Inappropriate Medication Prescriptions in Elderly Adults Surviving an Intensive Care Unit Hospitalization

Abstract

Background Elderly patients admitted to intensive care units (ICU) are at risk of receiving potentially (PIMs) and actually inappropriate medications (AIMs). Objectives To determine types of PIMs and AIMs, which PIMs are most likely to be considered AIMs, and risk factors for PIMs and AIMs at hospital discharge in elderly ICU survivors. Design Prospective cohort study Setting Tertiary care, academic medical center Participants 120 patients ≥ 60 years old who survived an ICU hospitalization Measurements PIMs were defined according to published criteria; AIMs were adjudicated by a multidisciplinary panel. Medication lists were abstracted at the time of pre-admission, ward admission, Intensive Care Unit (ICU) admission, ICU discharge, and hospital discharge. Poisson regression was used to examine independent risk factors for hospital discharge PIMs and AIMs. Results Of 250 PIMs prescribed at discharge, the most common were opioids (28%), anticholinergics (24%), antidepressants (12%), and drugs causing orthostasis (8%). The three most common AIMs were anticholinergics (37%), non-benzodiazepine hypnotics (14%), and opioids (12%). Overall, 36% of discharge PIMs were classified as AIMs, but the percentage varied by drug type. Whereas only 16% of opioids, 23% of antidepressants, and 10% of drugs causing orthostasis were classified as AIMs; 55% of anticholinergics, 71% of atypical antipyschotics, 67% of non-benzodiazepine hypnotics and benzodiazepines, and 100% of muscle relaxants were deemed AIMs. The majority of PIMs and AIMs were first prescribed in the ICU. Pre-admission PIMs, discharge to somewhere other than home, and discharge from a surgical service predicted number of discharge PIMs, but none of the factors predicted AIMs at discharge. Conclusions Certain types of PIMs, which are commonly initiated in the ICU, are more frequently considered inappropriate upon clinical review. Efforts to reduce AIMs in elderly ICU survivors should target these specific classes of medications.

Evaluation of Prescription Pattern for Internal Medicines Outpatients using World Health Organization Indicators

“…It can increase the risk of drugs interaction, low adherence to medication, and adverse drug reactions. 7,8 Indonesian regulation obligates the prescription of generic drugs to ensure accessibility of medication to all population. In this study, the majority of prescribed drugs were generic drugs.…”

Glucose Lowering Medicines and Older People with Diabetes: The Importance of Comprehensive Assessments and Pharmacovigilance

“…Many health professionals often focus on prescribing and administering medicines and patient nonadherence to medicines. Inappropriate prescribing including prescribing potentially inappropriate medicines (PIMS) for older people is common [12][13][14]. PIMS are still prescribed as first line management for vulnerable people even when evidence suggests their use leads to poor outcomes [15,16].…”

“…Many PIMs and medicines that are actually inappropriate (AIM) are prescribed during the hospital stay, often in intensive care units (ICU) [12,13]. Older people who survive ICU frequently experience polypharmacy, have several transitions to other wards/units during an admission, and are at high risk of AEs after discharge [12].…”

“…Older people who survive ICU frequently experience polypharmacy, have several transitions to other wards/units during an admission, and are at high risk of AEs after discharge [12]. Morandi et al [12,13] found 85% of older ICU survivors were discharged from hospital on one or more PIMs and > 50% were discharged with one or more AIM.…”

“…Commonly prescribed PIMs are opioids, anticholinergics and antidepressants, which cause confusion, cognitive impairment and falls. These doses and dose frequency of these medicines are likely to be inappropriate at discharge [12,13,15].…”