Effects of hyperpolypharmacy and potentially inappropriate medications (PIMs) on functional decline in older patients discharged from acute care hospitals

Fabbietti, Paolo; Ruggiero, Carmelinda; Sganga, Federica; Fusco, Sergio; Mammarella, Federica; Barbini, Norma; Cassetta, Laura; Onder, Graziano; Corsonello, Andrea; Lattanzio, Fabrizia; Rosa, Mirko Di

doi:10.1016/j.archger.2018.05.007

Cited by 76 publications

(47 citation statements)

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“…All the studies were observational and specifically, nine were prospective cohort studies, [8][9][10][11][12][13][14][15][16] eight were crosssectional studies, [17][18][19][20][21][22][23][24] and one was a case-control study. 25 Six studies were conducted in the USA; [10][11][12][17][18][19] two each in Germany, 21,24 Japan, 22,23 Italy, 13,15 and the UK; 16,25 and one study each in Australia, 20 Taiwan, 8 and Finland. 9 One study 14 was a multicenter cohort study, which was conducted in 50 European (seven countries) and seven Israeli facilities.…”

Section: Studies Characteristicsmentioning

confidence: 99%

“…The study size ranged between 294 and 29,544 individuals and for most of the studies, the sample consisted of community-dwelling individuals who were surveyed, interviewed, or assessed while living at their home. In two studies, 13,15 the population of interest was older patients admitted to the geriatric and internal medicine acute wards of specific hospitals and in two studies, 12,14 the study sample comprised of institutionalized individuals. The lower limit of age of the population in most of the studies was 65 years except for two studies, 9,21 which included people older than 70 years old, one study with a lower limit of age being 50 years, 25 and two studies without age restriction.…”

Section: Studies Characteristicsmentioning

confidence: 99%

“…Three studies 10,17,20 used a continuous measure of medications and one 25 categorized the number of medications into 4 groups. Major, hyper-PPha or excessive PPha groups were defined in four studies, with the cut-offs being nine and ten medications, respectively in each study 8,9,14,15 and two studies 13,19 used also an alternate cut-off to define PPha, in order to further confirm their results. Regarding the type of medications, most of the studies measured the number of prescriptions and OTCs as medications.…”

Section: Measures Of Medicationsmentioning

confidence: 99%

“…The most common measurement of physical function was derived from the use of basic ADL and instrumental ADL scales. In total, 9 studies 8-10, 12, 14, 15, 17, 18, 20-22 used scales of ADLs-Barthel Index, 26 Lawton-Brody IADL Scale, 8,9,12 Katz Index of ADLs, 8,15,20 Minimum Data Set ADL Hierarchy Scale, 14 OARS Scale of ADLs 10 -all of them resulting in a numerical total score, which evaluated ADL. Four of these studies, 9,17,18,21 did not report the scale of ADLs they used.…”

Section: Measures Of Physical Functionmentioning

confidence: 99%

“…Ten studies incorporated the physical function variable, as the outcome in their statistical analysis 9-12, 14-16, 19, 20, 25 and all of them, except for one, 14 found that PPha is associated with lower physical function ( Table 3). Seven of them were prospective cohort studies, [9][10][11][12][14][15][16] two of them were crosssectional studies, 19,20 and one was a case-control study. 25 Seven of them 9,11,12,15,16,19,25 showed that older adults in the PPha or excessive PPha group had lower physical function compared to people in the non-PPha group.…”

Section: Physical Function As the Outcome Variablementioning

confidence: 99%

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The Association Between Polypharmacy and Physical Function in Older Adults: a Systematic Review

et al. 2019

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BACKGROUND: Reduced physical function and polypharmacy (PPha) are two highly prevalent negative effects of aging, which are expected to increase more, since demographic aging is expected to grow rapidly within the next decades. Previous research suggests that polypharmacy (PPha) is a predictor of poor physical function and vice versa in older adults and therefore we conducted a systematic review of the literature to summarize and critically analyze the relationship between physical function and PPha and vice versa in older adults, in order to provide recent scientific evidence. METHODS: We searched MEDLINE and Embase from their inception to 19th October 2018 for Englishlanguage observational studies or trials assessing the effect of PPha on physical function and vice versa in older adults. Two investigators independently extracted study data and assessed the quality of the studies, after having screened the available studies from the literature search. Any disagreement was resolved by consensus. RESULTS: Eighteen observational studies met the inclusion criteria. Eight studies assessed the impact of physical function on PPha and ten studies assessed the impact of PPha on physical function. Regarding the studies with PPha measurements as the outcome, all of them, except for one, found that better physical function is associated with lower risk of PPha. Likewise, all the studies with physical function measurements as the outcome, except for one, suggested that PPha is associated with lower physical function. DISCUSSION: Evidence examining the effect of PPha on physical function and vice versa in older adults suggests a strong bidirectional association between these two factors and clinicians should be aware of this strong relationship. The limitations of our study include the high variability in PPha definitions and physical function measures, and the treatment of PPha and physical function as constant instead of time-varying variables in the studies' analyses.

