Number‐dependent association of potentially inappropriate medications with clinical outcomes and expenditures among community‐dwelling older adults: A population‐based cohort study

Su, Su; Gao, Lingling; Ma, Wenyao; Wang, Chunguang; Cui, Xiaohui; Liu, Tong; Yan, Suying

doi:10.1111/bcp.15286

Cited by 9 publications

(11 citation statements)

References 47 publications

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“…According to the results of previous studies, PIM use in older patients is closely related to an increase in the incidence of adverse drug events (ADEs) and emergency department visits . Meanwhile, compared with patients without PIM use, their health-related quality of life is worse.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide

Tian,

Chen,

Zeng

et al. 2023

JAMA Netw Open

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ImportanceThe use of potentially inappropriate medications (PIMs) is widespread yet continues to receive little attention in outpatient services.ObjectiveTo estimate the overall prevalence of PIM use in outpatient services.Data SourcesPubMed, Embase, and Web of Science were searched to identify relevant studies published from January 1, 1990, to November 21, 2022.Study SelectionObservational studies that reported the prevalence of PIM use among older patients in outpatient services were screened.Data Extraction and SynthesisTwo reviewers independently selected eligible articles, extracted data, and assessed the risk of bias. A random-effects meta-analysis was conducted to pool the prevalence estimates.Main Outcomes and MeasuresThe global patterns in the prevalence of PIM use among older patients in outpatient services were estimated, and the temporal trends and regional differences in PIM use were investigated.ResultsA total of 94 articles with 132 prevalence estimates were analyzed, including nearly 371.2 million older participants from 17 countries. Overall, the pooled prevalence of PIM use was 36.7% (95% CI, 33.4%-40.0%). Africa had the highest prevalence of PIM use (47.0%; 95% CI, 34.7%-59.4%), followed by South America (46.9%; 95% CI, 35.1%-58.9%), Asia (37.2%; 95% CI, 32.4%-42.2%), Europe (35.0%; 95% CI, 28.5%-41.8%), North America (29.0%; 95% CI, 22.1%-36.3%), and Oceania (23.6%; 95% CI, 18.8%-28.8%). In addition, the prevalence of PIM use is highest in low-income areas. Use of PIMs among older patients has become increasingly prevalent in the past 2 decades.Conclusions and RelevanceThis study of patterns of PIM use by different groups, such as geographic regions and World Bank countries, suggests noticeable geographic environment and economic income differences in the burden of PIMs in outpatient services. Furthermore, the high prevalence trend in the past 2 decades indicates that the global burden of PIM use continues to be worthy of attention.

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Section: Introductionmentioning

confidence: 99%

Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide

Tian,

Chen,

Zeng

et al. 2023

JAMA Netw Open

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“…Miller et al found that the risk of PIM exposure increased by 5.2% for each drug added to the list of medications for older adults ( 7 ). Adverse drug events in older adults caused by PIMs and polypharmacy may be associated with falls, fractures, constipation, emergency department admissions, hospital readmissions, and all-cause mortality ( 17 – 20 ), which have become a significant public health challenge.…”

Section: Introductionmentioning

confidence: 99%

“…Several surveys conducted in different health care settings showed that older adults with diabetes were the most commonly exposed to PIMs ( 5 , 17 , 21 – 23 ). Studies found that 24.9, 56.1, and 39.9% of older adults with diabetes had at least one PIM in The Netherlands, Canada and United States, respectively ( 22 , 24 , 25 ).…”

Section: Introductionmentioning

confidence: 99%

“…Studies found that 24.9, 56.1, and 39.9% of older adults with diabetes had at least one PIM in The Netherlands, Canada and United States, respectively ( 22 , 24 , 25 ). A previous retrospective cohort analysis conducted in Beijing, which included 506,214 older adults in outpatient settings, found a prevalence of PIM of 38.07% ( 17 ), but knowledge of the prevalence of PIMs in older people with diabetes is lacking in China. Hence, studies of the association between PIMs and polypharmacy due to comorbidities in older adults with diabetes in outpatient settings are needed for reducing PIM exposure in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of potentially inappropriate medications and association with comorbidities in older adults with diabetes in an outpatient visitation setting

