Abstract：
OBJECTIVE: The global older population is growing rapidly, and the rise in polypharmacy has increased potentially inappropriate medication (PIM) encounters. PIMs pose health risks, but detecting them automatically in large medical databases is complex. This review aimed to uncover PIM prevalence in individuals aged 65 years or older using health databases and emphasized the risk of underestimating PIM prevalence due to underutilization of detection tools.
METHODS: This study conducted a broad search on the Medline database to identify articles about the prevalence of PIMs in older adults using various databases. Articles published between January 2010 and June 2023 were included, and specific criteria were applied for study selection. Two literature reviews conducted before our study period were integrated to obtain a perspective from the 1990s to the present day. The selected papers were analysed for variables including database type, screening method, adaptations and PIM prevalence. The study categorized databases and original screening tools for clarity, examined adaptations and assessed concordance among different screening methods.
RESULTS: This study encompassed 48 manuscripts, covering 58 sample evaluations. The mean prevalence of PIMs within the general population aged over 65 years was 27.8%. Relevant heterogeneity emerged in both the utilized databases and the detection methods. Adaptation of original screening tools was observed in 86.2% (50/58) of cases. Half of the original screening tools used for assessing PIMs belonged to the simple category. About a third of the studies employed less than half of the original criteria after adaptation. Only three studies used over 75% of the original criteria and more than 50 criteria.
CONCLUSIONS: This extensive review highlights PIM prevalence among the older adults, emphasizing method intricacies and the potential for underestimation due to data limitations and algorithm adjustments. The findings call for enhanced methodologies, transparent algorithms and a deeper understanding of intricate rules\' impact on public health implications.
METHODS: This study conducted a broad search on the Medline database to identify articles about the prevalence of PIMs in older adults using various databases. Articles published between January 2010 and June 2023 were included, and specific criteria were applied for study selection. Two literature reviews conducted before our study period were integrated to obtain a perspective from the 1990s to the present day. The selected papers were analysed for variables including database type, screening method, adaptations and PIM prevalence. The study categorized databases and original screening tools for clarity, examined adaptations and assessed concordance among different screening methods.
RESULTS: This study encompassed 48 manuscripts, covering 58 sample evaluations. The mean prevalence of PIMs within the general population aged over 65 years was 27.8%. Relevant heterogeneity emerged in both the utilized databases and the detection methods. Adaptation of original screening tools was observed in 86.2% (50/58) of cases. Half of the original screening tools used for assessing PIMs belonged to the simple category. About a third of the studies employed less than half of the original criteria after adaptation. Only three studies used over 75% of the original criteria and more than 50 criteria.
CONCLUSIONS: This extensive review highlights PIM prevalence among the older adults, emphasizing method intricacies and the potential for underestimation due to data limitations and algorithm adjustments. The findings call for enhanced methodologies, transparent algorithms and a deeper understanding of intricate rules\' impact on public health implications.
摘要：
目标：全球老年人口增长迅速，以及多重用药的增加增加了潜在的不适当药物(PIM)的遭遇。PIM构成健康风险，但是在大型医疗数据库中自动检测它们是复杂的。这篇综述旨在使用健康数据库揭示65岁或以上个体的PIM患病率，并强调由于检测工具的未充分利用而低估PIM患病率的风险。
方法：这项研究在Medline数据库上进行了广泛的搜索，以使用各种数据库确定有关老年人PIM患病率的文章。包括2010年1月至2023年6月之间发表的文章，并将具体标准应用于研究选择。在我们研究期间之前进行的两个文献综述被整合，以获得从1990年代到现在的观点。对所选论文进行了变量分析，包括数据库类型，筛选方法,适应和PIM患病率。为了清晰起见，该研究对数据库和原始筛选工具进行了分类，检查适应性，并评估不同筛查方法之间的一致性。
结果：这项研究包括48份手稿，涵盖58个样本评估。65岁以上人群中PIM的平均患病率为27.8%。在使用的数据库和检测方法中都出现了相关的异质性。在86.2%(50/58)的病例中观察到原始筛查工具的适应性。用于评估PIM的原始筛选工具中有一半属于简单类别。大约三分之一的研究在适应后采用了不到原始标准的一半。只有三项研究使用了超过75％的原始标准和50多个标准。
结论：这项广泛的综述强调了老年人的PIM患病率，强调方法的复杂性和潜在的低估由于数据的限制和算法的调整。调查结果要求加强方法，透明的算法和对复杂规则对公共卫生影响的更深入的理解。
方法：这项研究在Medline数据库上进行了广泛的搜索，以使用各种数据库确定有关老年人PIM患病率的文章。包括2010年1月至2023年6月之间发表的文章，并将具体标准应用于研究选择。在我们研究期间之前进行的两个文献综述被整合，以获得从1990年代到现在的观点。对所选论文进行了变量分析，包括数据库类型，筛选方法,适应和PIM患病率。为了清晰起见，该研究对数据库和原始筛选工具进行了分类，检查适应性，并评估不同筛查方法之间的一致性。
结果：这项研究包括48份手稿，涵盖58个样本评估。65岁以上人群中PIM的平均患病率为27.8%。在使用的数据库和检测方法中都出现了相关的异质性。在86.2%(50/58)的病例中观察到原始筛查工具的适应性。用于评估PIM的原始筛选工具中有一半属于简单类别。大约三分之一的研究在适应后采用了不到原始标准的一半。只有三项研究使用了超过75％的原始标准和50多个标准。
结论：这项广泛的综述强调了老年人的PIM患病率，强调方法的复杂性和潜在的低估由于数据的限制和算法的调整。调查结果要求加强方法，透明的算法和对复杂规则对公共卫生影响的更深入的理解。
