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Inappropriate medication use in hospitalised oldest old patients across transitions of care

  • Elizabeth ManiasEmail author
  • Andrea Maier
  • Gopika Krishnamurthy
Original Article
  • 13 Downloads

Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.

Keywords

Oldest old Transition Inappropriate medication Prescribing Potentially inappropriate medication Potential prescribing omission 

Notes

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.

Informed consent

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.

Supplementary material

40520_2018_1114_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 KB)
40520_2018_1114_MOESM2_ESM.docx (18 kb)
Supplementary material 2 (DOCX 18 KB)

References

  1. 1.
    United Nations (2015) World population ageing. United Nations, New YorkGoogle Scholar
  2. 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. 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. 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
  5. 5.
    Hamilton H, Gallagher P, Ryan C et al (2011) Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med 171:1013–1019CrossRefGoogle Scholar
  6. 6.
    Runciman WB, Roughead EE, Semple SJ et al (2003) Adverse drug events and medication errors in Australia. Int J Qual Health Care 15:i49–i59CrossRefGoogle Scholar
  7. 7.
    Sakuma M, Morimoto T (2011) Adverse drug events due to potentially inappropriate medications. Arch Intern Med 171:1959.  https://doi.org/10.1001/archinternmed.2011.553 CrossRefGoogle Scholar
  8. 8.
    Yayla M, Bilge U, Binen E et al (2013) The use of START/STOPP criteria for elderly patients in primary care. Sci World J.  https://doi.org/10.1155/2013/165873 Google Scholar
  9. 9.
    Gallagher P, Ryan C, Byrne S et al (2008) STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther 46:72–83CrossRefGoogle Scholar
  10. 10.
    O’Mahony D, O’Sullivan D, Byrne S et al (2015) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 44:213–218.  https://doi.org/10.1093/ageing/afu145 CrossRefGoogle Scholar
  11. 11.
    Hill-Taylor B, Hayden J, Byrne S et al (2013) Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. J Clin Pharm Ther 38:360–372CrossRefGoogle Scholar
  12. 12.
    Elliott R, Stehlik P (2013) Identifying inappropriate prescribing for older people. J Pharmac Pract Res 43:312–319CrossRefGoogle Scholar
  13. 13.
    Charlson M, Pompei P, Ales K et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefGoogle Scholar
  14. 14.
    Manias E, Kusljic S, Berry C et al (2015) Use of the Screening Tool of Older Person’s Prescriptions (STOPP) in older people admitted to an Australian hospital. Aust J Ageing 34:15–20CrossRefGoogle Scholar
  15. 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
  16. 16.
    Wauters M, Elseviers M, Vaes B et al (2016) Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalization in a cohort of community-dwelling oldest old. Br J Clin Pharmacol 82:1382–1392.  https://doi.org/10.1111/bcp.13055 CrossRefGoogle Scholar
  17. 17.
    Lai X, Zhu H, Huo X, Li Z (2018) Polypharmacy in the oldest old (≥ 80 years of age) patients in China: a cross-sectional study. BMC Geriatr 18:64–64.  https://doi.org/10.1186/s12877-018-0754-y CrossRefGoogle Scholar
  18. 18.
    San-José A, Agustí A, Vidal X et al (2015) Inappropriate prescribing to the oldest old patients admitted to hospital: prevalence, most frequently used medicines, and associated factors. BMC Geriatr 15:42–42.  https://doi.org/10.1186/s12877-015-0038-8 CrossRefGoogle Scholar
  19. 19.
    Dalleur O, Boland B, De Groot A et al (2015) Detection of potentially inappropriate prescribing in the very old: cross-sectional analysis of the data from the BELFRAIL observational cohort study. BMC Geriatr 15:1CrossRefGoogle Scholar
  20. 20.
    San-José A, Agustí A, Vidal X et al (2014) Original article: Inappropriate prescribing to older patients admitted to hospital: a comparison of different tools of misprescribing and underprescribing. Eur J Intern Med 25:710–716.  https://doi.org/10.1016/j.ejim.2014.07.011 CrossRefGoogle Scholar
