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

Elizabeth Manias, Andrea Maier, Gopika Krishnamurthy

Research output: Contribution to JournalArticleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)1661-1673
Number of pages13
JournalAging Clinical and Experimental Research
Volume31
Issue number11
Early online date10 Jan 2019
DOIs
Publication statusPublished - 1 Nov 2019

Fingerprint

Patient Transfer
Inappropriate Prescribing
Interviews
Electronic Health Records
Proton Pump Inhibitors
Public Hospitals
Patient Rights
Vitamin D
Teaching Hospitals
Comorbidity
Length of Stay
Regression Analysis
Potentially Inappropriate Medication List
Health

Keywords

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

Cite this

@article{1fb4ff8fdf164a5dbb61e46b5a47c9f5,
title = "Inappropriate medication use in hospitalised oldest old patients across transitions of care",
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 = "Inappropriate medication, Oldest old, Potential prescribing omission, Potentially inappropriate medication, Prescribing, Transition",
author = "Elizabeth Manias and Andrea Maier and Gopika Krishnamurthy",
year = "2019",
month = "11",
day = "1",
doi = "10.1007/s40520-018-01114-1",
language = "English",
volume = "31",
pages = "1661--1673",
journal = "Aging - Clinical and Experimental Research",
issn = "1594-0667",
publisher = "Springer Verlag",
number = "11",

}

Inappropriate medication use in hospitalised oldest old patients across transitions of care. / Manias, Elizabeth; Maier, Andrea; Krishnamurthy, Gopika.

In: Aging Clinical and Experimental Research, Vol. 31, No. 11, 01.11.2019, p. 1661-1673.

Research output: Contribution to JournalArticleAcademicpeer-review

TY - JOUR

T1 - Inappropriate medication use in hospitalised oldest old patients across transitions of care

AU - Manias, Elizabeth

AU - Maier, Andrea

AU - Krishnamurthy, Gopika

PY - 2019/11/1

Y1 - 2019/11/1

N2 - 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.

AB - 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.

KW - Inappropriate medication

KW - Oldest old

KW - Potential prescribing omission

KW - Potentially inappropriate medication

KW - Prescribing

KW - Transition

UR - http://www.scopus.com/inward/record.url?scp=85059848017&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059848017&partnerID=8YFLogxK

U2 - 10.1007/s40520-018-01114-1

DO - 10.1007/s40520-018-01114-1

M3 - Article

VL - 31

SP - 1661

EP - 1673

JO - Aging - Clinical and Experimental Research

JF - Aging - Clinical and Experimental Research

SN - 1594-0667

IS - 11

ER -