1.What Do Older Adults and Their Caregivers in Malaysia Think of Home Medication Review? A Qualitative Inquiry
Ahlam Sundus ; Tan Maw Pin ; Renukha Sellappans
Malaysian Journal of Medicine and Health Sciences 2022;18(No.1):99-104
Introduction: Home medication review (HMR) involves a patient-centered approach, extending continuity of care
to the community setting with the intention of improving medication use and health outcome. The delivery of HMR
services in Malaysia remains limited to urban hospitals and clinics. Current study aimed to explore the perception
and acceptability of HMR in older adults. Methods: In-depth individual interviews were conducted among adults
aged ≥65 years old, taking ≥5 medications, recruited from geriatrics clinics at a tertiary teaching hospital. Home
interviews were conducted among 12 older adults and care givers between April to June 2019. Interviews were audio-taped, transcribed verbatim and analysed through descriptive interpretive approach of qualitative data analysis.
Results: HMR provided participants with opportunities to discuss medication-related issues with pharmacists in conducive environments. Pharmacists provided information which improved knowledge on indications, dosages and
safe storage of medications through HMR. Participants experienced relief and developed confidence in medication
self-management. Conclusion: The importance of follow-up visits to ensure adequate monitoring and continuity of
care were emphasized. Larger quantitative studies are required to determine the clinical impact and cost-effectiveness of HMR to justify the implementation and expansion of this service
2.Medication Appropriateness among Older Persons Admitted to a General Hospital in Malaysia
Heng Ker Sin ; Tan Kit Mun ; Khor Hui Min ; Noor Azleen Ahmad Tarmizi ; Renukha Sellappans
Malaysian Journal of Medicine and Health Sciences 2022;18(No.5):122-129
Introduction: Many tools have been developed to determine medication appropriateness in older persons including
the 2015 American Geriatric Society (AGS) Beers criteria and the Screening Tool of Older People’s Prescriptions
(STOPP) criteria. We aimed to determine and compare the prevalence of potentially inappropriate medications
(PIMs) based on the Beers criteria 2015 and the STOPP criteria v2 among older persons admitted to a general hospital in Malaysia. Methods: A cross-sectional study comprising of 160 patients aged 65 years old and above admitted
to the general medical wards of a tertiary teaching hospital were recruited. Beers criteria 2015 and the STOPP criteria v2 were used to evaluate participants’ medication list on admission, during hospitalisation and on discharge
for PIMs. Prevalence of PIMs which was calculated as the total number of patients with one or more PIMs over the
total number of patients. Results: The prevalence of PIMs identified by Beers criteria 2015 on admission, during
hospitalisation and on discharge were 54.85%, 64.40% and 48.80% respectively. The prevalence of PIM based on
STOPP criteria v2 were 33.08%, 47.50% and 42.50% respectively. The most prevalent PIMs according to Beers
criteria 2015 and STOPP criteria v2 were diuretics, tramadol, ticlopidine, proton pump inhibitor, benzodiazepines
and antipsychotics. Conclusion: The prevalence of PIMs use is high among hospitalised older persons in Malaysia.
While it is not possible to avoid all PIMs listed in the Beers and STOPP criteria, clinicians should exercise caution in
prescribing drugs such as benzodiazepines, antipsychotics and proton pump inhibitors for older persons weighing
the risk versus benefit of the drugs.