Multidrug use positively correlates with high-risk prescriptions in the Japanese elderly: a longitudinal study

Abstract

Background There is a lack of evidence that multidrug use triggers adverse events. Therefore, the main purpose of this study was to clarify the relationship between the total number of drugs and number of high-risk prescriptions administered to Japanese elderly patients. Methods Using hospital electronic medical records (EMR), we evaluated the prescriptions of outpatients aged 65 years or older. We defined prescriptions of potentially inappropriate medications (PIMs) and overlapping prescription of drugs with the same mechanism of action (DSAs) as high-risk prescriptions. We analyzed the relationship among total number of drugs and high-risk prescriptions. In addition, we performed a secondary research to determine whether the hospitalization rate and concomitant medication contents differ depending on the high-risk prescriptions. Results Data for 13,630 outpatients were analyzed. A significant positive correlation between the numbers of total drugs and PIMs was found. The prescription frequency of individual PIMs rose as the total number of prescription drugs increased. The odds ratio (OR) of overlapping DSAs was significantly higher in patients using 5 or more drugs. In addition, there were significantly more prescriptions of laxatives among patients with overlapping prescriptions of anticholinergic drugs. The use of almost all PIMs was not an independent risk factor for hospitalization; instead, the number of PIMs was an independent risk factor for hospitalization [OR 1.18 (95% CI, 1.12–1.26)]. Conclusions The number of PIMs and overlapping DSAs were high in patients receiving multidrug treatment. To avoid adverse events and hospitalization, it might be useful to review prescriptions and consider the number of PIMs and overlapping DSAs.

Association of Self-Reported Medication Adherence with Potentially Inappropriate Medications in Elderly Patients: A Cross-Sectional Pilot Study

“…Cross-sectional studies in Japan have reported that patients who were prescribed by two or more physicians or who consulted more medical institutions are more likely to have PP and PIM use [8,70], as shown in our study. Furthermore, our study demonstrated that there is also a significant association between PP and PIM use, which is supported by previous reports [8,[20][21][22][23][24][25][26][27]. The frequency of elderly PIM(+) patients in Japan varies from 22.9% to 67.3% [8,22,23,27,31,35,68,71,72] because of different study populations and settings, different definitions of PIMs, or different timings of the investigation.…”

“…Potentially inappropriate medications (PIMs), defined as medications with more harmful than beneficial effects on elderly patients [19], are closely related to PP [8,[20][21][22][23][24][25][26][27] and are a relevant public health concern for elderly patients [28,29]. In 2015, the Japan Geriatric Society (JGS) updated the "Guidelines for Medical Treatment and its Safety in the Elderly" and proposed medication lists regarding PIMs, "Screening Tool for Older Persons' Appropriate Prescriptions for Japanese" (STOPP-J), to contribute to improving prescription quality [30,31].…”

Are potentially inappropriate and anticholinergic medications being prescribed for institutionalized elderly subjects?

“…In this study, we have shown, in a population of elderly subjects living in nursing homes, that an increase in the anticholinergic burden of prescriptions is associated, on the one hand, with polypharmacy and, on the other hand, with prescription of PIMs. Other studies have suggested an association between polypharmacy and prescription of PIMs [17], but as far as we are aware, there are no studies analysing simultaneously the association between polypharmacy, anticholinergic burden and number of PIMs. Polypharmacy and prescription of PIMs are known risk factors for drug‐induced iatrogenic disorders [18,19].…”

FORTA(Fit-fOR-The-Aged)-based medication optimization: retrospective analysis of experiences from an unconventional outpatient service

“…In comparison, little is known about the utility of such approaches in the outpatient setting/ambulatory care. The negative impact of potentially inappropriate medications has been robustly demonstrated in older outpatients as well [ 11 ]. The main challenge, however, remains how to address this problem.…”