Yao²,

Chen

et al. 2022

Front. Public Health

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AimsPotentially inappropriate medications had been found associated with adverse drug events such as falls, emergency department admissions and hospital readmissions. There is lack of information about the prevalence of potentially inappropriate medications and associated chronic conditions in older patients with diabetes in China. This study aimed to assess the prevalence of potentially inappropriate medications in older adults with diabetes in an outpatient visitation setting and the association with polypharmacy due to comorbidities.Materials and methodsThis was a 3-year repeated cross-sectional study which conducted in outpatient setting of 52 hospitals in Shenzhen, China, using 2019 Beers criteria. The prevalence of potentially inappropriate medications, polypharmacy and comorbidities in older adults with diabetes in an outpatient setting was expressed as percentages. Logistic models were used to investigate the association between potentially inappropriate medication exposure and age, sex, polypharmacy and comorbidities.ResultsAmong the 28,484 older adults with diabetes in 2015, 31,757 in 2016 and 24,675 in 2017, the prevalence of potentially inappropriate medications was 43.2%, 44.88% and 42.40%, respectively. The top five potentially inappropriate medications were diuretics (20.56%), benzodiazepines (13.85%), androgens (13.18%), non-steroidal anti-inflammatory drugs (12.94%) and sulfonylureas (6.23%). After adjustment for age and polypharmacy, the probability of potentially inappropriate medication exposure was associated with chronic gastrointestinal diseases, followed by osteoarthritis and rheumatoid arthritis, chronic pulmonary disease, chronic kidney disease, tumor, dementia, chronic liver disease, hypertension, cardiovascular disease, cerebrovascular disease and hyperlipemia.ConclusionPotentially inappropriate medications were common in older patients with diabetes in an outpatient visitation setting. Higher probability of potentially inappropriate medication exposure was associated with the comorbidity chronic gastrointestinal diseases as well as osteoarthritis and rheumatoid arthritis. To ensure that iatrogenic risks remain minimal for older adults with diabetes, the clinical comorbidities should be considered.

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“…A decreased number of PIMs has been found to correlate with an improvement in quality of life, reduction in the number of emergency room visits, and the incidence of the hospitalization. 24,25) Although polypharmacy affects the increase in regimen complexity and PIM use, investigations considering both factors as medication-related problems have been limited. A study reported an increase in complexity and a decrease in PIMs after admission 26) ; another evaluated PIMs and regimen complexity in medication adherence as medication-related factors.…”

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confidence: 99%

Potentially Inappropriate Medications and Regimen Complexity on Readmission of Elderly Patients with Polypharmacy: A Retrospective Study

Lee

2023

Korean J Clin Pharm

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Polypharmacy, defined as the concurrent use of five or more medications, is a major public health concern and the potential cause of medication-related problems. 1) Drug treatment for elderly patients with chronic diseases has increased, and polypharmacy is common owing to complex morbidity. 2,3) The prevalence of polypharmacy is high, and the use of 5, 9, 10 drugs or more drugs was reported to be 91, 74, and 65%, respectively, depending on the facilities. 4) Polypharmacy is an indicator of medication-related problems, which is associated with admission and hospitalization in elderly patients. 5,6) Increased regimen complexity and the use of inappropriate medications have been studied as medication-related problems regarding polypharmacy. 7,8) First, the increase in the number of medications may lead to regimen complexity. 9) George et al. ( 2004) developed a methodology for quantifying regimen complexity as numbers known as the medication regimen complexity index (MRCI). 10,11) This instrument is an open index with no upper limit and consists of sections A (the dosage form), B (dosing frequency), and C (the instructions) of the regimen, which are expressed as the sum of regimen ABSTRACT Background: Along with the increase in the elderly population, concerns about polypharmacy, which can cause medication-related problems, are increasing. This study aimed to find out the association between drug-related factors and readmission in elderly patients within 30 days after discharge. Methods: Data of patients aged ≥65 years who were discharged from the respiratory medicine ward of a tertiary hospital between January and March 2016 were retrospectively obtained. The medication regimen complexity at discharge was calculated using the medication regimen complexity index (MRCI) score, comorbidity status was assessed using the Charlson comorbidity index (CCI), potentially inappropriate medications (PIMs) were evaluated based on the Beer 2019 criteria, and adverse drug events (ADEs) were examined using the ADE reporting system. Multivariable logistic regression analysis was used to evaluate the effect of medication-related problems on hospital readmission after controlling for other variables. Results: Of the 206 patients included, 84 (40.8%) used PIMs, 31 (15%) had ADEs, and 32 (15.5%) were readmitted. The mean age, total medications, MRCI, CCI, and PIMs in the readmission group were significantly higher than those in the non-readmission group. Age significantly decreased the risk of readmission (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.84-0.96) after adjusting for sex, length of hospital stay, and ADEs. The use of PIMs (OR, 2.38; 95% CI, 1.10-5.16) and increased CCI (OR, 1.50; 95% CI, 1.16-1.93) and MRCI (OR, 1.04; 95% CI, 1.01-1.07) were associated with an increased occurrence of readmission. Conclusion: PIMs were associated with a significantly greater risk for readmission than MRCI.

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Number‐dependent association of potentially inappropriate medications with clinical outcomes and expenditures among community‐dwelling older adults: A population‐based cohort study

Cited by 9 publications

References 47 publications

Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide

Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide

Prevalence of potentially inappropriate medications and association with comorbidities in older adults with diabetes in an outpatient visitation setting

Potentially Inappropriate Medications and Regimen Complexity on Readmission of Elderly Patients with Polypharmacy: A Retrospective Study

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