&lt;p&gt;Relationship Between Potentially Inappropriate Medications And The Risk Of Hospital Readmission And Death In Hospitalized Older Patients&lt;/p&gt;

Wang, Peng; Wang, Qing; Li, Fang; Bian, Meng; Yang, Kun

doi:10.2147/cia.s218849

Cited by 36 publications

(46 citation statements)

References 27 publications

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“…Our results showed no significant difference between readmitted patients and those that were not readmitted in regard to the use of PIMs, FRIDs or three or more psychoactive drugs, which is in agreement with previous research [9,57]. Other studies [58,59], however, do show an association between the use of PIMs and an increased risk of being readmitted to hospital. In these studies the follow-up time was longer than 30 days implying that the use of PIMs may be a risk factor of readmission to hospital in the long run but not within 30 days.…”

Section: Discussionsupporting

confidence: 92%

Risk factors for hospital readmission in older adults within 30 days of discharge – a comparative retrospective study

Glans

Ekstam²,

Jakobsson

et al. 2020

BMC Geriatr

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Background The area of hospital readmission in older adults within 30 days of discharge is extensively researched but few studies look at the whole process. In this study we investigated risk factors related, not only to patient characteristics prior to and events during initial hospitalisation, but also to the processes of discharge, transition of care and follow-up. We aimed to identify patients at most risk of being readmitted as well as processes in greatest need of improvement, the goal being to find tools to help reduce early readmissions in this population. Methods This comparative retrospective study included 720 patients in total. Medical records were reviewed and variables concerning patient characteristics prior to and events during initial hospital stay, as well as those related to the processes of discharge, transition of care and follow-up, were collected in a standardised manner. Either a Student’s t-test, χ2-test or Fishers’ exact test was used for comparisons between groups. A multiple logistic regression analysis was conducted to identify variables associated with readmission. Results The final model showed increased odds of readmission in patients with a higher Charlson Co-morbidity Index (OR 1.12, p-value 0.002), excessive polypharmacy (OR 1.66, p-value 0.007) and living in the community with home care (OR 1.61, p-value 0.025). The odds of being readmitted within 30 days increased if the length of stay was 5 days or longer (OR 1.72, p-value 0.005) as well as if being discharged on a Friday (OR 1.88, p-value 0.003) or from a surgical unit (OR 2.09, p-value 0.001). Conclusion Patients of poor health, using 10 medications or more regularly and living in the community with home care, are at greater risk of being readmitted to hospital within 30 days of discharge. Readmissions occur more often after being discharged on a Friday or from a surgical unit. Our findings indicate patients at most risk of being readmitted as well as discharging routines in most need of improvement thus laying the ground for further studies as well as targeted actions to take in order to reduce hospital readmissions within 30 days in this population.

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Section: Discussionsupporting

confidence: 92%

Risk factors for hospital readmission in older adults within 30 days of discharge – a comparative retrospective study

Glans

Ekstam²,

Jakobsson

et al. 2020

BMC Geriatr

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“…In the first place, the HRPOMs referred to non-steroidal anti-inflammatory drugs (NSAIDs, aspirin≤100mg/day excluded) that were used by 257 participants (31.7%). The utilization rate of NSAIDs in our study was much higher than what was reported in previous literature regarding geriatric medication 26,30,31 mainly due to their foundational role in postsurgical analgesic, anti-inflammatory, anti-stress 32 and anti-fever. Whereas the short-term use of postsurgical NSAIDs is associated with increased risk of bleeding 33 and acute kidney injury 34 especially in the older population and/or patients with related underlying medical conditions.…”

