Inappropriate medication use in hospitalised oldest old patients across transitions of care
- 6 Downloads
Oldest old patients aged 85 years and over are at risk of experiencing potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) across transitions of care. Geriatricians also face enormous challenges in prescribing medications for these patients.
A mixed-methods, sequential explanatory design was undertaken of electronic medical records and semi-structured interviews with geriatricians at a public teaching hospital. Data were collected at four time points using the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to the Right Treatment (START).
Of 249 patients, the prevalence of at least 1 PIM varied between 36.9 and 51.0%, while the prevalence of at least 1 PPO varied between 36.9 and 44.6%. The most common PIM was use of proton pump inhibitors while the most common PPO was omission of vitamin D supplements in housebound patients or patients experiencing falls. Poisson regression analysis showed that PIMs were significantly associated with use of mobility aids, 1.430 (95% CI 1.109–1.843, p = 0.006), and number of medications prescribed at admission, 1.083 (95% CI 1.058–1.108, p < 0.001). PPOs were significantly associated with comorbidities, 1.172 (95% CI 1.073–1.280, p < 0.001), medications prescribed at admission, 0.989 (95% CI 0.978–0.999, p = 0.035), and length of stay, 1.004 (95% CI 1.002–1.006, p < 0.001). Geriatrician interviews (N = 9) revealed medication-related, health professional-related and patient-related challenges with managing medications.
Inappropriate prescribing is common in oldest old patients. Greater attention is needed on actively de-prescribing medications that are not beneficial and commencing medications that would be advantageous. Tailored strategies for improving prescribing practices are needed.
KeywordsOldest old Transition Inappropriate medication Prescribing Potentially inappropriate medication Potential prescribing omission
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For the retrospective clinical audit of electronic medical records, formal consent was not required. For the semi-structured interviews with geriatricians, informed consent was obtained from all individual participants included in the study.
- 1.United Nations (2015) World population ageing. United Nations, New YorkGoogle Scholar
- 2.Ortman J, Velkoff V, Hogan H (2014) An aging nation: the older population in the United States. Department of Commerce, US Census Bureau, Washington, DC, USGoogle Scholar
- 3.Galvin R, Moriarty F, Cousins G et al (2014) Prevalence of potentially inappropriate prescribing and prescribing omissions in older Irish adults: findings from The Irish LongituDinal Study on Ageing study (TILDA). Eur J Clin Pharmacol 70:599–606. https://doi.org/10.1007/s00228-014-1651-8 CrossRefGoogle Scholar
- 4.Hamilton HJ, Gallagher P, O’Mahony D (2009) Inappropriate prescribing and adverse drug events in older people. BMC Geriatr 9 (5): https://doi.org/10.1186/1471-2318-1189-1185
- 15.Ble A, Masoli JAH, Barry HE et al (2015) Any versus long-term prescribing of high risk medications in older people using 2012 Beers Criteria: results from three cross-sectional samples of primary care records for 2003/4, 2007/8 and 2011/12. BMC Geriatr 15:146–146. https://doi.org/10.1186/s12877-015-0143-8 CrossRefGoogle Scholar
- 27.Miller G, Wong C, Pollack A (2015) Gastro-oesophageal reflux disease (GORD) in Australian general practice patients. Aust Fam Phys 44:701–704Google Scholar
- 29.Rane PP, Guha S, Chatterjee S et al Prevalence and predictors of non-evidence based proton pump inhibitor use among elderly nursing home residents in the US. Res Soc Adm Pharm 13 (2):358–363. https://doi.org/10.1016/j.sapharm.2016.02.012