# Trajectories of potentially inappropriate medication use among older adults in Saudi Arabia

## TL;DR

This study tracks how older adults in Saudi Arabia are prescribed potentially inappropriate medications over three years and finds that many continue to receive them, linked to conditions like diabetes and high blood pressure.

## Contribution

The study identifies long-term patterns of inappropriate medication use in older Saudi adults and links these patterns to specific health conditions and medication counts.

## Key findings

- Over 82% of older adults received at least one potentially inappropriate medication (PIM), with 55.9% having sustained PIM dispensation.
- Diabetes, hypertension, and gastrointestinal disorders were strongly associated with sustained PIM dispensation.
- More diagnoses and medications increased the odds of PIM dispensation across different trajectories.

## Abstract

The trajectories of potentially inappropriate medications (PIMs) among older adults have not been well studied. This study aims to determine the 3-year trajectories of PIM dispensation and their determinants in older adults in Saudi Arabia.

A cohort study was carried out based on medical records from visits by 9,887 older adults (≥65 years) to outpatient clinics at King Saud University Medical City in Saudi Arabia from 2017 to 2019. PIMs were identified using the 2019 Beers Criteria, using the first category: medications that should be avoided by most older adults. Multinomial logistic regression was used to estimate the associations between clinical factors and the trajectories of PIM adjusting for sociodemographic factors.

The analysis showed that over 82% dispensed at least one PIM, with 55.9% having sustained PIMs, 17.9% having no PIMs, 14.0% starting PIMs, and 12.2% experiencing sporadic PIM dispensations. After adjustment, metabolic disorders (adjusted odds ratio [aOR]: 2.61, 95% confidence interval [95% CI]: 2.17–3.15), hypertensive diseases (aOR: 5.32, 95% CI: 4.67–6.07), diabetes mellitus (aOR: 10.22, 95% CI: 8.80–11.86), and diseases of the esophagus, stomach, or duodenum (aOR: 10.90, 95% CI: 7.39–16.09) were significantly associated with sustained PIM dispensation. With an increasing number of diagnoses we found an increasing odds for three trajectories (starting PIM (aOR range 1.56 to 5.82), sporadic PIM (aOR range 1.47 to 4.86), and sustained PIM (aOR range 3.91 to 37.3). Furthermore, an increasing number of medications was associated with higher odds for the same trajectories: starting PIM (aOR range 2.01 to 6.03), sporadic PIM (aOR range 1.50 to 7.10), and sustained PIM (aOR range 4.34 to 59.9).

This study showed a high prevalence of sustained trajectories of PIMs over time. Further, several common diagnoses and a greater total number of medications were identified as being associated with different PIM trajectories.