***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Older people often need comprehensive treatment , including many medications , and polypharmacy is common . The aims of this cross-sectional investigation were to examine the potentially inappropriate medication during the hospitalization and to identify the factors that may influence such inappropriateness among elderly in Italy . Methods A sample of 605 individuals aged 65 years and older admitted in non-academic public acute care hospitals was r and omly selected . Prescription of inappropriate medications were evaluated during the period from the day of admission to a r and omly preselected day ( index day ) .  Beers Criteria  were used to evaluate appropriateness . Results At least one potentially inappropriate medication prescription from the day of hospital admission to the index day has been observed in 188 patients ( 31.1 % ) , and respectively 84.1 % and 15.9 % of them had received one or two inappropriate medications . A total of 15 medications was prescribed inappropriately to these 188 patients , for 215 times with a total of 1143 doses . The multivariate logistic regression analysis revealed that the significant predictors for having at least one potentially inappropriate medication prescription during the hospitalization were : patients having an elementary education level , a lower pre-admission performance-based measure of basic activities of daily living , having received an inappropriate drug before the hospitalization , a hospital stay in the general and in the specialties surgical wards , a longer length of hospital stay from the admission to the index day , and having received a higher number of drugs from the day of the hospital admission to the index day . The most prevalent inappropriate medications administered were ketorolac ( 27.4 % ) , amiodarone ( 19.1 % ) , and clonidine ( 11.2 % ) . Conclusions This study supports the need for clinical guidelines implementation to assist physicians in choosing the most appropriate drugs for the elderly and for effective education of all physicians Background The use of potentially inappropriate medications ( PIMs ) is common in the older population . Inappropriate medications as well as polypharmacy expose older people to a greater risk of adverse drug reactions and may result in hospitalizations . Objective To evaluate the prevalence of PIMs among acutely hospitalized patients aged ≥65 years in an acute medical unit , and to investigate the relationship between use of PIMs and weakness . Setting This longitudinal observational study was undertaken in the Acute Medical Unit , Hvidovre Hospital , University of Copenhagen , Denmark . Method Patients aged ≥65 years admitted to the acute medical unit during the period October to December 2011 were included . Patients were interviewed at admission and at a follow-up visit 30 days after discharge . Data included information about medications , social status , functional status , cognitive status , h and grip strength , health-related quality of life , visual acuity , days of hospitalization , and comorbidities , and was prospect ively collected . Polypharmacy was defined as regular use of 5 or more drugs . The Charlson Comorbidity Index was used to categorize comorbidities . Main outcome measure The prevalence of PIMs and the association with PIMs and functional status h and grip strength , HRQOL , comorbidities , social demographic data and vision . Results Seventy-one patients ( 55 % men ) with a median age of 78.7 years participated . The median number of medications was eight per person . Eighty percent were exposed to polypharmacy . PIMs were used by 85 % of patients , and PIMs were associated with low functional status ( p = 0.032 ) , low h and grip strength ( p = 0.006 ) , and reduced health-related quality of life ( p = 0.005 ) , but not comorbidities ( p = 0.63 ) , age ( p = 0.60 ) , sex ( p = 0.53 ) , education ( p = 0.94 ) , cognition ( p = 0.10 ) , pain ( p = 0.46 ) , or visual acuity ( p = 0.55 ) . Conclusions Use of PIMs was very common among older people admitted to an acute medical unit . The use of PIMs is associated with low functional status , low h and grip strength , and reduced health-related quality of life Purpose Adverse drug events ( ADEs ) lead to adverse clinical outcomes such as hospitalization . There is little information about the characteristics of ADEs in patients with advanced chronic conditions and have a prognosis of limited life expectancy . This study aim ed to evaluate ( i ) the prevalence of ADEs at the time of admission to hospital , ( ii ) the causality , severity , and preventability of the ADEs , and ( iii ) the clinical and pharmacological characteristics associated with the ADEs . Methods This is a prospect i ve cross-sectional study ( county of Osona , Catalonia , Spain ) . We included patients who required palliative care as identified by the NECPAL CCOMS-ICO tool who were hospitalized in an acute geriatric unit ( AGU ) .  