Long-term continuous exposure to potentially inappropriate medications (PIMs) can lead to adverse events in the elderly. However, the effects of long-term exposure of the elderly to PIM and the relationship between PIM and chronic diseases remain unclear. The objective of this study was to investigate the continuous use of PIMs in a community-dwelling elderly population. A cross-sectional population-based study was conducted using community pharmacy–filed dispensing records from the Hcare system. Twenty-three community pharmacies were sampled from 2013 to 2015 to obtain records of patients above 65 years-old with continuous prescriptions. PIM were identified according to the 2015 Beers Criteria. The prevalence of patients using PIM was highest in patients with co-morbid mental disorders (40.05%), followed by neurological system disorders (28.91%). Patients who were prescribed a PIM were more than three times as likely to have a mental disorder as those (odds ratio 3.16, 95% confidence interval: 3.06–3.28) with non-chronic diseases. The most prescribed PIM agents were central nervous system drugs (53.16%), and benzodiazepines (35.15%). Patients with mental disorders had the highest rate of long-term persistent PIM exposure, with benzodiazepines being the most frequently dispensed. Drug safety concerns should be closely monitored in elderly patients with the abovementioned conditions.

Taiwan offers affordable access to health care through the National Health Insurance (NHI) Program, but this increases the risk of waste of medications and pollution caused by improper disposal. This research aimed to: (1) understand methods of disposal of unused medications, and public awareness of related issues, (2) understand the sources and types of unused medications and reasons for their disposal, and (3) propose improvements to current disposal practices. Data on practices and perspectives on the disposal of medications were collected from members of the public using a questionnaire, and subjected to chi-square analysis of demographic variables. The survey found that many respondents disposed of medications inappropriately, but most believed the government should establish a return system. The majority of discarded medications came from hospitals, and were most frequently discarded because patients had forgotten to take them. Based on these findings, the study proposes that receiving stations be established across Taiwan for the safe and environmentally friendly disposal of unused medications, along with a system of monthly checks and compensation for pharmacists’ costs. The study also suggests that pharmacists strengthen medication guidance, spend more time on medication counseling, better understand the reasons for medication waste, and offer health education and advice to physicians and the public.

Patients with high healthcare utilization are at increased risk of polypharmacy and drug interactions. This study investigated the changes in the number of medications, drug interactions and interaction severity in high frequency outpatients with polypharmacy at hospitals and clinics in Taiwan after home pharmaceutical care, to understand the effectiveness of interventions by pharmacists. This was a retrospective observational study. Cases with excessive polypharmacy (10+ drugs) were selected from the Pharmaceutical Care Practice System database of the Taiwan Pharmacist Association in 2017. After the home care intervention, the number of drug types used decreased 1.89-fold (p < 0.001), and the number of medications fell 61.6%. The incidence of drug interaction was 93.82%. In an average case, the incidence of drug interaction after the pharmacist intervention decreased 0.6-fold (p < 0.001). The drug most commonly causing interactions was aspirin, followed by diclofenac; also common were three used in diabetes, two psycholeptics and two beta blockers. Among 22 cases of severe drug interaction, seven resulted in increased risk of extrapyramidal symptoms and neuroleptic malignant syndrome. By analyzing the relationship between the side effects of individual drugs and the pharmacokinetic T_max, a sequential thermal zone model of adverse drug reactions can be established, the value of which could prompt physicians and pharmacists to intervene in order to prevent adverse events. It is concluded that home pharmaceutical care by pharmacists can significantly reduce the number of medications and interactions in patients with excessive polypharmacy and high healthcare utilization.

Aging is accompanied by changes in organ degeneration, and susceptibility to multiple diseases, leading to the frequent occurrence of adverse drug reactions resulting from polypharmacy (PP) and potentially inappropriate medications (PIM) in older patients. This study employs a retrospective cohort design and investigates the association of PP with PIM among older patients with high rates of medical utilization. Using records from a national pharmaceutical care database, an experimental group is formed from patients meeting these criteria, who are then offered home pharmaceutical care. Correspondingly, a control group is formed by identifying older patients with regular levels of use of medical services who had been dispensed medications at community pharmacies. Multivariate logistic regression is performed to assess the association between the rate of PIM and variables, including age, gender, and PP. The study finds that experimental PP participants had a higher rate of PIM prescription (odds ratio (OR) = 5.4) than non-PP control participants (all p < 0.001). In clinical practice, additional caution is required to avoid PIMs. Patients engaged in continuously using long-term medication should take precautions in daily life to alleviate related discomforts. Pharmacists should serve as a bridge between patients and physicians to enhance their health and improve their quality of life.

Aging increases the danger of adverse reactions to medication, which can lead to hospitalization and mortality. Aging is also associated with increased rates of polypharmacy, which can lead to harmful interactive effects. The introduction of personalized pharmaceutical counseling for elderly patients when medications are prescribed can potentially reduce the danger of adverse reactions to medications, and thus promote public health. This paper reports on an exploratory project in elderly pharmaceutical counseling conducted in Taiwan from 2010 to 2012. An experiment group consisting of 40 patients received home pharmaceutical counseling from hospital pharmacists and community pharmacists, while a control group received only routine counseling at the time their medications were dispensed. The two groups' prescriptions were analyzed according to Beer's Criteria for Potentially Inappropriate Use of Medication. It was found that the rate of prescription of potentially inappropriate medications was reduced after home pharmaceutical counseling, when considered in terms of gender, rate of polypharmacy and age group. However, while home counseling appeared to reduce the incidence of prescription of potentially inappropriate medications at hospitals, this was not the case for community clinics. The paper discusses implications of these findings for future research and pharmaceutical practice.

Potentially inappropriate medication (PIM) is defined as medication which may result in higher than expected risk when used by elderly patients. Its risk of occurrence may be increased through the effects of drug interactions, adverse drug reactions (ADR), adverse drug effects (ADE), and so on. At the commencement of this study, we hypothesized that: 1. After the release of a revised version of the Beers Criteria, the number of medications prescribed that are inappropriate under these guidelines would decline. 2. Polypharmacy would lead to increased potentially inappropriate use of medication. 3. More PIM would be prescribed at hospitals than at local clinics. To test these hypotheses, we analyzed prescriptions that had been issued by physicians at local hospitals and clinics and dispensed at a community pharmacy in Kaohsiung City, from 2009 to 2015. We found that the overall rate of prescription of PIM for elderly patients was 50.8% from 2009-2012, compared with 37.6% from 2013-2015. The largest number of prescriptions filled at the pharmacy was for the 'young-old', while the smallest number was for the 'oldest-old'. Prior to the introduction of the guidelines, the incidence of PIM was highest among the 'oldest-old', while after their introduction, PIM was highest among the 'aged'. In terms of prescribing institutions, physicians in hospitals were more likely to prescribe PIM than those in clinics. In terms of polypharmacy, inappropriate medications were most likely to be prescribed when ten or more medications were being used simultaneously. After the release of the guidelines, the rate of PIM among patients using ten kinds of medication or more exceeded that of those using one to four medications by a factor of six. This study involved only a retro-analysis of prescriptions dispensed at a community pharmacy. In the future, if pharmacists can discuss the appropriateness of prescriptions with physicians after medications have been prescribed, it is likely that the rate of PIM can be reduced, thus contributing to an improved quality of life for elderly patients.