Polypharmacy and the Use of Beers Criteria in Iranian Geriatric Patients: A Review of Published Literature

  • Atena Ezati Student research committee, Ahvaz Jundishpur University of Medical Sciences, Ahvaz, Iran
  • Leila Kouti Department of Clinical Pharmacy, School of Pharmacy, Ahvaz Jundishpur University of Medical Sciences, Ahvaz, Iran
  • Kaveh Eslami Department of Clinical Pharmacy, School of Pharmacy, Ahvaz Jundishpur University of Medical Sciences, Ahvaz, Iran
  • Saeid Saeidimehr Department of Clinical Laboratory, Naft Grand Hospital, Ahvaz, Iran
  • Marjan Khanifar Student Research Committee, Ahvaz Jundishpur University of Medical Sciences, Ahvaz, Iran
Keywords: Polypharmacy, Geriatrics, Iran


The senior population in Iran is growing, and polypharmacy is common among them. Certain drugs are considered inappropriate in elderly due to age related changes and awareness of clinicians in this area is crucial. The Beers criteria is the most evidence based reference for proper drug selection in geriatric patients. This study reviews the scholarly articles published in English or Farsi that had studied potentially inappropriate medications (PIMs) according to beers criteria and polypharmacy in the Iranian geriatric population.By searching Pubmed, Scopus and Google scholar databases from 1989-2016, all studies in Farsi or English with key terms polypharmacy, drug-drug interactions, Beers, medication, drug, prescribing, older adult, geriatric, elderly, aging, pharmacotherapy, persian and Iran were evaluated. 11 studies were found: 5 studies on polypharmacy, 3 studies on polypharmacy and PIMs, one study on PIMs, one study on drug drug interactions and PIMs, and only one study on polypharmacy, PIMs and drug-drug interactions. The majority of these studies were published in Farsi (8 articles). The oldest found article was conducted in 2005 and the most recent published study was in 2016. Studies in aging population in Iran are very few. This growing patient group with the highest number of drug consumption seems to be under-researched in Iran       


