Observational studySingapore medical journal2019
Improving prescribing for older patients - 'Yes S-I-R-E!'
Observational study in Singapore medical journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
3 citing papers in PubMed, 18 citations in OpenAlex.
- Prevalence of polypharmacy: a cross-sectional study in Singapore public healthcare institutions.Singapore medical journal · 2026Article
- Interdisciplinary pharmaceutical care model engaging patient participation alleviate the anticholinergic burden in community-dwelling older adults: subgroup analysis of a randomized controlled trial.Therapeutic advances in drug safety · 2025Article
- Appropriate Prescribing for older adults with Multimorbidity (Pro-M): protocol for a feasibility study.Archives of public health = Archives belges de sante publique · 2024Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionPolypharmacy and inappropriate prescribing are associated with negative health outcomes in the elderly. Several prescribing tools have been developed to assess medication appropriateness. Explicit (criteria-based) tools often do not take into account patients' preferences and comorbidities, and have little room for individualised clinical judgement.
methodsA cross-sectional observational study was conducted in 243 elderly patients admitted to the Geriatric Medicine service in a Singapore tertiary hospital over one month. We incorporated an implicit (judgement-based) tool developed by Scott et al into a mnemonic, 'S-I-R-E', to assess medication appropriateness: S = symptoms ('Have symptoms resolved?'), I = indication ('Is there a valid indication?'), R = risks ('Do risks outweigh benefits?') and E = end of life ('Is there short life expectancy limiting clinical benefit?').
resultsInappropriate prescribing was present in 27.6% of patients. The most common reason for inappropriateness of medications was lack of valid indication (62.2%), followed by high risk-benefit ratio (20.7%). The most common medications that lacked valid indication were supplements and proton pump inhibitors. Polypharmacy was found in 93% of patients and was significantly associated with inappropriate prescribing (p = 0.047).
conclusionInappropriate prescribing and polpharmacy are highly prevalent in the hospitalised elderly. The 'S-I-R-E' mnemonic can be used as a memory aid and practical framework to guide appropriate prescribing in the elderly.
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