IMPACT researchers have narrowed down the lists of potentially inappropriate medications (PIMs) in a recent study that revealed Australian clinicians need to look beyond well-known PIMs lists and instead consider lists that are more ‘fit for purpose’ to reduce medication-related harm and poorer health outcomes in older adults.
The paper, titled “Applicability of explicit potentially inappropriate medication lists to the Australian context: A systematic review” and published in the Australasian Journal on Ageing (DOI: 10.1111/ajag.13038), was led by Georgie Lee, a PhD candidate at IMPACT.
The paper unpicked how researchers and clinicians chose an appropriate explicit PIMs lists in Australia – with an overall aim to provide an up-to-date summary of current explicit PIMs lists that could be compared and investigated to reveal lists that contain medications available in Australia.
‘Unfortunately, this research did not unearth a ‘golden’ list that is appropriate for all purpose and settings,’ says Lee, whose research team consists of her IMPACT supervisors – Dr Sarah Hosking and Professor Julie Pasco, in addition to supervisors from the University of Western Australia Centre for Healthy Ageing, Dr Amy Page and Professor Christopher Ethernton-Beer.
‘But by investigating the applicability of PIMs lists to the Australian context, we hope to highlight that not all lists are equal and encourage researchers and clinicians to look beyond the most well-known lists and consider a PIMs list for their practice that is more fit for purpose.’
Currently, there is a well-established link between the use of PIMs and medication-related harm and poorer health outcomes. According to Lee, the research was the first of IMPACT’s knowledge to outline the applicability of PIMs lists to Australia by presenting data on which medications are available in Australia.
‘Across the 35 explicit PIMs lists we looked at, we identified 645 different potentially inappropriate medications (PIMs), of which 64% were available in Australia,’ Lee says.
‘By each list, the proportion of medications available in Australia ranged from 50-96%, which suggests some lists are more applicable than others.
‘To assist in the identification of PIMs, there are numerous explicit PIMs lists to choose from.
‘However, there is no gold standard for measuring PIMs in Australia. While the more well-known lists, namely the Beers Criteria and the STOPP, are most frequently applied in both local and international research, it is unclear if they, or another list, may be more appropriate for detecting PIMs among Australian populations.
‘This research looks to inform how researchers and/or clinicians may choose a list for their practice.’
Lee says her research to date has focused on the challenges of measuring potentially suboptimal medication regimens such as polypharmacy.
‘PIMs are another example of suboptimal medication regimens and encompass medications with an unfavourable risk-benefit ratio among older adults,’ she says.
‘Undertaking this systematic review investigating the applicability of PIMs lists to the Australian context, was a perfect opportunity to refine how we might measure PIMs among Australian older adults.’
Lee says measuring the extent of the problem is the first step to preventing or minimising the impact of the problem mediations-related harm among older adults.
‘In research, by using a PIMs list that is fit for purpose and applicable to the Australian context, we will be able to gain more accurate estimates of PIMs prevalence and the associated risk factors,’ she says.
‘These findings may be used to inform interventions that aim to reduce medications-related harm among older adults.
‘To overestimate the risk may result in overly burdensome medication reviews and potentially unsafe underprescribing, yet underestimating the risk may lead to missed opportunities and potentially preventable medication-related harm.’
Further work is still required to determine the clinical significance of PIMs lists to the Australian setting.
‘We need to determine which list(s) best predict poorer health outcomes amongst older Australians, with the potential for the development of a clinically significant PIMs list designed specifically for the Australian context,’ Lee says.
Read the complete publication online here.