  21. 21.
    Wauters M, Elseviers M, Vaes B et al (2016) Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalisation in a cohort of community-dwelling oldest old. Br J Clin Pharmacol.  https://doi.org/10.1111/bcp.13055 Google Scholar
  22. 22.
    Wahab MSA, Nyfort-Hansen K, Kowalski SR (2012) Inappropriate prescribing in hospitalised Australian elderly as determined by the STOPP criteria. Int J Clin Pharm 34:855–862.  https://doi.org/10.1007/s11096-012-9681-8 CrossRefGoogle Scholar
  23. 23.
    Manias E, Kusljic S, Lam D-L (2015) Use of the Screening Tool of Older Persons’ Prescriptions (STOPP) and the Screening Tool to Alert doctors to the Right Treatment (START) in hospitalised older people. Aust J Ageing 34:252–258.  https://doi.org/10.1111/ajag.12186 CrossRefGoogle Scholar
  24. 24.
    Frankenthal D, Lerman Y, Lerman Y (2015) The impact of hospitalization on potentially inappropriate prescribing in an acute medical geriatric division. Int J Clin Pharm 37:60–67.  https://doi.org/10.1007/s11096-014-0040-9 CrossRefGoogle Scholar
  25. 25.
    Blanco Reina E, Ariza Zafra G, Ocaña Riola R et al (2015) Optimizing elderly pharmacotherapy: polypharmacy vs. undertreatment. Are these two concepts related? Eur J Clin Pharmacol 71:199–207CrossRefGoogle Scholar
  26. 26.
    Di Giorgio C, Provenzani A, Polidori P (2016) Potentially inappropriate drug prescribing in elderly hospitalized patients: an analysis and comparison of explicit criteria. Int J Clin Pharm 38:462–468.  https://doi.org/10.1007/s11096-016-0284-7 CrossRefGoogle Scholar
  27. 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
  28. 28.
    Wallerstedt SM, Fastbom J, Linke J et al (2017) Long-term use of proton pump inhibitors and prevalence of disease- and drug-related reasons for gastroprotection—a cross-sectional population-based study. Pharmacoepidemiol Drug Saf 26:9–16.  https://doi.org/10.1002/pds.4135 CrossRefGoogle Scholar
  29. 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
  30. 30.
    Eusebi LH, Rabitti S, Artesiani ML et al (2017) Proton pump inhibitors: Risks of long-term use. J Gastroenterol Hepatol 32:1295–1302.  https://doi.org/10.1111/jgh.13737 CrossRefGoogle Scholar
  31. 31.
    Trivedi DP, Doll R, Khaw KT (2003) Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ 326:469.  https://doi.org/10.1136/bmj.326.7387.469 CrossRefGoogle Scholar
  32. 32.
    Broe KE, Chen TC, Weinberg J et al (2007) A higher dose of vitamin D reduces the risk of falls in nursing home residents: a randomized, multiple-dose study. J Am Geriatr Soc 55:234–239.  https://doi.org/10.1111/j.1532-5415.2007.01048.x CrossRefGoogle Scholar
  33. 33.
    de Groote P, Isnard R, Assyag P et al (2007) Is the gap between guidelines and clinical practice in heart failure treatment being filled? Insights from the IMPACT RECO survey. Eur J Heart Fail 9:1205–1211.  https://doi.org/10.1016/j.ejheart.2007.09.008 CrossRefGoogle Scholar
  34. 34.
    Napolitano F, Izzo M, Di Giuseppe G et al (2013) Frequency of inappropriate medication prescription in hospitalized elderly patients in Italy. PLoS One 8:e82359–e82359CrossRefGoogle Scholar
  35. 35.
    Wimmer BC, Bell JS, Fastbom J et al (2016) Medication regimen complexity and polypharmacy as factors associated with all-cause mortality in older people: a population-based cohort study. Ann Pharmacother 50:89–95.  https://doi.org/10.1177/1060028015621071 CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Centre for Quality and Patient Safety Research, School of Nursing and MidwiferyDeakin UniversityBurwoodAustralia
  2. 2.Department of MedicineThe Royal Melbourne Hospital, The University of MelbourneParkvilleAustralia
  3. 3.Department of Medicine and Aged Care, @AgeMelbourneThe Royal Melbourne Hospital, The University of MelbourneParkvilleAustralia
  4. 4.Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement SciencesVrije Universiteit, Amsterdam Movement SciencesAmsterdamThe Netherlands
  5. 5.The Royal Melbourne HospitalParkvilleAustralia

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