Potentially inappropriate medication use and related hospital admissions in aged care residents: The impact of dementia

Abstract

To determine the prevalence of potentially inappropriate medication (PIM) use at hospital admission and discharge, and the contribution to hospital admission among residential aged care facility residents with and without dementia. Methods: We conducted a secondary analysis using data from a multihospital prospective cohort study involving consecutively admitted older adults, aged 75 years or older, who were taking 5 or more medications prior to hospital admission and discharged to a residential aged care facility in South Australia. PIM use was identified using the 2015 Screening Tool for Older Persons' Prescription and 2019 Beers criteria. An expert panel of clinicians with geriatric medicine expertise evaluated the contribution of PIM to hospital admission. Results: In total, 181 participants were included, the median age was 87.5 years and 54.7% were female. Ninety-one (50.3%) had a diagnosis of dementia.

Comment on the article by Eshetie et al. entitled “Potentially inappropriate medication use and related hospital admissions in aged care residents: The impact of dementia”

“…Therefore, even if the lower hospitalization rate in patients without STOPP PIMs we observed in our study cannot be fully ascribed to reduced drug-related hospital admissions, these findings maintain some clinical relevance, demonstrating once more that adherence to well-acknowledged criteria of appropriate prescribing in older subjects is associated with overall clinical benefit. In accordance with previous studies, [5][6][7][8][9] and combining the strengths of our work (i.e., a large sample size and correction for important prognostic variables) 2,3 with the proof of a direct implication of PIMs in hospital admission by Eshetie et al 1 there is a strong rationale that reducing polypharmacy and IP may reduce hospitalizations in vulnerable older patients. The results of recently concluded randomized clinical trials 10,11 will help clinicians to disentangle the impact of STOPP PIM reduction on hard clinical outcomes, including drug-related admissions.…”

“…Yet, some potential limitations should be discussed. First, the prevalence of STOPP PIMs could be overestimated both in our study 2,3 and in that by Eshetie et al 1 multimorbidity and polypharmacy may induce a high number of PIMs that the geriatrician in charge may consider irrelevant for the single patient. In recent years, several criteria were suggested for use in vulnerable patients, including the STOPPFrail, recently updated.…”

“…report conflicting results of previous studies on the impact of hospital admission on PIM prevalence, including a Spanish cohort study on 200 patients discharged from an acute geriatric ward (GW) that did not demonstrate a change in PIM use. 1 At this regard, we would like to report the results of two papers we recently published on this topic, investigating the prevalence and clinical implications of polypharmacy and IP among patients aged ≥65 years discharged from three internal medicine wards (IMWs) and two GWs of two tertiary hospitals in North-western Italy. 2,3 In the cross-sectional part of the study, we investigated the prevalence of, and factors associated with, PIMs and potential prescribing omissions (PPOs) identified at discharge according to 2015 STOPP/START criteria.…”

“…We collected a sample of 726 patients (mean age 81.5 years, 36% discharged to medium/long-term care facilities, MLTCFs) with a high burden of comorbidities and geriatric syndromes (28.5% had moderate to severe cognitive impairment). 2 Table 1 compares principal characteristics of our sample 2 and that by Eshetie et al 1 ; because of less stringent inclusion criteria, our sample was generally younger and presumably had better overall health status, resulting in a lower number of prescribed medications (mean 7.5 vs. 11) and a lower prevalence of STOPP PIMs (54.4% vs. 82.3%) at discharge. However, this gap significantly narrows when considering patients with hyperpolypharmacy, that presented a 74.4% STOPP PIM prevalence in our sample.…”

Potentially inappropriate prescribing and its associations with health‐related and system‐related outcomes in hospitalised older adults: A systematic review and meta‐analysis

“…Hospitalisation offers an opportunity for medication review and rationalisation although a high rate of PIM, including new PIMs, is also likely at hospital discharge. 44,74 The strength of associations with health outcomes was consistently highest for new PIMs. 94 It is, therefore, recommended to have a comprehensive assessment of medication use, especially during care transitions such as hospital discharge, in order to prevent new PIMs from occurring during the patient's journey, and not cascaded into the community.…”