Importance of potentially inappropriate medications, number of chronic conditions and medications for the risk of hospitalisation in elderly in Sweden: a case–control study

Abstract

ObjectivesThis study aimed to investigate the importance of potentially inappropriate medications, number of medications and chronic conditions for the risk of hospitalisation among an elderly population.DesignThis is a case–control study.SettingPopulation-based study in 2013 of all individuals aged 75 years and older (17 203) in the county of Blekinge in the southeast of Sweden.ParticipantsA total of 2941 individuals were included who had at least one hospitalisation to a medical, geriatric and palliative, or orthopaedic ward during 2013. From this total, 81 were excluded because of incomplete data or absence of controls. In total, 5720 patients were included and formed 2860 risk sets matched on age and gender.Primary and secondary outcome measuresConditional logistic regression was used to analyse the odds for hospitalisation according to use of potentially inappropriate medication (PIM), number of chronic conditions and medicines using univariate and multivariate models. PIM was defined as long-acting benzodiazepines, tramadol, propiomazine and medicines with anticholinergic effect.ResultsThe univariate analysis for use of PIM showed a significant association with hospitalisation (OR 1.54, 95% CI 1.30 to 1.83). For the number of chronic conditions, the OR was increased and was significant from two or more chronic conditions, and for the number of medicines from the use of five or more medicines, in the univariate analysis. Use of PIM has no association with hospitalisation in the full model. The number of chronic conditions and medicines in the full models continued to have strong associations for hospitalisation, from five to seven chronic conditions (OR 1.86, 95% CI 1.49 to 2.33) and use of five to nine medicines (OR 1.46, 95% CI 1.21 to 1.77) at the same time.ConclusionThe number of chronic conditions and medications are important for the odds of hospitalisation, while the use of PIM, according to the definition used in this study, was no significant in the full model.

Clinical Features and Mortality of Nosocomial Candidemia in Very Old Patients: A Multicentre Italian Study

“…The age established for defining VO patient was ≥75 years in the present study since subjects who present physiological changes, health issues, and drug responses that are more distinctively related with old age are currently ≥75 years of age, as shown in recent studies from developed countries [7, 10, 14, 16].…”

Association between pill burden and interdialytic weight gain in patients with hemodialysis: A multi‐center cross‐sectional study

“…PIMs are likely to cause adverse drug side effects, adverse drug reactions, and drug‐related problems, especially in elderly patients, and polypharmacy including PIMs has been associated with increased mortality. Deprescribing can be performed in many patients by using the Beers criteria 19,20 and STOPP criteria, 21 both of which are used to avoid the prescription of unnecessary drugs. According to the STOPP criteria, most commonly prescribed PIMs are PPIs for uncomplicated peptic ulcer disease at the full therapeutic dose for 8 weeks or more; aspirin in patients with no history of coronary, cerebral, or peripheral vascular symptoms, or occlusive arterial events; benzodiazepines in patients who have had ≥1 fall in the past 3 months; and duplicate drug class prescriptions.…”

Sex differences in multimorbidity and polypharmacy trends: A repeated cross-sectional study of older adults in Ontario, Canada

“…For many older adults living with multimorbidity, a high rate of use of multiple medications may reflect appropriate pharmacotherapeutic care [40,41]. However, the concurrent use of multiple medications raises concerns about the potential of drugdrug and drug-disease interactions, adverse drug events, treatment burden and non-adherence among this population [12][13][14][15][16][17][18][19]23,41]. The relative balance between benefit and harm is a priority area for further clinical and research investigations.…”

“…The potential for significant expansion in years lived with multimorbidity [1] has important implications for healthcare outcomes and costs [5,10]. As both the number and heterogeneity of co-occurring chronic conditions increases with age [6,7], older adults are more likely to be exposed to complex drug regimens that place them at risk for inappropriate use [11,12], treatment burden [13], nonadherence [14] and adverse drug events [15][16][17][18]. As with multimorbidity, prevalence estimates of polypharmacy (5+ drugs) and hyper-polypharmacy (10+ drugs) among persons aged 65 and older have increased significantly over the past 20 years [12,19] with recent international estimates ranging between 50-66% and 23-27%, respectively [20][21][22][23].…”