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Patterns of inappropriate prescribing and clinical characteristics in patients at admission to an acute care of the elderly unit

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Abstract

Purpose

Inappropriate prescribing (IP) is common among the elderly and is associated with adverse health outcomes. The role of different patterns of IP in clinical practice remains unclear. The aim of this study is to analyse the characteristics of different patterns of IP in hospitalized older adults.

Methods

This is a prospective observational study conducted in the acute care of elderly (ACE) unit of an acute hospital in Barcelona between June and August 2021. Epidemiological and demographic data were collected, and a comprehensive geriatric assessment (CGA) was performed on admitted patients. Four patterns of inappropriate prescribing were identified: extreme polypharmacy (10 or more drugs), potentially inappropriate medications (PIMs), potential prescribing omissions (PPOs) and anticholinergic burden.

Results

Among 93 admitted patients (51.6% male, mean age of 82.83), the main diagnosis was heart failure (36.6%). Overprescribing patterns (extreme polypharmacy, PIMs, PPOs and anticholinergic burden) were associated with higher comorbidity, increased dependence on instrumental activities of daily living (IADL) and greater prevalence of dementia. Underprescribing (omissions) was associated with important comorbidity, residence in nursing homes, an increased risk of malnutrition, higher social risk and greater frailty. Comparing different patterns of IP, patients with high anticholinergic burden exhibited more extreme polypharmacy and PIMs. In the case of omissions, no association was identified with other IP patterns.

Conclusions

We found statistically significant association between patterns of inappropriate prescribing and clinical and CGA variables such as comorbidity, dependency, dementia or frailty. There is a statistically significant association between patterns of overprescribing among patients admitted to the ACE unit.

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Availability of data and materials

The data that support the findings of this study are available upon reasonable request from the corresponding author.

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Authors and Affiliations

  1. Geriatric Unit, Internal Medicine Department, Vall d’Hebron Hospital, 08035, Barcelona, Spain

    Mónica Zuleta, Antonio San-José, Margarita Sánchez-Arcilla, Gabriela Carrizo, Marcelo Alvarado & Carmen Pérez-Bocanegra

  2. Pharmacy Department, Sant Rafael Hospital, Barcelona, Spain

    Inés Gozalo

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  1. Mónica Zuleta
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  2. Antonio San-José
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  3. Inés Gozalo
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Contributions

M.Z. wrote the entire manuscript and all the authors reviewed the manuscript.

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Correspondence to Mónica Zuleta.

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This is a prospective observational study that has the approval of the Ethics Committee of Vall d’Hebron Hospital and adheres to the Declaration of Helsinki (1964) and its later amendments (current version dating from 2013).

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All patients provided informed consent to participate in this study.

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Zuleta, M., San-José, A., Gozalo, I. et al. Patterns of inappropriate prescribing and clinical characteristics in patients at admission to an acute care of the elderly unit. Eur J Clin Pharmacol 80, 553–561 (2024). https://doi.org/10.1007/s00228-024-03627-3

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