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Potentially Inappropriate Medications and the Time to Full Functional Recovery After Hip Fracture

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Abstract

Background

Older adults after hip fracture are at increased risk of being prescribed potentially inappropriate medications, and may be particularly vulnerable to their adverse effects.

Objective

The objective of this study was to examine the association of potentially inappropriate medication use with the time to full functional recovery within 1 year of hip fracture repair.

Methods

We conducted a secondary analysis of a prospective longitudinal study of eight hospitals in St. Louis, MO, USA. The participants were older adults (n = 477) aged 60 years or older who had undergone surgical repair of a hip fracture free of delirium, dementia or depression at baseline. Drugs at baseline were categorised using the American Geriatrics Society 2012 Beers criteria. The outcome was the Functional Recovery Scale total score measured at four time points during a 12-month period of observation. Cox proportional hazards models examined the time to 95% recovery of function (‘full recovery’), adjusting for demographics, cognition, depression, medical co-morbidity, pre-fracture functioning and pain as covariates.

Results

Potentially inappropriate medication use was common following hip fracture, with 51% of participants prescribed at least one potentially inappropriate medication and 17.4% prescribed two or more potentially inappropriate medications. Potentially inappropriate medication use was significantly associated with a longer time to achieve full recovery with a hazard ratio of 0.69 (95% confidence interval 0.52–0.92; p = 0.012) and this association was stronger for two or more potentially inappropriate medications compared with one potentially inappropriate medication (hazard ratio = 0.60; 95% confidence interval 0.40–0.90; p = 0.014).

Conclusion

Potentially inappropriate medication use was associated with a longer time to full functional recovery in older adults who underwent surgery for a hip fracture, particularly in those using two or more potentially inappropriate medications at baseline.

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Author information

Authors and Affiliations

  1. Toronto Rehabilitation Institute, 550 University Avenue, Toronto, ON, M5G 2A2, Canada

    Andrea Iaboni

  2. Centre for Mental Health, University Health Network, Toronto, ON, Canada

    Andrea Iaboni & Alastair J. Flint

  3. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Andrea Iaboni & Alastair J. Flint

  4. Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA

    Kerri Rawson & Eric J. Lenze

  5. Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada

    Craig Burkett

Authors
  1. Andrea Iaboni
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  2. Kerri Rawson
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  3. Craig Burkett
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  4. Eric J. Lenze
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  5. Alastair J. Flint
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Corresponding author

Correspondence to Andrea Iaboni.

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Funding

Eric J. Lenze was supported in this work by the National Institute of Mental Health (Grant No. R01MH074596] and the Taylor Family Institute for Innovative Psychiatric Research. Andrea Iaboni was supported by a University Health Network Psychiatric Consultants Research Grant. No other sources of funding were used to assist in the conduct of this study or the preparation of this article.

Conflict of interest

Andrea Iaboni, Kerri Rawson and Craig Burkett have no conflicts to report. Eric J. Lenze receives grant/research support from Takeda, Lundbeck and Janssen, as well as foundations (Barnes Jewish foundation, Taylor Family Institute for Innovative Psychiatric Research). Alastair J. Flint currently receives grant support from the US National Institutes of Health, the Canadian Institutes of Health Research, Brain Canada, the Ontario Brain Institute and Lundbeck, and within the past 3 years has received honoraria from Pfizer Canada.

Ethics approval

Procedures were approved by the Institutional Review Boards of the Washington University School of Medicine and the eight participating hospitals.

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Iaboni, A., Rawson, K., Burkett, C. et al. Potentially Inappropriate Medications and the Time to Full Functional Recovery After Hip Fracture. Drugs Aging 34, 723–728 (2017). https://doi.org/10.1007/s40266-017-0482-6

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  • DOI: https://doi.org/10.1007/s40266-017-0482-6

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