data).\nConclusions: The PIM identified in both elderly groups suggested potential risks for the occurrence of adverse\nevents specific to the elderly population. Larger studies, both observational and interventional, are needed to\nensure a safer therapeutic approach.
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