A system of alerts ( trigger tool ) was used together with a multidisciplinary review for the detection of the ADEs . Results Over the course of 10 months , 235 patients were recruited . Seventy-six ADEs affecting 24.68 % of the sample were identified , and of these , 23 ( 30.26 % of the ADEs ; 8.51 % of the sample ) were directly related to hospitalization . The multivariate logistic regression analysis identified the following risk factors : presence of extreme polypharmacy ( ≥10 medications ) ( OR = 3.02 ; 95 % CI = 1.48–6.19 ) , anticholinergic burden according to the Anticholinergic Drug Scale ( ADS ) ( OR = 2.32 ; 95 % CI = 1.13–4.78 ) , and treatment complexity according to the Medication Regimen Complexity Index ( MRCI ) scale ( OR = 2.90 ; 95 % CI = 1.44–5.83 ) . The vast majority ( 94.45 % ) of the ADEs were considered to be preventable . There were no differences in the survival of the patients . Conclusions ADEs are common , largely preventable , and implicated in the hospitalization of patients who require palliative care BACKGROUND Beers criteria and screening tool of older person 's prescriptions ( STOPP ) criteria are widely used to assess potentially inappropriate drug use ( PIDU ) . OBJECTIVE the aims of the present study are ( i ) to assess the prevalence of PIDU based on 2012 Beers criteria and STOPP criteria and ( ii ) to determine the impact of PIDU , as defined by these criteria , on health outcomes among older in-hospital patients . DESIGN prospect i ve observational study . SETTING AND SUBJECTS a total of 871 in-hospital patients participating to the CRIteria to Assess Appropriate Medication Use among Elderly Complex Patients project . METHODS outcome measures were ( i ) adverse drug reactions ( ADR ) ; ( ii ) decline in functional status ; ( iii ) combined outcome ( ADR or declined in functional status ) . RESULTS the prevalence of PIDU was 58.4 % applying Beers criteria , 50.4 % applying STOPP criteria and 75.0 % combining both sets of criteria . PIDU defined based on STOPP criteria was significantly associated with ADR [ odds ratio ( OR ) 2.36 ; 95 % confidence interval ( CI ) 1.10 - 5.06 ] , and decline in physical function ( OR : 2.00 ; 95 % CI : 1.10 - 3.64 ) , while , despite a positive trend , no significant association was observed for Beers criteria or the combination of both criteria . The combined outcome was significantly associated with PIDU defined based on Beers ( OR : 1.74 ; 95 % CI : 1.06 - 2.85 ) , STOPP criteria ( OR : 2.14 ; 95 % CI : 1.32 - 3.47 ) or both ( OR 2.02 ; 95 % CI : 1.06 - 3.84 ) . CONCLUSIONS PIDU is common in hospitalised older adults and the combination of Beers and STOPP criteria might lead to the identification of a larger number of cases of PIDU than the application of a single set of criteria . STOPP criteria significantly predict all in-hospital outcomes considered , while Beers criteria were significantly associated with the combined outcome only Background The elderly population is increasing worldwide . Due to age-related physiological changes that affect the pharmacokinetics and pharmacodynamics of drugs , the elderly are predisposed to adverse drug reactions . Prescribing of potentially inappropriate medications ( PIMs ) has been found to be prevalent among the elderly and PIM use has been associated with hospitalisations and mortality . Objectives This study aims to identify the prevalence and nature of pre-admission inappropriate prescribing by using the STOPP ( screening tool of older people ’s prescriptions ) criteria amongst a sample of hospitalised elderly in patients in South Australia . Setting Medical , surgical and rehabilitation wards of a public teaching hospital in Adelaide , South Australia . Main outcome measure Pre-admission prevalence of PIM . Method Medication management plans of 100 patients of ≥65 years old were prospect ively studied to determine the prevalence of pre-admission PIM use . Sixty-five criteria of STOPP were applied to identify PIMs . Results The total number of pre-admission medications screened during the study period was 949 ; the median number of medicines per patient was nine ( range 2–28 ) . Overall the STOPP criteria identified 138 PIMs in 60 % of patients . The most frequently