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Section: Studies Characteristicsmentioning

confidence: 99%

Section: Studies Characteristicsmentioning

confidence: 99%

Section: Measures Of Medicationsmentioning

confidence: 99%

Section: Measures Of Physical Functionmentioning

confidence: 99%

Section: Physical Function As the Outcome Variablementioning

confidence: 99%

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The Association Between Polypharmacy and Physical Function in Older Adults: a Systematic Review

et al. 2019

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Hospital‐associated deconditioning: Not only physical, but also cognitive

Chen

Almirall‐Sanchez

Mockler

et al. 2022

Int J Geriat Psychiatry

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Introduction: Hospital-associated deconditioning (HAD) or post-hospital syndrome is well recognized as reduced functional performance after an acute hospitalization.Recommendations for the management of HAD are still lacking, partly due to a poor understanding of the underlying processes. We aimed to review existing data on risk factors, pathophysiology, measurement tools, and potential interventions. Materials and methods:We conducted a systematic review from bibliographical databases in English, Spanish and French with keywords such as 'post-hospitalization syndrome' or 'deconditioning'. We selected studies that included people aged 60 years or older. Three researchers independently selected articles and assessed their quality. Results: From 4421 articles initially retrieved, we included 94 studies. Most were related to risk factors, trajectories and measures, and focused on the physical aspects of deconditioning. Risk factors for HAD included age, nutritional status, mobility, and pre-admission functional status, but also cognitive impairment and depression. Regarding interventions, almost all studies were devoted to physical rehabilitation and environmental modifications. Only one study focused on cognitive stimulation. Discussion: In the last decade, studies on HAD have mostly focused on the physical domain. However, neurological changes may also play a role in the pathophysiology of HAD. Beyond physical interventions, cognitive rehabilitation and neurological interventions should also be evaluated to improve deconditioning prevention and treatment in the hospital setting.

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Potentially inappropriate medications among elderly patients in community healthcare institutions in Beijing, China

Wushouer

Nie

et al. 2020

Pharmacoepidemiology and Drug

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PurposeTo evaluate potentially inappropriate medications (PIMs) prevalence and predictors in community healthcare institutions (CHIs) for the elderly.MethodsWe conducted a retrospective observational study, deriving data of patients aged ≥60 from 66 CHIs in Beijing, 2014‐2018. The system of Criteria of PIM for Older Adults in China was applied to identify PIMs. The primary outcome was the prevalence of visits with at least one PIM; secondary outcomes were the frequency and rate per thousand visits of specific PIMs. We used descriptive analysis and generalized linear models to analyzed PIMs and the predictors, and marginal effects methods were applied to estimate the mean adjusted PIMs prevalence.ResultsOverall, 4 528 884 elderly patient visits from 2014 to 2018 were eligible for inclusion. A total of 719 757 PIMs were detected, with 14.1% of the visits contained at least one PIM. PIM prevalence was significantly correlated with age, number of prescribed medications and number of diagnoses. Overall, 6.0 per thousand elderly patients in CHIs were exposed to at least one high‐risk PIM, while 117.5 per thousand were exposed to at least one low‐risk PIM. In 2018, 20% of GPs were responsible for more than half of overall PIM visits.ConclusionPrescribing of PIMs for older adults is common in CHIs in China, especially for patients who are aged, having multiple medications and diagnostic diseases. Strategies should be developed to enhance prescribing quality for geriatric patients, with special targeting of doctors responsible for a high number of PIMs.

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Effects of hyperpolypharmacy and potentially inappropriate medications (PIMs) on functional decline in older patients discharged from acute care hospitals

Cited by 76 publications

References 31 publications

The Association Between Polypharmacy and Physical Function in Older Adults: a Systematic Review

The Association Between Polypharmacy and Physical Function in Older Adults: a Systematic Review

Hospital‐associated deconditioning: Not only physical, but also cognitive

Potentially inappropriate medications among elderly patients in community healthcare institutions in Beijing, China

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