Potentially inappropriate prescribing in older patients admitted to acute care hospitals and discharged to residential aged care facilities

Poudel, A., Nissen, L., Mitchell, C., Peel, N.M., Gray, L.C., & Hubbard, R.E. (2014) Potentially inappropriate prescribing in older patients admitted to acute care hospitals and discharged to residential aged care facilities. In Journal of the American Geriatrics Society, John WIley & Sons Inc, Orlando, FL, s264.

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Abstract

Background

The frequency of prescribing potentially inappropriate medications (PIMs) in older patients remains high regardless of the evidence of adverse outcomes from their use. This study aims to identify the prevalence and nature of PIMs at admission to acute care and at discharge to residential aged care facilities (RACFs) using the recently updated Beers’ Criteria. We also aim to identify if polypharmacy, age, gender and the frailty status of patients are independent risk factors for receiving a PIM.

Methods

This was a retrospective study of 206 patients discharged to RACFs from acute care. All patients were aged at least70 years and were admitted between July 2005 and May 2010; their admission and discharge medications were evaluated. Frailty status was measured as the Frailty Index (FI), adding each individual’s deficits and dividing by the total number of deficits considered, with FI 0.25 used as the cut-off between “fit” and “frail”.

Results

Mean patient age was 84.8 ± 6.7 years; the majority (57%) were older than 85 years and approximately 90% were frail. Patients were prescribed a mean of 7.2 regular medications at admission and 8.1 on discharge. At least one PIM was identified in 112 (54.4%) patients on admission and 102 (49.5%) patients on discharge. Of all medications prescribed at admission (1728), 10.8% were PIMs and at discharge of 1759 medications, 9.6% were PIMs. Of the total 187 PIMs on admission, 56 (30%) were stopped, and 131 were continued; 32 new PIMs were introduced. Commonly prescribed PIMs at both admission and discharge were central nervous system, cardiovascular and gastrointestinal drugs and analgesics. Of the potential risk factors, frailty status was the only significant predictor of PIMs at both admission and discharge (p = 0.016).

Conclusion

A high prevalence of unnecessary drug use was observed in frail older patients on admission to acute care hospitals and on discharge to RACFs. The only association with PIM use was the frailty status of patients. Further studies are needed to further evaluate this association.

Impact and interest:

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ID Code: 80231
Item Type: Conference Paper
Refereed: Yes
Additional Information:

Abstract published in Journal of the American Geriatrics Society

Special Issue: 2014 Annual Scientific Meeting Abstract Book

Volume 62, Issue Supplement s1, pages S1–S331, March 2014

DOI: 10.1111/jgs.12870
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PHARMACOLOGY AND PHARMACEUTICAL SCIENCES (111500)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PHARMACOLOGY AND PHARMACEUTICAL SCIENCES (111500) > Clinical Pharmacology and Therapeutics (111502)
Australian and New Zealand Standard Research Classification
Divisions: Current > Schools > School of Clinical Sciences
Current > QUT Faculties and Divisions > Faculty of Health
Deposited On: 20 Jan 2015 04:20
Last Modified: 20 Jan 2015 22:43

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