Potentially inappropriate medications in a large cohort of patients in geriatric units: association with clinical and functional characteristics
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- Fromm, M.F., Maas, R., Tümena, T. et al. Eur J Clin Pharmacol (2013) 69: 975. doi:10.1007/s00228-012-1425-0
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With the aim of reducing the risk of adverse drug effects, expert groups have defined lists of potentially inappropriate medications (PIM) for drug therapy in the elderly. However, it is unclear whether use of PIM at discharge from specialized geriatric units is associated with altered clinical characteristics.
A post-hoc analysis of 376,335 drug prescriptions in 45,809 patients aged 70 years or older at discharge from 44 geriatric units located in Bavaria was performed (1 January 2009 to 31 December 2010). The main outcome measures were patient-related characteristics including functional status, which were independently associated in a multivariable logistic regression model with PIM at discharge.
Male gender was associated with a lower odds ratio (OR) for the use of PIM [OR 0.72, 95 % confidence interval (CI) 0.67–0.76, P < 0.001]. The Barthel score at discharge was associated with a modestly increased odds ratio for receiving at least one PIM (OR 1.00, 95 % CI 1.00–1.01, P < 0.001). Patients who were only able to walk with assistant or who were unable to walk in the Timed Up-and-Go-Test, had adjusted odds ratios of 1.18 (95 % CI 1.08–1.28, P < 0.001) and 1.22 (95 % CI 1.07–1.39, P = 0.003), respectively, for receiving PIM. In additional multivariate analyses we found no evidence for a significant impact of PIM use on the change in the Barthel score during the hospital stay and on the ability to walk.
Several factors, including gender and Barthel score, are associated with the use of drugs classified as potentially inappropriate for drug therapy in the elderly. However, the use of potentially inappropriate medications is not a clinically meaningful indicator of functional status at discharge.