Potentially Inappropriate Drug Prescriptions and Risk of Hospitalization among Older, Italian, Nursing Home Residents
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Background Potentially inappropriate medications in older patients increase the risk of adverse drug events, which are an important cause of hospital admission and death among hospitalized patients. Little information is available about the prevalence of potentially inappropriate drug prescriptions (PIDPs) and the related health adverse outcomes among nursing home (NH) residents.
Objective To estimate the prevalence of PIDPs and the association with adverse outcomes in NH residents.
Methods A total of 1716 long-term residents aged ≥65 years participating in the ULISSE (Un Link Informatico sui Servizi Sanitari Esistenti per l’anziano [A Computerized Network on Health Care Services for Older People]) project were evaluated using a standardized comprehensive geriatric assessment instrument, i.e. the inter Resident Assessment Instrument Minimum Data Set. A thorough evaluation of residents’ drug use, medical diagnoses and healthcare resource utilization was performed. A PIDP was defined according to the most recent update of the Beers criteria.
Results Almost one out of two persons (48%) had at least one PIDP and almost one out of five had two or more PIDPs (18%). Residents with a higher number of PIDPs had a higher likelihood of being hospitalized. Compared with residents without PIDPs, those with two or more PIDPs at baseline had a higher probability of being hospitalized (hazard ratio 1.73; 95% CI 1.14, 2.60) during the following 12 months. Risk of PIDP was positively associated with the total number of drugs and diseases, but negatively with age. PIDPs defined according to specific conditions (n = 780; 55%) were slightly more frequent than PIDPs based on single medications irrespective of specific indication (n=639; 45%).
Conclusions PIDP is a significant problem among Italian NH residents. There is an urgent need for intervention trials to test strategies to reduce inappropriate drug use and its associated adverse health outcomes.
KeywordsNursing Home Resident Inappropriate Medication Inappropriate Drug Beers Criterion Cumulative Illness Rate Scale
This study was developed within the CRIME (Development and validation of new CRiteria to assess Inappropriate Medication use among Elderly patients) project. The CRIME project was supported by project grants from the Italian Ministry of Labour, Health and Social Policy (Bando Giovani Ricercatori 2007 convenzione n. 4). The ULISSE project was supported by the Italian Ministry of Health and Pfizer SrL, Italy. The public funding agency and the private sponsor had no role in the design and conduct of the study; in the collection, analysis and interpretation of the data; or in the preparation, review or approval of the manuscript.
The authors have no conflicts of interest that are directly relevant to the content of this study.
The authors thank all persons participating in the ULISSE study group as reported in the methodological paper.
This study was previously presented in part at the 54th Annual National Congress of the Italian Gerontological and Geriatric Society, 3 December 2009, Florence, Italy.
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