Potentially Inappropriate Medication Prescriptions for Older Adults with Painful Conditions and Association with Return Emergency Department Visits

Abstract

Objectives To describe the frequency and risk of return visit to the emergency department (ED) by older adults after prescription of any of four potentially inappropriate medication (PIM) classes included in the 2015 Beers Criteria commonly used for the relief of acute pain in the ED. Design Retrospective cohort study. Setting Large urban academic ED from January 1, 2013, to December 31, 2015. Participants Patients age 65 and older discharged from the ED with an initial pain score of 1 or higher (11 822 visits). Measurements Prescriptions for PIM classes were collected from the medical record: nonsteroidal anti‐inflammatory drugs (NSAIDs), benzodiazepines, skeletal muscle relaxants, and opioids. The proportion of patients with ED returns within 9 days were compared by medication class and pain severity (mild, moderate, or severe). Multivariable logistic regression was performed for each pain category to determine adjusted odds ratios (aORs) of ED return. Results Of 11 822 included patients, PIMs were prescribed in 3392 (28.7%): 2550 (21.6%) opioids, 826 (7.0%) NSAIDs, 277 (2.3%) benzodiazepines, and 68 (0.6%) nonbenzodiazepine skeletal muscle relaxants. Total 9‐day ED returns were 1125 (9.5%): mild 7.0%, moderate 8.3%, and severe pain 11.7%. Opioids were not associated with more frequent ED returns for mild or moderate pain, and they were associated with less frequent ED returns for severe pain (9.2% vs 12.7%; p < .001; aOR 0.69; 95% confidence interval [CI] = 0.54‐0.87). Benzodiazepines were associated with more frequent ED returns for patients with moderate pain (15.5% vs 8.2%; p < .01; aOR = 2.01; 95%CI = 1.10‐3.70). Conclusions These results are consistent with recommendations to limit benzodiazepine prescriptions for older adults and that among older adults with severe pain, opioid prescribing is associated with less frequent ED visits within 9 days of discharge. However, this study was not designed to evaluate safety, adverse events, or other important patient‐centered outcomes. J Am Geriatr Soc 67:719–725, 2019.

Relationship between potentially inappropriate medications and functional prognosis in elderly patients with distal radius fracture: a retrospective cohort study

“…To the best of our knowledge, this is the first study to determine characteristics of PIM use and assess the occurrence of subsequent falls in elderly patients with DRF. Chukwulebe et al [19] and Akkawi et al [20] reported PIM use rates of 28.7% and 28.5%, respectively, among elderly individuals. On the other hand, Huang et al [21] reported that 67.3% of patients receiving home care use PIMs.…”

“…Chukwulebe et al [ 19 ] and Akkawi et al [ 20 ] reported PIM use rates of 28.7% and 28.5%, respectively, among elderly individuals. On the other hand, Huang et al [ 21 ] reported that 67.3% of patients receiving home care use PIMs.…”

Potentially inappropriate medications and medication combinations before, during and after hospitalizations: an analysis of pathways and determinants in the Swiss healthcare setting

“…Pain management is the central part of the treatment both before and after musculoskeletal interventions [ 39 – 41 ]. That these medications may be prescribed inappropriately is well documented in the literature [ 42 – 45 ] and their prescription is recommended only after a sound consideration of the benefits and risks. Nonetheless, this finding is intended to raise awareness particularly among healthcare providers outside the hospital setting regarding the prescribing practices of anti-inflammatory and anti-rheumatic PIMs.…”

Outcomes of adverse drug events reported with potentially inappropriate medications in older adults, 2004–2017

“…PIMs are defined as medications that should be avoided due to their risk outweighing their benefit, 12,13 and explicitly listed in the Beers Criteria which is a commonly used tool to evaluate prescribing of PIMs in older adults. 14 While prescribing of PIMs in older adults has been shown to be prevalent 10,12,[15][16][17][18] and has a direct association with an increased ADE incidences, 5,6,15,18 the impact of PIMs on ADE rates and consequential clinical outcomes in older adults are largely unknown at a national level.…”