Potentially inappropriate medication in older adults that have the capacity to induce cognitive impairment: prevalence and associated factos
DOI:
https://doi.org/10.30968/jhphs.2025.164.1309Abstract
Objective: To investigate the prevalence of use of potentially inappropriate medications for older adults that have the capacity to induce cognitive impairment (PIMs-cog) and associated factors. Methods: Cross-sectional study with quantitative approach. PIMs-cog include drugs with anticholinergic, sedative, hypnotic effects and others capable of inducing delirium. Older adults were interviewed in two outpatient clinics of teaching hospitals in Belo Horizonte and in homes in the metropolitan region. The independent variables were divided into sociodemographic, pharmacotherapeutic and clinical-functional variables. The descriptive analysis included determination of the frequency of proportion for categorical variables and measures of central tendency and dispersion for numerical variables. Normality was assessed by the Shapiro-Wilk test. Univariate analysis was performed by Pearson’s chi-square test. Variables with p<0.20 were included in the multivariate analysis. In the final model, variables with p<0.05 remained. Results: A total of 344 older adults, with a median age of 67.5 years, participated in this study. PIMs-cog was used by 14.5% of older adults. The use of at least one PIM-cog was independently associated with the presence of polypharmacy (OR = 5.84, CI = 2.67–12.80, p = 0.00), cancer (OR = 5.07, CI = 2.18–11.76, p = 0.00), neuropsychiatric diseases (OR = 4.09, CI = 2.03–8.25, p = 0.00) and rheumatic disease (OR = 2.06, CI = 1.04–4.06, p = 0.04). Conclusion: The prevalence of PIM-cog use was 14.5% in the sample investigated and showed a positive and independent association with polypharmacy, cancer, neuropsychiatric diseases and rheumatic diseases.
Downloads
References
1. Dziechciaż M, Filip R. Biological psychological and social determinants of old age: bio-psycho-social aspects of human aging. Ann Agric Environ Med. 2014;21(4):835-838. doi:10.5604/12321966.1129943
2. Kritsilis M, V Rizou S, Koutsoudaki PN, et al. Ageing, Cellular Senescence and Neurodegenerative Disease. Int J Mol Sci. 2018;19(10):2937. doi:10.3390/ijms19102937
3. Randles MA, O’Mahony D, Gallagher PF. Frailty and Potentially Inappropriate Prescribing in Older People with Polypharmacy: A Bi-Directional Relationship?. Drugs Aging. 2022;39(8):597-606. doi:10.1007/s40266-022-00952-z
4. Reallon E, Chavent B, Gervais F, et al. Medication exposure and frailty in older community-dwelling patients: a cross-sectional study. Int J Clin Pharm. 2020;42(2):508-514. doi:10.1007/s11096-020-01007-2
5. Do D, Schnittker J. Utilization of Medications With Cognitive Impairment Side Effects and the Implications for Older Adults’ Cognitive Function. J Aging Health. 2020;32(9):1165-1177. doi:10.1177/0898264319895842
6. Sunwoo Y, Eom SH, Yun JS, et al. Real-World Data-Derived Pharmacovigilance on Drug-Induced Cognitive Impairment Utilizing a Nationwide Spontaneous Adverse Reporting System. Medicina (Kaunas). 2024;60(7):1028. doi:10.3390/medicina60071028
7. Taylor-Rowan M, Kraia O, Kolliopoulou C, et al. Anticholinergic burden for prediction of cognitive decline or neuropsychiatric symptoms in older adults with mild cognitive impairment or dementia. Cochrane Database Syst Rev. 2022;8(8):CD015196. doi:10.1002/14651858.CD015196.pub2em
8. American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372
9. O’Mahony D, Cherubini A, Guiteras AR, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023;14(4):625-632. doi:10.1007/s41999-023-00777-y
10. Hefner G, Hahn M, Toto S, et al. Potentially inappropriate medication in older psychiatric patients. Eur J Clin Pharmacol. 2021;77(3):331-339. doi:10.1007/s00228-020-03012-w
11. Kristensson JH, Zahirovic I, Londos E, et al. Medications causing potential cognitive impairment are common in nursing home dementia units - A cross-sectional study. Explor Res Clin Soc Pharm. 2021;3:100054. doi:10.1016/j.rcsop.2021.100054
12. Dos Santos ANM, Farias-Itao DS, Benseñor IM, et al. Potentially inappropriate medications and cognitive performance: cross-sectional results from the ELSA-Brasil study. Eur J Clin Pharmacol. 2023;79(7):927-934. doi:10.1007/s00228-023-03504-5
13. Cross AJ, George J, Woodward MC, et al. Potentially Inappropriate Medication, Anticholinergic Burden, and Mortality in People Attending Memory Clinics. J Alzheimers Dis. 2017;60(2):349-358. doi:10.3233/JAD-170265
14. Pantuzza LLN. Desenvolvimento e validação de um instrumento para mensuração do Medication Literacy em idosos [tese]. UFMG: Belo Horizonte;2022.
