Inappropriate medication use and polypharmacy in older people

Garfinkel, Doron; Bilek, Aaron Jason

doi:10.1136/bmj.m2023

Cited by 13 publications

(14 citation statements)

References 15 publications

(25 reference statements)

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“…Despite our results and other publications and research underlining the challenge of PP among multimorbid older patients, there is no overall consensus about the best way to deal with the broad general relationship between PP and hospital readmission. 76 Our advanced statistical analysis demonstrated that some specific drugs and the concomitant use of specific drug combinations were significantly associated with 30-day readmission risk, although this was not unexpected and has been confirmed in previous publications. 37 77 Mostly in line with the research findings of Zhang et al, drugs including hormones, antineoplastics, immunosuppressors, neoplastic antibiotics and bacterial vaccines were substantial risk factors for hospital readmission.…”

Section: Discussionsupporting

confidence: 82%

Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study

et al. 2021

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ObjectivesThe present study analysed 4 years of a hospital register (2015–2018) to determine the risk of 30-day hospital readmission associated with the medical conditions and drug regimens of polymedicated, older inpatients discharged home.DesignRegistry-based cohort study.SettingValais Hospital—a public general hospital centre in the French-speaking part of Switzerland.ParticipantsWe explored the electronic records of 20 422 inpatient stays by polymedicated, home-dwelling older adults held in the hospital’s patient register. We identified 13 802 hospital readmissions involving 8878 separate patients over 64 years old.Outcome measuresSociodemographic characteristics, medical conditions and drug regimen data associated with risk of readmission within 30 days of discharge.ResultsThe overall 30-day hospital readmission rate was 7.8%. Adjusted multivariate analyses revealed increased risk of hospital readmission for patients with longer hospital length of stay (OR=1.014 per additional day; 95% CI 1.006 to 1.021), impaired mobility (OR=1.218; 95% CI 1.039 to 1.427), multimorbidity (OR=1.419 per additional International Classification of Diseases, 10th Revision condition; 95% CI 1.282 to 1.572), tumorous disease (OR=2.538; 95% CI 2.089 to 3.082), polypharmacy (OR=1.043 per additional drug prescribed; 95% CI 1.028 to 1.058), and certain specific drugs, including antiemetics and antinauseants (OR=3.216 per additional drug unit taken; 95% CI 1.842 to 5.617), antihypertensives (OR=1.771; 95% CI 1.287 to 2.438), drugs for functional gastrointestinal disorders (OR=1.424; 95% CI 1.166 to 1.739), systemic hormonal preparations (OR=1.207; 95% CI 1.052 to 1.385) and vitamins (OR=1.201; 95% CI 1.049 to 1.374), as well as concurrent use of beta-blocking agents and drugs for acid-related disorders (OR=1.367; 95% CI 1.046 to 1.788).ConclusionsThirty-day hospital readmission risk was associated with longer hospital length of stay, health disorders, polypharmacy and drug regimens. The drug regimen patterns increasing the risk of hospital readmission were very heterogeneous. Further research is needed to explore hospital readmissions caused solely by specific drugs and drug–drug interactions.

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Section: Discussionsupporting

confidence: 82%

Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study

et al. 2021

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“…Polypharmacy can be appropriate, but many older people are taking medicines that are no longer needed or are unsafe [3]. As life expectancy decreases, the goals of care focus less on prevention and more on quality of life, and the number of medications that can be considered appropriate are significantly reduced [4]. At the same time the potential harm of taking medicines increases, particularly for those who are frail and have multi-morbidity and polypharmacy.…”

Section: Introductionmentioning

confidence: 99%

The Effect of a Comprehensive, Interdisciplinary Medication Review on Quality of Life and Medication Use in Community Dwelling Older People with Polypharmacy

Bosch-Lenders

Jansen

Stoffers

et al. 2021

JCM

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We conducted a comprehensive medication review at the patients’ home, using data from electronic patient records, and with input from relevant specialists, general practitioners and pharmacists formulated and implemented recommendations to optimize medication use in patients aged 60+ years with polypharmacy. We evaluated the effect of this medication review on quality of life (QoL) and medication use. Methods: Cluster randomized controlled trial (stepped wedge), randomly assigning general practices to one of three consecutive steps. Patients received usual care until the intervention was implemented. Primary outcome was QoL (SF-36 and EQ-5D); secondary outcomes were medication changes, medication adherence and (instrumental) activities of daily living (ADL, iADL) which were measured at baseline, and around 6- and 12-months post intervention. Results: Twenty-four general practices included 360 women and 410 men with an average age of 75 years (SD 7.5). A positive effect on SF-36 mental health (estimated mean was stable in the intervention, but decreased in the control condition with −6.1, p = 0.009,) was found with a reduced number of medications at follow-up compared to the control condition. No significant effects were found on other QoL subscales, ADL, iADL or medication adherence. Conclusion: The medication review prevented decrease of mental health (SF36), with no significant effects on other outcome measures, apart from a reduction in the number of prescribed medications.

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“…Multimorbidität ist altersassoziiert und triggert Polypharmazie [2]. Zudem steigt mit der Zahl der verordneten Medikamente das Risiko für Interaktionen, eine sogenannte potenziell inadäquate Medikation (PIMs) [3]. Für die Erfassung potenziell unerwünschter Medikamenteneffekte und deren Schwere sind zahlreiche Computerprogramme verfügbar – eines davon ist beispielsweise das Programm AiD Klinik von der Dosing GmbH Heidelberg (www.dosing-gmbh.de).…”

Section: Transfer In Die Praxis Von Prof Dr Helmut Frohnhofen (Düssel...unclassified

Geriatrische Pneumologie: Individualisiertes Medikamentenmanagement implementieren

Frohnhofen

2022

Kompass Pneumol

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Background: An aging society is frequently affected by multimorbidity and polypharmacy, which, in turn, leads to an increased risk for drug interaction. The aim of this study was to evaluate the influence of drug interactions on the length of stay (LOS) in hospitals. Methods: This retrospective, single-centre study is based on patients treated for community-acquired pneumonia in the hospital. Negative binomial regression was used to analyse the association between drug interactions and the LOS in the hospital. Results: The total cohort contained 503 patients, yet 46 inpatients (9%) that died were not included in the analyses. The mean age was 74 (±15.3) years, 35% of patients older than 65 years were found to have more than two drug interactions, and 55% had a moderate, severe, or contraindicated adverse drug reaction. The regression model revealed a significant association between the number of drug interactions (rate ratio (RR) 1.02; 95%-CI 1.01–1.04) and the severity of drug interactions (RR 1.22; 95%-CI 1.09–1.37) on the LOS for the overall cohort as well as for the subgroup of patients aged 80 years and older. Conclusion: Drug interactions are an independent risk factor for prolonged hospitalisation. Standardised assessment tools to avoid drug interactions should be implemented in clinical routines.

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Inappropriate medication use and polypharmacy in older people

Abstract: Computerised tools can help but rational prescribing depends on real collaboration

Cited by 13 publications

References 15 publications

Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study

Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study

The Effect of a Comprehensive, Interdisciplinary Medication Review on Quality of Life and Medication Use in Community Dwelling Older People with Polypharmacy

Geriatrische Pneumologie: Individualisiertes Medikamentenmanagement implementieren

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