Journal
JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES
Volume 72, Issue 2, Pages 271-277Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/gerona/glw140
Keywords
Adverse drug events; Potentially inappropriate prescribing; Community-dwelling
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Funding
- Health Research Board of Ireland [HPF/2012/20]
- HRB Scholar's programme in Health Services Research at the HRB Centre for Primary Care Research [PhD/2007/16, HRC/2007/1]
- Health Research Board (HRB) [HPF-2012-20] Funding Source: Health Research Board (HRB)
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Background: Potentially inappropriate prescribing (PIP) describes medications where risk generally outweighs benefit for older people. Cross-sectional studies suggest an association between PIP and poorer health outcomes but there is a paucity of prospective cohort studies. This study investigates the longitudinal association of PIP with adverse drug events (ADEs), health related quality of life, and accident & emergency visits. Methods: Study design: Two-year (2010-2012) prospective cohort study (n = 904, >= 70 years, community-dwelling) with linked pharmacy dispensing data. Exposure: Baseline PIP: Screening Tool for Older Persons potentially Inappropriate Prescriptions (STOPP) and Beers 2012 applied 12 months prior. Study outcomes: ADEs (patient interview), health related quality of life (EQ-5D-3L: patient questionnaire), and accident & emergency visits (general practice medical record review). Statistical analysis: Descriptive statistics: Poisson (incidence rate ratio [95% confidence interval [CI]], linear regression models [regression coefficient [95% CI]], and logistic [odds ratio [OR] [95% CI]). Results: Of 791 participants eligible for follow-up, 673 (85%) returned a questionnaire and 605 (77%) also completed an ADE interview. Baseline STOPP PIP prevalence was 40% and 445 (74%) patients reported = 1 ADE at follow-up. In multivariable analysis, >= 2 STOPP PIP was associated with ADEs (adjusted incidence rate ratio: 1.29 [95% CI 1.03, 1.85; p =.03]; poorer health related quality of life [adjusted regression coefficient: -0.11 [95% CI -0.16, -0.06; p <.001]]; and, >= 1 accident & emergency visit [adjusted OR: 1.85 [95% CI 1.06, 3.24; p = .03]]). Baseline Beers 2012 prevalence was 26% and there was no association with adverse health outcomes in multivariable analysis. Conclusions: Older community-dwelling people, prescribed >= 2 STOPP PIP are more likely to report ADEs, poorer health related quality of life and attend the accident & emergency department over 2-year follow-up.
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