Survival of hospitalized older adults with prior use of potentially inappropriate medicine

Abstract

Objectives We aimed to evaluate the impact of potentially inappropriate medications prescribed prior to hospitalization (PIM-ph) on the mortality Methods We included 318 patients, aged ≥65 who sought emergency care and were hospitalized for any clinical reasons. Information on patients' clinical and social indicators was obtained via structured interviews conducted 24 to 48 hours after hospitalization. All medications used by older adults prior to hospitalization were recorded, and PIM-ph were identified using the Brazilian PIM Consensus. The study considered the influence of the entire set of PIM-ph and specific PIM-ph used by these patients. The impact of PIM-ph use during hospitalization and after 30 days of this event was statistically determined by multivariable Cox proportional hazard regression analysis, which included sex, age, and other clinical and functional indicators as intervening variables. Results The prevalence of PIM-ph use was 49.7% (n=158). A total of 85 (26.7%) patients died during hospitalization or within 30 days after discharge. Eighteen pharmacological classes of PIM-ph use were identified. The use of total PIM-ph, benzodiazepines (IC: 1.055-3.365, p= 0.032), digoxin(IC: 1.623-7.048, p=0.001), and loop diuretics (IC: 1.000-3.455, p=0.05) increased the relative risk of mortality independent of sex, age, clinical causes of hospitalization, frailty risk, social support, presence of confusion symptoms, polypharmacy, and in-hospital evolution of geriatric complications. Conclusion PIM-ph use, especially benzodiazepines, digoxin, and loop diuretics, could contribute to mortality risk in hospitalized older adults. These results could be relevant in the management and therapeutic care of hospitalized patients.