The Impact of Potentially Inappropriate Medications and Polypharmacy on 3-Month Hospital Readmission among Older Patients: A Retrospective Cohort Study from Malaysia

Abstract

Introduction: Potentially inappropriate medications (PIMs) use and polypharmacy are two issues that are commonly encountered among older people. They are associated with several negative outcomes including adverse drug reactions and medication-related hospitalization. There are insufficient studies regarding the impact of both PIMs and polypharmacy on hospital readmission, especially in Malaysia. Aim: To investigate the possible association between polypharmacy and prescribing PIMs at discharge and 3-month hospital readmission among older patients. Materials and method: A retrospective cohort study involved 600 patients ≥60 years discharged from the general medical wards in a Malaysian teaching hospital. The patients were divided into two equal groups: patients with or without PIMs. The main outcome was any readmission during the 3-month follow-up. The discharged medications were assessed for polypharmacy (≥five medications) and PIMs (using 2019 Beers’ criteria). Chi-square test, Mann–Whitney test, and a multiple logistic regression were conducted to study the impact of PIMs/polypharmacy on 3-month hospital readmission. Results: The median number for discharge medications were six and five for PIMs and non-PIMs patients, respectively. The most frequently prescribed PIMs was aspirin as primary prevention of cardiovascular diseases (33.43%) followed by tramadol (13.25%). The number of medications at discharge and polypharmacy status were significantly associated with PIMs use. Overall, 152 (25.3%) patients were re-admitted. Polypharmacy and PIMs at discharge did not significantly impact the hospital readmission. After applying the logistic regression, only male gender was a predictor for 3-month hospital readmission (OR: 2.07, 95% CI: 1.022–4.225). Conclusion: About one-quarter of the patients were admitted again within three months of discharge. PIMs and polypharmacy were not significantly associated with 3-month hospital readmissions while male gender was found to be an independent risk factor for readmission.

The current view of potentially inappropriate medications (PIMs) among older adults in Saudi Arabia: a systematic review

“…Consequently, older adults often require a higher number of prescription medications (Gurwitz et al, 2003;Mangoni and Jackson, 2004;Jaul and Barron, 2017). On a global scale, the inappropriate use of medications in this demographic, known as potentially inappropriate medication (PIM) use, poses a significant risk (Akkawi et al, 2023;AlHarkan K et al, 2023). Several studies suggested that PIM use elevates the likelihood of experiencing adverse drug reactions, hospital admissions, emergency room visits, and, in severe cases, mortality.…”

“…Several studies suggested that PIM use elevates the likelihood of experiencing adverse drug reactions, hospital admissions, emergency room visits, and, in severe cases, mortality. (Akkawi et al, 2023;AlHarkan K et al, 2023).In a local context, health system in Saudi Arabia is eager to change and improve the citizen health by increasing the life expectancy age to 78 by 2030 according to Saudi Vision 2030 by several programs and initiatives run by Saudi health transformational plan. Such implementation of PIM will improve health services, promoting prevention of health risk, improving quality and efficiency of the current health services towards older adults and eventually will lead to improve the health of Saudi Older adults (Chowdhury et al, 2021).…”

“…Identifying PIM depends on the tools that clinicians are using like Beer's criteria, STOPP and START criteria which are the most commonly used in practice. Thus, PIM has been linked to negative health outcom61es such as drug-drug interactions, interactions with existing health conditions, and a higher incidence of adverse drug reactions, particularly within the older adult population (Akkawi et al, 2023). Numerous prior research investigations have documented the global prevalence of PIM use in older adult populations (Saqlain et al, 2020a).…”