Use of potentially inappropriate medications among older outpatients and inpatients in a tertiary care hospital in Malaysia

Abstract

Background Older individuals are seemingly having more medical conditions, which predispose them to a greater risk of polypharmacy. Potentially inappropriate medications (PIMs), including those having anticholinergic and sedative properties, are common in their prescriptions, often associated with functional decline and negative health outcomes. Thus, this study reports proportions of inappropriate drugs and drug burden exposures and its correlation with patient‐reported outcomes (PROs) among cognitively intact older adults admitted to a ward or visiting the outpatient clinic at a tertiary care hospital in Malaysia. Methods This cross‐sectional study included data from 344 older (173 inpatients and 171 outpatients) patients, aged 60 years and above, through validated questionnaires. Medication appropriateness was assessed via Medication Appropriateness Index (MAI) tool, whereas Beers and Screening Tool of Older Person's Potentially Inappropriate Prescribing (STOPP) criteria were used to evaluate PIMs and potentially inappropriate prescribing (PIP), respectively. The Drug Burden Index (DBI) and polypharmacy, as well as PROs, included Groningen Frailty Indicator (GFI), Katz Index of Independence in Activities of Daily Living (Katz ADL) and Older People's Quality of Life (OPQOL) were also evaluated. Results Overall, inpatients received significantly higher medications (6.90 ± 2.70 vs 4.49 ± 3.20) than outpatients. A significantly higher proportion of inpatients received at least one PIM (65% vs 57%) or PIP (57.4% vs 17.0%) and higher mean MAI score (1.76 ± 1.08 and 1.10 ± 0.34) and DBI score (2.67 ± 1.28 vs 1.49 ± 1.17) than outpatients. Inpatients had significantly higher total OPQOL (118.53 vs 79.95) and GFI score (5.44 vs 3.78) than outpatients. We only found significant correlations between GFI and DBI and total OPQOL and the number of PIMs. Conclusions Proportions of PIMs and DBI exposure were significantly higher in an inpatient setting. No significant correlations between exposures to inappropriate medications or drug burden and PROs were observed.

Inappropriate medications and physical function: a systematic review

“…Of the 10 studies involved in the examination of inappropriate medication use and measures of functional independence, 9 demonstrated that inappropriate medication use was significantly associated with increased impediment with functional independence. 35 , 41 – 48 PIM use was associated significantly with a decrease in the Health-Related Quality-of-Life Score. 42 In one study, a lowering in the number of PIMs was associated with a significant increase in the Functional Independence Measure.…”

“… 66 In some studies, more than one tool was used. 8 , 15 , 17 , 21 , 23 – 25 , 28 , 34 , 36 , 37 , 43 , 47 – 50 , 52 , 55 , 56 , 59 Table 2 shows the associations between inappropriate medication prescriptions and physical function. Table 3 provides an illustrative summary of the associations between inappropriate medication prescriptions and physical function.…”

“…The characteristics of included studies are summarised in Table 1. A total of 37 studies used various versions of the Beers criteria, 8,13–48 19 studies used the Screening Tool of Older Person’s prescriptions (STOPP) criteria, 21,23,25,34,36,37,43,48–59 9 studies used the Screening to Alert to Right Treatment (START) criteria, 36,47–50,52,55,56,59 2 studies used the Meds 75+ Database, 60,…”

“…66 In some studies, more than one tool was used. 8,15,17,21,[23][24][25]28,34,36,37,43,[47][48][49][50]52,55,56,59 Table 2 shows the associations between inappropriate medication prescriptions and physical function.…”

Potentially inappropriate medications at discharge among elderly patients at a single tertiary emergency medical institution in Japan: a retrospective cross‐sectional observational study

“… 6 , 7 In addition, a separate study reported that 65%–87% of elderly patients admitted to tertiary care hospitals are prescribed with PIMs. 8 , 9 However, to the best of our knowledge, there have been no reports about PIMs at the time of discharge among elderly patients transported to, hospitalized at, and discharged alive from tertiary care hospitals in Japan. We hypothesized that elderly patients are more likely to receive more PIMs during admission at tertiary care hospitals because they have more comorbidities and are more critically ill.…”