European Geriatric Medicine

, Volume 9, Issue 2, pp 161–168 | Cite as

Clinical factors affecting potentially inappropriate medications at discharge in older stroke patients

Research Paper

Abstract

Introduction

Factors for increased in potentially inappropriate medications (PIMs) are poorly documented in a rehabilitation setting. The goal of this study is to identify clinical factors that are strongly associated with increased PIMs in stroke patients.

Methods

This retrospective cohort study included consecutive geriatric stroke patients in convalescent rehabilitation wards between 2010 and 2016. We investigated functional independence measure (FIM) and the characteristics of patients with and without PIMs at discharge. We used the 2015 American Geriatrics Society Beers Criteria to screen for PIMs. Multiple linear regression analysis was performed to analyze the relationship between PIM use and functional recovery.

Results

In total, 418 participants (171 males, 247 females; median age 78 years; interquartile range 72–84 years) were included in the present study. Multiple linear regression analysis of PIMs use at discharge adjusting for potential confounders showed that gender, cardiac disease, diabetes mellitus, number of drugs at discharge, FIM-cognitive gain, and age are independent factors associated with PIMs prescribed at discharge (R2 = 0.384; p < 0.0001).

Conclusion

Potentially inappropriate medications use at discharge is negatively correlated with cognitive recovery of activities of daily living. This suggests that PIMs increase might have caused cognitive deterioration.

Keywords

Cognitive function Convalescent rehabilitation ward Functional independence measure Stroke Potentially inappropriate medications 

Notes

Acknowledgements

The authors thank the manager of Hitachinaka General Hospital who agreed for this study to take place.

Compliance with ethical standards

Conflict of interests

The authors declare no conflict of interest.

Ethical approval

The ethics committee of the Hitachinaka General Hospital approved the present study. In addition, the present study was conducted with the approval of the Nihon University School of Pharmacy’s Ethics Committee.

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

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Hajjar ER, Cafiero AC, Hanlon JT (2007) Polypharmacy in elderly patients. Am J Geriatr Pharmacother 5:345–351CrossRefPubMedGoogle Scholar
  2. 2.
    O’Connor MN, Gallagher P, O’Mahony D (2012) Inappropriate prescribing: criteria, detection and prevention. Drugs Aging 29:437–452CrossRefPubMedGoogle Scholar
  3. 3.
    Spinewine A, Schmader KE, Barber N et al (2007) Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 370:173–184CrossRefPubMedGoogle Scholar
  4. 4.
    Fick DM, Semla TP, Beizer J et al (2015) American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 63:2227–2246CrossRefGoogle Scholar
  5. 5.
    Kose E, Maruyama R, Okazoe S, Hayashi H (2016) Impact of polypharmacy on the rehabilitation outcome of japanese stroke patients in the convalescent rehabilitation ward. J Aging Res 2016:7957825CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 130:461–470CrossRefPubMedGoogle Scholar
  7. 7.
    Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC (1996) The reliability of the functional independence measure:a quantitative review. Arch Phys Med Rehabil 77:1226–1232CrossRefPubMedGoogle Scholar
  8. 8.
    Cahir C, Fahey T, Teeling M, Teljeur C, Feely J, Bennett K (2010) Potentially inappropriate prescribing and cost outcomes for older people: a national population study. Br J Clin Pharmacol 69:543–552CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Gallagher P, O’Mahony D (2008) STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers'criteria. Age Ageing 37:673–679CrossRefPubMedGoogle Scholar
  10. 10.
    Ryan C, O’Mahony D, Kennedy J, Weedle P, Byrne S (2009) Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol 68:936–947CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Hill-Taylor B, Sketris I, Hayden J, Byrne S, O’Sullivan D, Christie R (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 38:360–372CrossRefPubMedGoogle Scholar
  12. 12.
    Walston J, Hadley EC, Ferrucci L et al (2006) Research agenda for frailty in older adults: toward a better understanding of physiology and etiology:summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc 54:508–513CrossRefGoogle Scholar
  13. 13.
    Nozaki S (2016) Medication and dysphagia. J JSPEN 31:699–704Google Scholar
  14. 14.
    McDonald K, Trick L, Boyle J (2008) Sedation and antihistamines: an update. Review of inter-drug differences using proportional impairment ratios. Hum Psychopharmacol Clin Exp 23:555–570CrossRefGoogle Scholar
  15. 15.
    Eitan N, Levin Y, Ben-Artzi E, Levy A, Neumann M (1992) Effects of antipsychotic drugs on memory functions of schizophrenic patients. Acta Psychiatr Scand 85:74–76CrossRefPubMedGoogle Scholar
  16. 16.
    Kurita GP, Lundorff L, Pimenta CA, Sjøgren P (2009) The cognitive effects of opioids in cancer: a systematic review. Support Care Cancer 17:11–21CrossRefPubMedGoogle Scholar
  17. 17.
    Eggermont LH, de Vries K, Scherder EJ (2009) Psychotropic medication use and cognition in indementia. Int Psychogeriatr 21:286–294CrossRefPubMedGoogle Scholar
  18. 18.
    Perry E, Walker M, Grace J, Perry R (1999) Acetylcholine in mind: a neurotransmitter correlate of consciousness? Trends Neurosci 22:273–280CrossRefPubMedGoogle Scholar
  19. 19.
    Glass J, Lanctot KL, Herrmann N, Sproule BA, Busto UE (2005) Sedatvite hypnotics in older people with insommia: mate-analysis of risks and benefits. BMJ 331:1169–1176CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Billioti de Gage S, Bégaud B, Bazin F et al (2012) Benzodiazepine use and risk of dementia: prospective population based study. BMJ 345:e6231CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Zhong G, Wang Y, Zhang Y, Zhao Y (2015) Association between benzodiazepine use and dementia: a meta-analysis. PLoS ONE 10:e0127836CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Whitbeck MG, Charnigo RJ, Khairy P et al (2013) Increased mortality among patients taking digoxin–analysis from the AFFIRM study. Eur Heart J 34:1481–1488CrossRefPubMedGoogle Scholar
  23. 23.
    Vamos M, Erath JW, Hohnloser SH (2015) Digoxin-associated mortality: a systematic review and meta-analysis of the literature. Eur Heart J 36:1831–1838CrossRefPubMedGoogle Scholar
  24. 24.
    Makani H, Bangalore S, Romero J et al (2011) Peripheral edema associated with calcium channel blockers: incidence and withdrawal rate—a meta-analysis of randomized trials. J Hypertens 29:1270–1280CrossRefPubMedGoogle Scholar
  25. 25.
    Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP Jr, Selby JV (2009) Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA 301:1565–1572CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Hippisley-Cox J, Coupland C (2016) Diabetes treatments and risk of amputation, blindness, severe kidney failure, hyperglycaemia, and hypoglycaemia: open cohort study in primary care. BMJ 352:i1450CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Roth EJ, Heinemann AW, Lovell LL, Harvey RL, McGuire JR, Diaz S (1998) Impairment and disability: their relation during stroke rehabilitation. Arch Phys Med Rehabil 79:329–335CrossRefPubMedGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2018

Authors and Affiliations

  1. 1.Department of Pharmacotherapy, School of PharmacyNihon UniversityFunabashi-shiJapan
  2. 2.Department of PharmacyHitachinaka General HospitalHitachinaka-shiJapan

Personalised recommendations