Use of potentially inappropriate medications and adverse events in older outpatients with acute conditions

Abstract

Objective: To examine associations between potentially inappropriate medication, use and the risk of falls, unplanned hospitalization and death in older patients receiving initial care in a geriatric day hospital due to acute conditions. Methods: Cohort study with older adults referred to a geriatric day hospital from 2014 to 2017 due to acute conditions. Patients were submitted to comprehensive geriatric assessment. Use of medications was analyzed according to Beers Criteria 2019. Outcome assessment was based on monthly follow-up telephone calls made over the course of one year. Results: In this sample, 40.6% of patients had been prescribed at least one potentially inappropriate medication, particularly proton pump inhibitors (66.5%). Over the course of follow-up, 44.7% of patients receiving potentially inappropriate medications sustained at least one fall (p=0.0043) and 70% visited the emergency department (p=0.0452). These outcomes were more common among patients using two or more of drugs. Use of potentially inappropriate medication was associated with a 64% increase in the odds of unplanned hospitalization and a two-fold increase in risk of death. Conclusion: Associations between potentially inappropriate medication use and unfavorable outcomes such as falls and unplanned hospitalizations within one year of admission to a geriatric day hospital support the application of Beers Criteria and emphasize the importance of periodic prescription review, deprescription and rational use of these drugs whenever possible.

Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide

“…Following exclusion of 213 duplicate studies, 1258 studies were excluded by the titles and abstracts. Ninety-four studies with 371 224 692 older outpatients were included for analysis (Figure 1; eAppendix 2 in Supplement 1).…”

“…Forty-one studies were conducted in Asia, followed by 22 studies in Europe, 14 studies in North America, 8 studies in South America, 7 studies in Africa, and 2 studies in Oceania. Between 1999 and 2021, a total of 51 studies were performed in high-income countries, 23 studies in upper- to middle-income countries, 17 studies in lower- to middle-income countries, and 3 studies in low-income countries. Sixty-three studies of the PIM prevalence estimates were based on the Beers criteria, 26 studies…”

“…Between 1999 and 2021, a total of 51 studies were performed in high-income countries, 23 studies in upper- to middle-income countries, 17 studies in lower- to middle-income countries, and 3 studies in low-income countries. Sixty-three studies of the PIM prevalence estimates were based on the Beers criteria, 26 studies were based on the STOPP/START criteria, 13 studies on localization criteria that were developed based on the characteristics of medication for older patients in their own country, and 13 studies on other criteria. Eighty-five studies…”

“…Eighty-five studies were cross-sectional in design, and 11 studies were conducted in a national population survey. The mean age of the participants in most studies (65 studies) was younger than 80 years and older than 65 years, and 31 studies had a mean number of drugs greater than 5. Thirty-four studies had a male ratio of more than 50%, and 34 studies included older outpatients with certain diseases.…”

“…The 94 studies were conducted across 17 countries. Forty-one studies were conducted in Asia, followed by 22 studies 11, in Europe, 14 studies [79][80][81][82][83][84][85][86][87][88][89][90][91][92] in North America, 8 studies [93][94][95][96][97][98][99][100] in South America, 7 studies [101][102][103][104][105][106][107] in Africa, and 2 studies 108,109 in Oceania. Between 1999 and 2021, a total of 51 studies 11,[37][38][39][40][41][42][79][80][81][82][83][84][85][86][87][88][89][90][91]…”