1. Hoffman JM, Li E, Doloresco F, et al. Projecting future drug expenditures2012. Am J Health Syst Pharm 2012;69(5):405-21.
2. Hoffman JM, Li E, Doloresco F, et al. Projecting future drug expendituresin U.S. nonfederal hospitals and clinics--2013. Am J Health Syst Pharm2013;70(6):525-39.
3. Ishii S, Kojima T, Ezawa K, et al. The association of change in medicationregimen and use of inappropriate medication based on beers criteria withadverse outcomes in Japanese long‐term care facilities. Geriatr GerontolInt 2017;17(4):591-597.
4. Di Giorgio C, Provenzani A, Polidori P. Potentially inappropriate drug prescribing in elderly hospitalized patients: an analysis and comparison ofexplicit criteria. Int J Clin Pharm 2016;38(2):462-8.
5. Gutiérrez-Valencia M, Izquierdo M, Malafarina V, et al. Impact of hospitalization in an acute geriatric unit on polypharmacy and potentially inappropriate prescriptions: A retrospective study. Geriatr GerontolInt 2017;17(12):2354-2360.
6. Deliens C, Deliens G, Filleul O, et al. Drugs prescribed for patients hospitalized in a geriatric oncology unit: potentially inappropriatemedications and impact of a clinical pharmacist. J GeriatrOncol 2016;7(6):463-470.
7. Spinewine A, Swine C, Dhillon S, et al. Appropriateness of use of medicines in elderly inpatients: qualitative study. BMJ 2005;331(7522):935.
8. Pasina L, Djade CD, Tettamanti M, et al. Prevalence of potentially inappropriate medications and risk of adverse clinical outcome in a cohort of hospitalized elderly patients: results from the REPOSI Study. J ClinPharm Ther 2014;39(5):511-5.
9. Greene M, Steinman MA, McNicholl IR, Valcour V. Polypharmacy, drug–drug interactions, and potentially inappropriate medications in older adults with human immunodeficiency virus infection. J Am GeriatrSoc 2014;62(3):447-53.
10. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother 2007;5(4):345-51.
11. Nguyen JK, Fouts MM, Kotabe SE, Lo E. Polypharmacy as a risk factorfor adverse drug reactions in geriatric nursing home residents. Am JGeriatr Pharmacother 2006;4(1):36-41.
12. Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM; HARMStudy Group. Frequency of and risk factors for preventable medicationrelated hospital admissions in the Netherlands. Arch Intern Med2008;168(17):1890-6.
13. Rollason V, Vogt N. Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist. Drugs Aging 2003;20(11):817-32.
14. Boparai MK, Korc-Grodzicki B. Prescribing for older adults. Mt Sinai JMed 2011;78(4):613-26.
15. Heuberger RA, Caudell K. Polypharmacy and nutritional status in olderadults. Drugs Aging 2011;28(4):315-23.
16. Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivelä SL, Isoaho R.Use of medications and polypharmacy are increasing among the elderly. JClin Epidemiol 2002;55(8):809-17.
17. Venturini CD, Engroff P, Ely LS, et al. Gender differences, polypharmacy,and potential pharmacological interactions in the elderly. Clinics (SaoPaulo) 2011;66(11):1867-72.
18. Lim LM, McStea M, Chung WW, et al. Prevalence, risk factors and healthoutcomes associated with polypharmacy among urban community-dwellingolder adults in multi-ethnic Malaysia. PLoS One 2017;12(3):e0173466.
19. Bahat G, Bay I, Tufan A, Tufan F, Kilic C, Karan MA. Prevalence ofpotentially inappropriate prescribing among older adults: A comparison ofthe Beers 2012 and Screening Tool of Older Person’s Prescriptions criteriaversion 2. Geriatr Gerontol Int 2017;17(9):1245-51.
20. Greene M, Steinman MA, McNicholl IR, Valcour V. Polypharmacy, drugdruginteractions, and potentially inappropriate medications in olderadults with human immunodeficiency virus infection. J Am GeriatrSoc 2014;62(3):447-53
21. Jano E, Aparasu RR. Healthcare outcomes associated with beers’ criteria:a systematic review. Ann Pharmacother 2007;41(3):438-47.
22. Mori AL, Carvalho RC, Aguiar PM, et al., Potentially inappropriateprescribing and associated factors in elderly patients at hospital dischargein Brazil: a cross-sectional study. Int J Clin Pharm 2017;39(2):386-393.
23. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH.Updating the Beers criteria for potentially inappropriate medication usein older adults: results of a US consensus panel of experts. Arch InternMed 2003;163(22):2716-24.
24. Delshad Noghabi A, Darabi F, Baloochi Beydokhti T, Shareinia H,Radmanesh R. Irrational use of medicine status in elderly population ofGonabad. Quarterly of the Horizon of Medical Sciences 2014;19(5):49-56.
25. Dianati M, Shojaegharebag G A, Mesdaghinia A, et al . Polypharmacyand its related factors among the elderly population in Kashan, Iran during 2011-2012. Feyz 2015;18 (6):578-84
26. Heidari S, Aliabadi A, Naebi A, Khoramirad A. Frequency of use ofpotentially inappropriate medications and its associated factors in elderlypeople in Qom City, 2012, Iran. Qom Univ Med Sci J 2014; 8(4):44-52.
27. Azoulay L, Zargarzadeh A, Salahshouri Z, Oraichi D, Bérard A.Inappropriate medication prescribing in community-dwelling elderlypeople living in Iran. Eur J Clin Pharmacol 2005;61(12): 913-9.
28. Ahmadi B, Ali Mohammadian M, Mahmoodi M. Drug PatternConsumption Among People Of 55 Years Age and Older in Tehran. sija2008;2(4):421-6.
29. Saeedi S, Foroughan M, Akbari Kamrani A, GHaem magham farahaniZ, Delbari A. Clinical Features of Elderly Patients Admitted to AhvazPetroleum Hospital, 2010. Quarterly Journal of Sabzevar University of Medical Sciences 2012;19:85-95
30.Yavari H, Akbari A, Saboor M, Delbari A. Prevalence of Poly pharmacyMedical Sciences 2012;19:85-95.among the Elderly residents of Kahrizak Charity Foundation (KCF),Tehran, 2010-2011. Quarterly Journal of Sabzevar University of MedicalSciences 2013;20(1):42-50.
31. Saboor M, Foroughan M, Mohammadi Shahbalaghi F. Drug PrescriptionPatterns in Older People Residential Homes. sija 2012;6(S1):7-13.
32. Ghadimi H, Esmaily HM, Wahlstrom R. General practitioners’ prescribingpatterns for the elderly in a province of Iran. Pharmacoepidemiol Drug Saf2011;20(5):482-7.
33. Kavosi Z, Vali L, Mahmoudi L, Mirzaie M. Study of non-appropriatemedications among elderly patients in hospitals affiliated with IUMSusing the STOPP screening tool in 2013. Bali Med J 2016;5(1):98-104.
34. Talebi-Taher M, Javad-Moosavi SA, Taherian S, Barati M. Surveying theInappropriate Drug Adminstrution using Beers Criteria in Elderly Patientsat the Internal Medicine Ward of Rasoul-E-Akram Hospital of Tehran in2012. Arak Med Univ J 2014;17(2):33-39.
35. No Kohan Ahvazi K, Sahaf R, Akbari Kamrani A. Drug PerscriptionPatterns of Out Patient Medication for Older People Insured by SocialOrganization Insurance in Year 2009. sija 2012; 6 (S1) :14-23.
36. Barat I, Andreasen F, Damsgaard EMS. The consumption of drugs by75-year-old individuals living in their own homes. Eur J Clin Pharmacol2000;56(6-7):501-9.
37. Hanlon JT, Schmader KE, Semla TP. Update on drug-related problems inthe elderly. J Am Geriatr Soc 2013;61(8):1365-8
38. Rodrigues MC, Oliveira Cd. Drug-drug interactions and adverse drugreactions in polypharmacy among older adults: an integrative review. RevLat Am Enfermagem 2016;24:e2800.
How to Cite
Ezati A, Kouti L, Eslami K, Saeidimehr S, Khanifar M. Polypharmacy and the Use of Beers Criteria in Iranian Geriatric Patients: A Review of Published Literature. jpc. 6(1-2):29-3.
Review Article(s)