Associations between hyper-polypharmacy and potentially inappropriate prescribing with clinical and functional outcomes in older adults

Background Hyper-polypharmacy and potentially inappropriate prescribing (PIP) are common among older inpatients. This study investigated associations between hyper-polypharmacy and PIP with clinical and functional outcomes in older adults at 3-months after hospital discharge. Research design and method At discharge, prescribed medications were collected and PIPs, comprising potentially inappropriate medications (PIM) and potential prescribing omissions (PPO), were retrospectively identified using STOPP/START version 2. Outcomes were collected prospectively via telephone follow-up and audit. Results Data for 232 patients (mean age 80 years) were analyzed. PIP prevalence at discharge was 73.7% (PIMs 62.5%, PPOs 36.6%). Exposure to at least 1 PIM was associated with an increased occurrence of unplanned hospital readmission (adjusted odds ratio (AOR) 5.09; 95% CI 2.3810.85), emergency department presentation (AOR 4.69; 95% CI 1.5514.21) and the composite outcome (AOR 6.83; 95% CI 3.2014.57). The number rather than the presence of PIMs was significantly associated with increased dependency in at least 1 activity of daily living (ADL) (AOR 2.31; 95% CI 1.084.20). Increased PIP use was associated with mortality (AOR 1.45; 95% CI 1.051.99). Conclusion PIPs overall, and PIMs specifically, were frequent in older adults at hospital discharge, and were associated with increased re-hospitalizations and dependence in ADLs at 3-months post-discharge.

Automated summary

This study found that potentially inappropriate prescribing (PIP), including potentially inappropriate medication (PIM) use and potential prescribing omissions (PPO), were common among older adults at hospital discharge. Patients with PIM use had a higher risk of unplanned hospital readmission, emergency department presentation, and poor composite outcome at 3 months post-discharge. The number of PIMs was associated with increased dependency in activities of daily living (ADLs). Increased PIP use was also associated with higher mortality.