Center for Pharmacoeconomic Research

College of Pharmacy

New Research Released on Polypharmacy

Important New Research on Polypharmacy and Beers Criteria on Inappropriate Medications

Using data from 29 Alzheimer’s Disease Centers across the United States, the team of researchers found that patients taking five or more medications were more likely to suffer from functional decline compared to patients taking four or less medications. However, surprisingly, the increased risk was only apparent in participants who did not have “PIRx” (potentially inappropriate medication use) defined by the Beers criteria.  The criteria is a commonly used measure of medications-to-avoid among the general older adult population due the drugs’ ineffectiveness and adverse side-effect profiles.

Dr. Lau’s research interests lie in examining the quality and safety of medications used in vulnerable older adult populations. Cognitive impairment is prevalent in older individuals and that is what led him to examine medication use and its risks on functional decline in this population.   “These individuals are particularly vulnerable because of their complex medical needs, high functional dependence, and significant risk for nursing home placement,” noted Dr. Lau.

After conducting several published studies that examined the Beers criteria in nursing home residents, Dr. Lau expected to observe similar adverse effects of PIRx among community-dwelling older adults. “It is important to conduct research that tests our assumptions about established measures - such as polypharmacy and PIRx as defined by the Beers criteria - to determine whether these measures can be used universally or need to be refined for different clinical situations,” Dr. Lau said regarding his continuing work with the Beers criteria.

Dr. Lau and his colleagues’ study provides important new evidence needed to reshape the clinical landscape in regards to polypharmacy use in older patients with dementia. Dr. Lau’s latest findings indicate that taking a high number of medications (either five or more, or seven or more) leads to functional decline only when those medications do not include PIRx on the Beers criteria. Contrary to hypothesis, the Beers drugs seemed to have a slight protective effect in this population. More research is needed to further understand the clinical explanations underlying these findings and to investigate which particular classes of medications may have the most harmful side effects on this population. “In terms of clinical implications, healthcare providers should not merely decrease the number of medications used in older patients with dementia, and should still closely monitor potential adverse health effects when medications on the Beers criteria must be prescribed,” suggested by Dr. Lau.