Section: Discussioncontrasting

confidence: 75%

High-Risk Perioperative Medications in the Chinese Elderly Population

Wang

Ren

Tan

et al. 2021

CIA

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Background: Inappropriate perioperative medications among elderly patients increase the risk of adverse events and undermine surgical outcomes. This study aimed to assess the prevalence of high-risk medications in elderly surgical patients and verify the effectiveness of a new-developed high-risk perioperative medications (HRPOMs) list for the elderly. Methods: A cross-sectional, single-center study was conducted at Jinshan Hospital of Fudan University. A total of 810 elderly surgical patients were included in the study. The HRPOMs list was applied to patients' data to identify the HRPOMs including chronic medications and medications related to surgery. Results: A total of 2113 HRPOMs were identified in 810 patients who fulfilled the inclusion criteria. Of these, 1067 (50.5%) involved medications related to surgery, and 982 (46.5%) involved chronic medications. The prevalence of HRPOM exposure, which was defined as at least one HRPOM was 76.3%. Patients that were 70 years or older (adjusted odds ratio [AOR] =2.118, 95% confidence interval [CI], 1.420~3.159), hospitalized over two weeks (AOR =4.192, 95% CI, 1.493~11.771), with more than 2 distinct diagnoses (AOR =3.407, 95% CI, 2.224~5.220) and with 16 or more medications during hospitalization were more likely to be exposed to HRPOMs. Patients who underwent surgeries of Grade IV were at 1.73 increased odds of HRPOM exposure compared with those who received surgeries of Grade III or lower (P=0.071). Conclusion:HRPOMs are more common in patients of 70 years or older, with 3 or more distinct diagnoses, with 16 or more medications and hospitalized for 15 days or longer. Our study showed the validity of the HRPOMs list in the perioperative medication review for the elderly and may induce further research to reveal the impact of HRPOMs upon the surgical outcomes of the elderly.

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“…39 In comparison with the PIMs based on Chinese criteria, Beers-defined PIMs engendered more substantial adverse outcomes, such as rehospitalization. 8 One additional consideration is that the Chinese criteria were revised in 2017, and it may need to be updated with new information about currently available drugs. The Beers list that was updated in 2019 demonstrated a more robust evidence of PIMs use in Chinese geriatric inpatients than the 2015 version.…”

Section: Discussionmentioning

confidence: 99%

“…5 The use of Beers-PIMs has been associated with a range of adverse events including falls, fractures, cognitive dysfunction and rehospitalization, along with increased health expenditure. [6][7][8][9][10] The prevalence of CAD-PIMs in the geriatric population ranged from 20% to 60% in the USA, Sweden and Ethiopia. [11][12][13] A study in Taiwan stated that 86.1% of older patients with both heart failure and diabetes were taking PIMs.…”

Section: Introductionmentioning

confidence: 99%

Potentially Inappropriate Medication and Associated Factors Among Older Patients with Chronic Coronary Syndrome at Hospital Discharge in Beijing, China

Zhao¹,

Song²,

Zheng³

et al. 2021

CIA

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Medication therapy is crucial in the management of chronic coronary syndrome (CCS). The use of potentially inappropriate medications (PIMs) contributes to poor outcomes in older patients, making it a major public health concern. However, few studies are available on PIMs use in older Chinese CCS patients. To investigate the frequency of prescribed PIMs at discharge and explore risk factors in older adults with CCS. Patients and Methods: The cross-sectional study was conducted in a tertiary hospital in China over three months, from 1st October to 31st December, 2019. CCS patients aged over 60 years who were discharged alive were recruited. Information on demographics and medications at discharge was collected. Clinical data including diagnoses, frailty status, New York Heart Association (NYHA) class and age-adjusted Charlson Comorbidity Index (ACCI) were evaluated in each patient. PIMs were identified using the 2019 Beers criteria. Binary logistic regression was performed to recognize variables related to PIMs. Results: A total of 447 eligible patients with 2947 medications were included. The prevalence of PIMs use was 38%. Medications to be avoided, to be used with caution, and with drug-drug interactions were 38.4%, 48.9% and 12.7% of the PIMs, respectively. Medications with drug-disease/syndrome interactions and those adjusted for kidney function were not identified. The common PIMs were diuretics (37.1%), benzodiazepines and benzodiazepine receptor agonist hypnotics (15.2%), glimepiride (13.1%), and co-prescription of potassiumsparing diuretics and renin-angiotensin system (RAS) inhibitors (9.7%). Individuals with frailty syndrome, polypharmacy, multiple comorbidities, atrial fibrillation, psychiatric disorders and greater NYHA class severity were more likely to receive PIMs. Conclusion: Prescription of PIMs was a common burden in older adults. A CCS multidisciplinary team is needed to control PIMs, especially in vulnerable older patients.

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<p>Relationship Between Potentially Inappropriate Medications And The Risk Of Hospital Readmission And Death In Hospitalized Older Patients</p>

Cited by 36 publications

References 27 publications

Risk factors for hospital readmission in older adults within 30 days of discharge – a comparative retrospective study

Risk factors for hospital readmission in older adults within 30 days of discharge – a comparative retrospective study

High-Risk Perioperative Medications in the Chinese Elderly Population

Potentially Inappropriate Medication and Associated Factors Among Older Patients with Chronic Coronary Syndrome at Hospital Discharge in Beijing, China

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