encountered PIM was opiates prescribed in patients with recurrent falls ( 12.3 % ) , followed by benzodiazepines in fallers ( 10.1 % ) and proton pump inhibitors when prescribed for peptic ulcer disease for long-term at maximum doses ( 9.4 % ) . The number of medications were found to have a positive correlation with pre-admission PIM use ( rs = 0.49 , P < 0.01 ) . Conclusions Pre-admission PIM use is highly prevalent among the studied population . Strategies to reduce PIM use should be undertaken by physicians and pharmacists . The use of the STOPP criteria in clinical practice to reduce prescriptions of inappropriate medications requires further investigation Background It is advocated that interventions to improve clinical practice should be developed using a systematic approach and intervention development methods should be reported . However , previous interventions aim ed at ensuring that older people receive appropriate polypharmacy have lacked details on their development . This study formed part of a multiphase research project which aim ed to develop an intervention to improve appropriate polypharmacy  in older people in primary care . Methods The target behaviours for the intervention were prescribing and dispensing of appropriate polypharmacy to older patients by general practitioners ( GPs ) and community pharmacists . Intervention development followed a systematic approach , including previous mapping of behaviour change techniques ( BCTs ) to key domains from the Theoretical Domains Framework that were perceived by GPs and pharmacists to influence the target behaviours . Draft interventions were developed to operationalise selected BCTs through team discussion . Selection of an intervention for feasibility testing was guided by a subset of the APEASE ( Affordability , Practicability , Effectiveness/cost-effectiveness , Acceptability , Side-effects/safety , Equity ) criteria . Results Three draft interventions comprising selected BCTs were developed , targeting patients , pharmacists and GPs , respectively . Following assessment of each intervention using a subset of the APEASE criteria ( affordability , practicability , acceptability ) , the GP-targeted intervention was selected for feasibility testing . This intervention will involve a demonstration of the behaviour and will be delivered as an online video . The video demonstrating how GPs can prescribe appropriate polypharmacy during a typical consultation with an older patient will also demonstrate salience of consequences ( feedback emphasising the positive outcomes of performing the behaviour ) . Action plans and prompts/cues will be used as complementary intervention components . The intervention is design ed to facilitate the prescribing of appropriate polypharmacy in routine practice . Conclusion A GP-targeted intervention to improve appropriate polypharmacy  in older people has been developed using a systematic approach . Intervention content has been specified using an established taxonomy of BCTs and selected to maximise feasibility . The results of a future feasibility study will help to determine if the theory-based intervention requires further refinement before progressing to a larger scale r and omised evaluation INTRODUCTION STOPP ( Screening Tool of Older Persons '  potentially inappropriate Prescriptions ) is a new , systems-defined medicine review tool . We compared the performance of STOPP to that of established Beers ' criteria in detecting potentially inappropriate medicines ( PIMs ) and related adverse drug events ( ADEs ) in older patients presenting for hospital admission . METHODS we prospect ively studied 715 consecutive acute admissions to a university teaching hospital . Diagnoses , reason for admission and concurrent medications were recorded . STOPP and Beers ' criteria were applied . PIMs with clear causal connection or contribution to the principal reason for admission were determined . RESULTS median patient age ( interquartile range ) was 77 ( 72 - 82 ) years . Median number of prescription medicines was 6 ( range 0 - 21 ) . STOPP identified 336 PIMs affecting 247 patients ( 35 % ) , of whom one-third ( n = 82 ) presented with an associated ADE . Beers ' criteria identified 226 PIMs affecting 177 patients ( 25 % ) , of whom 43 presented with an associated ADE . STOPP-related PIMs contributed to 11.5 % of all admissions . Beers ' criteria -related PIMs contributed to significantly fewer admissions ( 6 % ) . CONCLUSION STOPP criteria 
    Output:
    
Our findings suggest a high prevalence of PIMs in older in patients with and without cognitive impairment .