title: Potentially inappropriate medication use in older people with cancer: prevalence and correlates.
abstract: OBJECTIVE
  Potentially inappropriate medication (PIM) use has been associated with an increase in adverse drug events, hospitalization and mortality. This study investigated the prevalence and factors associated with PIM use in patients presenting to a medical oncology outpatient clinic.
  
  
  METHODS
  Consecutive patients (n=385) aged ≥ 70 years referred to a medical oncology outpatient clinic between January 2009 and July 2010 completed a structured data collection instrument. The instrument assessed medication use, diagnoses, self-reported falls in the previous six months, pain (10-point visual analog scale [VAS]) and distress (10-point VAS). Frailty was defined using exhaustion, weight loss, Karnofsky Performance Scale, instrumental activities of daily living and physical function. PIM use was defined by the Beers Criteria. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with PIM use.
  
  
  RESULTS
  In total, 26.5% (n=102) of the sample used ≥1 PIM. The five most prevalent classes of PIMs were benzodiazepines (n=34, 8.8%), tricyclic antidepressants (n=16, 4.2%), alpha-adrenoreceptor antagonists (prazosin) (n=15, 3.9%), propulsives (metoclopramide) (n=15, 3.9%) and non-steroidal anti-inflammatory drugs (n=14, 3.6%). In multivariate analyses, PIM use was associated with age 75-79 years (OR 1.83; 95%CI 1.02-3.26) compared to age 70-74 years, using ≥ 5 medications (OR 4.10; 95%CI 2.26-7.44) compared to <5 medications and being frail (OR 3.05; 95%CI 1.18-7.87) compared to being robust.
  
  
  CONCLUSIONS
  More than one quarter of older people with cancer used one or more PIMs, and this was associated with being frail compared to being robust.
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Saarelainen
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia. Electronic address: justin.turner@unisa.edu.au.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Turner
authors.affiliation: Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Sepehr
authors.initials: S
authors.lastname: Shakib
authors.affiliation: Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; School of Medicine, Adelaide University, Adelaide, South Australia, Australia.
authors.forename: Nimit
authors.initials: N
authors.lastname: Singhal
authors.affiliation: Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Hogan-Doran
authors.affiliation: Geriatric and Rehabilitation Medication, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Prowse
authors.affiliation: Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Sally
authors.initials: S
authors.lastname: Johns
authors.affiliation: Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Judith
authors.initials: J
authors.lastname: Lees
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D017677:Age Distribution; D000368:Aged; D001315:Australia / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D015995:Prevalence; D015431:Weight Loss / Q000187:drug effects
keywords: Aged; Aged 80 and over; Frail elderly; Inappropriate prescribing; Medical oncology; Medication therapy management