Factors Associated with the Detection of Inappropriate Prescriptions in Older People: A Prospective Cohort

Abstract

(1) Background: Ageing is associated with complex and dynamic changes leading to multimorbidity and, therefore, polypharmacy. The main objectives were to study an older community-dwelling cohort, to detect inappropriate prescriptions (IP) applying the Patient-Centred Prescription model, and to evaluate the most associated factors. (2) Methods: This was a prospective, descriptive, and observational study conducted from June 2019 to October 2020 on patients ≥ 65 years with multimorbidity who lived in the community. Demographic, clinical and pharmacological data were assessed. Variables assessed were: degree of frailty, using the Frail-VIG index; therapeutical complexity and anticholinergic and sedative burden; and the number of chronic drugs to determine polypharmacy or excessive polypharmacy. Finally, a medication review was carried out through the application of the Patient-Centred Prescription model. We used univariate and multivariate regression to identify the factors associated with IP. (3) Results: We recruited 428 patients (66.6% women; mean age 85.5, SD 7.67). A total of 50.9% of them lived in a nursing home; the mean Barthel Index was 49.93 (SD 32.14), and 73.8% of patients suffered some degree of cognitive impairment. The prevalence of frailty was 92.5%. Up to 90% of patients had at least one IP. An increase in IP prevalence was detected when the Frail-VIG index increased (p < 0.05). With the multivariate model, the relationship of polypharmacy with IP detection stands out above all. (4) Conclusions: 90% of patients presented one IP or more, and this situation can be detected through the PCP model. Factors with higher association with IP were frailty and polypharmacy.

Individualized Medication Review in Older People with Multimorbidity: A Comparative Analysis between Patients Living at Home and in a Nursing Home

“…This was a quasi-experimental pre-post study of a cohort of patients who lived either in their own home or in a nursing home (Community Older Patients cohort (COP cohort)) [ 21 ], in the county of Osona, a mixed urban-rural district in Catalonia (Spain), with a three-month follow-up. Data were collected from June 2019 to October 2020.…”

“…Some of the results of the same study with COP cohort, using different range of research data, have been previously published [ 21 ].…”

“…Each patient’s treatment was analysed by applying the Patient-Centred-Prescription (PCP) model [ 21 ]. This is a systematic 4-stage process, carried out by an interdisciplinary team formed by the patient’s General Practitioner and the nurse with a consultant team (a geriatrician and a clinical pharmacist).…”

“…This scenario becomes especially relevant in nursing homes due to the high proportion of patients with multimorbidity, functional and cognitive impairment, and consequently, frailty [ 21 ]. In this context, establishing a geriatric assessment to improve polypharmacy in nursing homes becomes essential [ 22 ].…”

“…The objectives of the study were to perform a comparative analysis of the impact of place of residence (own home vs. nursing home) in a cohort of older patients (COP-cohort [ 21 ]) in (i) baseline situation; (ii) characteristics of the baseline therapeutic plan: prevalence of polypharmacy, number of (IP), medication complexity, anticholinergic and sedative burden and, monthly drug expenditure (MDE); (iii) the same characteristics of the therapeutic plan after a medication review based on the application of a patient-centred prescription model.…”