15. Masnoon N, Shakib S, Kalisch-Ellett L, et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. doi:10.1186/s12877-017-0621-2
16. Teng EL, Hasegawa K, Homma A, et al. The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia. Int Psychogeriatr. 1994;6(1):45-62. doi:10.1017/s1041610294001602
17. Damasceno A, Delicio AM, Mazo DF, et al. Validation of the Brazilian version of mini-test CASI-S. Arq Neuropsiquiatr. 2005;63(2B):416-421. doi:10.1590/s0004-282x2005000300010
18. Cross AJ, George J, Woodward MC, et al. Potentially Inappropriate Medications and Anticholinergic Burden in Older People Attending Memory Clinics in Australia. Drugs Aging. 2016;33(1):37-44. doi:10.1007/s40266-015-0332-3
19. Caçador C, Teixeira-Lemos E, Oliveira J, et al. The prevalence of polypharmacy and potentially inappropriate medications and its relationship with cognitive status in Portuguese institutionalized older adults: a cross-sectional study. Int J Environ Res Public Health. 2022;19(5):2637. doi:10.3390/ijerph19052637
20. Niikawa H, Okamura T, Ito K, et al. Association between polypharmacy and cognitive impairment in an elderly Japanese population residing in an urban community. Geriatr Gerontol Int. 2017;17(9):1286-1293. doi:10.1111/ggi.12862
21. Bandidwattanawong C, Rattanaserikulchai P, Jetsadavanit N. Polypharmacy and potentially-inappropriate medications are prevalent in the elderly cancer patients receiving systemic cancer therapy and they co-relate with adverse outcomes. BMC Geriatr. 2023;23(1):775. doi:10.1186/s12877-023-04471-3
22. Ozkan M, Karahan I, Yalcin S, et al. Effects of Potentially Inappropriate Medications in Older Patients with Gastrointestinal System Cancer. Medeni Med J. 2023;38(4):284-290. doi:10.4274/MMJ.galenos.2023.03063
23. Ramsdale E, Ramsdale E, Mohamed M, Yu V, et al. Polypharmacy, potentially inappropriate medications, and drug-drug interactions in vulnerable older adults with advanced cancer initiating cancer treatment. Oncologist. 2022;27(7):e580-e588. doi:10.1093/oncolo/oyac053
24. Sharma R, Bansal P, Sharma A, et al. Prevalence and predictors of Potentially Inappropriate Psychotropic Medication in older adults with psychiatric illness. Asian J Psychiatr. 2021;66:102872. doi:10.1016/j.ajp.2021.102872
25. Hong CT, Chan L, Wu D, et al. Antiparkinsonism anticholinergics increase dementia risk in patients with Parkinson’s disease. Parkinsonism Relat Disord. 2019;65:224-229. doi:10.1016/j.parkreldis.2019.06.022
26. Lee J, Singh N, Gray SL, et al. Optimizing Medication Use in Older Adults With Rheumatic Musculoskeletal Diseases: Deprescribing as an Approach When Less May Be More. ACR Open Rheumatol. 2022;4(12):1031-1041. doi:10.1002/acr2.11503
27. Séguin DJ, Peschken CA, Dolovich C, et al. Polypharmacy and potentially inappropriate medication use in older adults with systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2023;75(2):356-364. doi:10.1002/acr.24766
28. De Alcubierre D, Ferrari D, Mauro G, et al. Glucocorticoids and cognitive function: a walkthrough in endogenous and exogenous alterations. J Endocrinol Invest. 2023;46(10):1961-1982. doi:10.1007/s40618-023-02091-7
29. Khan Z, Mehan S, Saifi MA, et al. Proton Pump Inhibitors and Cognitive Health: Review on Unraveling the Dementia Connection and Co-morbid Risks. Curr Alzheimer Res. 2024;20(11):739-757. doi:10.2174/011567205028994624022-3050737
30. Nevado-Holgado AJ, Kim CH, Winchester L, et al. Commonly prescribed drugs associate with cognitive function: a crosssectional study in UK Biobank. BMJ Open. 2016;6(11):e012177. doi:10.1136/bmjopen-2016-012177
31. Zerah L, Bihan K, Kohler S, et al. Iatrogenesis and neurological manifestations in the elderly. Rev Neurol (Paris). 2020;176(9):710-723. doi:10.1016/j.neurol.2019.11.010
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Authors
This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors hereby transfer, assign, or otherwise convey to JHPHS : (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print republish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to JHPHS with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Serlf-archiving policy
This journal permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.
