Background: Older adults experience progressive decline in various organs and changes in pharmacokinetics and pharmacodynamics of the drugs in the body which lead to an increased risk of medication-related problems. Potentially inappropriate medications (PIMs) and medication complexity are key factors contributing to adverse drug events in the emergency department (ED). Objective: To estimate the prevalence and investigate the risk factors of PIMs and medication complexity among older adults admitted to the ED. Methods: A retrospective observational study was conducted among patients aged > 60 years admitted to the ED of Universitas Airlangga Teaching Hospital in January -June 2020. PIMs and medication complexity were measured using the 2019 American Geriatrics Society Beers Criteria® and Medication Regimen Complexity Index (MRCI), respectively. Results: A total of 1005 patients were included and 55.0% (95% confidence interval [CI]: 52 -58%) of them received at least one PIM. Whereas, the pharmacological therapy prescribed to older adults had a high complexity index (mean MRCI 17.23 + 11.15). Multivariate analysis showed that those with polypharmacy (OR= 6.954; 95% CI: 4.617 -10.476), diseases of the circulatory system (OR= 2.126; 95% CI: 1.166 -3.876), endocrine, nutritional, and metabolic diseases (OR= 1.924; 95% CI: 1.087 -3.405), and diseases of the digestive system (OR= 1.858; 95% CI: 1.214 -2.842) had an increased risk of receiving PIM prescriptions. Meanwhile, disease of the respiratory system (OR = 7.621; 95% CI: 2.833 -15.150), endocrine, nutritional and metabolic diseases (OR = 6.601; 95% CI: 2.935 -14.847), and polypharmacy (OR = 4.373; 95% CI: 3.540 -5.401) were associated with higher medication complexity. Conclusion: In our study, over one in every two older adults admitted to the ED had PIMs, and a high medication complexity was observed. Endocrine, nutritional and metabolic disease was the leading risk factors for receiving PIMs and high medication complexity.

BACKGROUND: Elderly patients are associated with an increasing prevalence of chronic degenerative diseases which need emergency services which can be a factor in the occurrence of potentially inappropriate medication (PIM). The use of PIM increases the risk of patients requiring hospitalization, drug-related problems, and adverse health outcomes with a prevalence of up to 2–3 times. AIM: This study aimed to determine the possible incidence of admission and discharge events on PIM in Elderly patients (>60 years old) visiting the emergency department (ED). MATERIALS AND METHODS: This is a retrospective and observational study at Universitas Airlangga Teaching Hospital in Surabaya for 4 months. This study involved Elderly patients who visited the ED. The 2019 Beers criteria were used to identify the use of PIM. Spearman rho analysis was used to determine the relationship between the possibility of hospital admission and the discharge of patients with PIM. RESULTS: Most patients were female (50.4%) and aged 60−96. The percentage of elderly patients who received PIM and hospital admission was 73.1%, while those who received PIM and hospital discharge were 26.9%. The Spearman rho analysis showed a weak relationship between the  possibility of hospital admission or discharge (p-value 0.000, R 0.255) with PIM. CONCLUSION: There is a weak but significant correlation between PIM and patient admission and discharge. Elderly patients are more at risk of being hospitalized due to PIM. The number of ED patients who received PIM had a high prevalence of being hospitalized compared to patients who did not receive PIM.