Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalization in a cohort of community-dwelling oldest old.
Maarten Wauters,Monique Elseviers,Bert Vaes,Bert Vaes,Jean-Marie Degryse,Jean-Marie Degryse,Olivia Dalleur,Olivia Dalleur,Robert Vander Stichele,Thierry Christiaens,Majda Azermai +10 more
TLDR
Surprisingly, underuse and not misuse had strong associations with mortality and hospitalization in adults, aged 80 years and older.Abstract:
Aims
Little is known about the impact of inappropriate prescribing (IP) in community-dwelling adults, aged 80 years and older. The prevalence at baseline (November 2008September 2009) and impact of IP (misuse and underuse) after 18 months on mortality and hospitalization in a cohort of community-dwelling adults, aged 80 years and older (n = 503) was studied.
Methods
Screening Tool of Older People's Prescriptions (STOPP-2, misuse) and Screening Tool to Alert to Right Treatment (START-2, underuse) criteria were cross-referenced and linked to the medication use (in Anatomical Therapeutic Chemical coding) and clinical problems. Survival analysis until death or first hospitalization was performed at 18 months after inclusion using Kaplan–Meier, with Cox regression to control for covariates.
Results
Mean age was 84.4 (range 80–102) years. Mean number of medications prescribed was 5 (range 0–16). Polypharmacy (≥5 medications, 58%), underuse (67%) and misuse (56%) were high. Underuse and misuse coexisted in 40% and were absent in 17% of the population. A higher number of prescribed medications was correlated with more misused medications (rs = .51, P < 0.001) and underused medications (rs = .26, P < 0.001).
Mortality and hospitalization rate were 8.9%, and 31.0%, respectively. After adjustment for number of medications and misused medications, there was an increased risk of mortality (HR 1.39, 95% CI 1.10, 1.76) and hospitalization (HR 1.26, 95% CI 1.10, 1.45) for every additional underused medication. Associations with misuse were less clear.
Conclusion
IP (polypharmacy, underuse and misuse) was highly prevalent in adults, aged 80 years and older. Surprisingly, underuse and not misuse had strong associations with mortality and hospitalization.read more
Citations
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Journal ArticleDOI
The epidemiology of polypharmacy in older adults: register-based prospective cohort study.
TL;DR: The prevalence and incidence of polypharmacy are high among older adults in Sweden and interventions aimed at reducing the prevalence and investigating the associated factors should also target potential incident polyPHarmacy users as they are the ones who fuel future polyphARMacy.
Journal ArticleDOI
Irrational Use of Medicines-A Summary of Key Concepts.
TL;DR: This article summarizes basic concepts such as rational medicine use, good prescribing and dispensing, and explores some of the factors that contribute to irrational use of medicines as well as potential impacts of such practices.
Journal ArticleDOI
STOPP/START criteria for potentially inappropriate medications/potential prescribing omissions in older people: origin and progress
TL;DR: Even with well-functioning software for the application of STOPP/START criteria, the need remains for face-to-face interaction between attending clinicians and appropriately trained personnel to explain and qualify specific STOPP /START recommendations in individual multi-morbid older patients.
Journal ArticleDOI
Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study.
Teresa Pérez,Teresa Pérez,Frank Moriarty,Emma Wallace,Ronald McDowell,Ronald McDowell,Patrick Redmond,Patrick Redmond,Tom Fahey +8 more
TL;DR: It is important to determine how hospital admission may affect appropriateness of prescribing for older people and how potential adverse consequences of admission can be minimised.
Journal ArticleDOI
Associations Between Potentially Inappropriate Medications and Adverse Health Outcomes in the Elderly: A Systematic Review and Meta-analysis.
Xiao Xuan Xing,Chen Zhu,Hua Yu Liang,Ke Wang,Yan Qi Chu,Li Bo Zhao,De Chun Jiang,Yu Qin Wang,Su Ying Yan +8 more
TL;DR: It is recommended that clinicians avoid prescribing PIMs for older adults whenever feasible and the observed associations should be generalized to other countries with different PIM criteria with caution.
References
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Journal ArticleDOI
American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults
TL;DR: This update has much strength, including the use of an evidence-based approach using the Institute of Medicine standards and the development of a partnership to regularly update the Criteria.
Journal ArticleDOI
STOPP/START criteria for potentially inappropriate prescribing in older people: version 2
TL;DR: STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people based on an up-to-date literature review and consensus validation among a European panel of experts.
Journal ArticleDOI
STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation.
TL;DR: StopP/START as discussed by the authors is a screening tool of older persons' prescriptions incorporating criteria for potentially inappropriate drugs called STOPP (Screening Tool of Older Persons' Prescriptions).
Journal ArticleDOI
Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine.
Mark H. Beers,Joseph G. Ouslander,Irving Rollingher,David B. Reuben,Jacqueline Brooks,John C. Beck +5 more
TL;DR: 30 factors agreed on by this method identify inappropriate use of such commonly used categories of medications as sedative-hypnotics, antidepressants, antipsychotics, antihypertensives, nonsteroidal anti-inflammatory agents, oral hypoglycemics, dementia treatments, platelet inhibitors, histamine2 blockers, antibiotics, decongestants, iron supplements, muscle relaxants, gastrointestinal antispasmodics, and antiemetics.
Journal ArticleDOI
Appropriate prescribing in elderly people: how well can it be measured and optimised?
Anne Spinewine,Kenneth E. Schmader,Nick Barber,Carmel Hughes,Kate L. Lapane,Christian Swine,Joseph T. Hanlon +6 more
TL;DR: This work defines and categorise appropriate prescribing in elderly people, critically review the instruments that are available to measure it and discuss their predictive validity, and critically review recent randomised controlled intervention studies that assessed the effect of optimisation strategies on the appropriateness of prescribing.