Associations between potentially inappropriate prescribing and increased number of medications with postdischarge health outcomes among geriatric rehabilitation inpatients: RESORT study

Alemayehu B Mekonnen; Esmee M Reijnierse; Cheng Hwee Soh; Wen Kwang Lim; Andrea B Maier; Elizabeth Manias

doi:10.1111/bcp.15838

Associations between potentially inappropriate prescribing and increased number of medications with postdischarge health outcomes among geriatric rehabilitation inpatients: RESORT study

Br J Clin Pharmacol. 2023 Nov;89(11):3375-3388. doi: 10.1111/bcp.15838. Epub 2023 Jul 17.

Authors

Alemayehu B Mekonnen^{1

2}, Esmee M Reijnierse², Cheng Hwee Soh², Wen Kwang Lim², Andrea B Maier^{2

3

4

5}, Elizabeth Manias^{1

2

6}

Affiliations

¹ Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.
² Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
³ Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
⁴ Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁵ Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore, Singapore.
⁶ School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.

PMID: 37376923
DOI: 10.1111/bcp.15838

Abstract

Aims: Older adults are vulnerable to medication-related harm mainly due to high use of medications and inappropriate prescribing. This study aimed to investigate the associations between inappropriate prescribing and number of medications identified at discharge from geriatric rehabilitation with subsequent postdischarge health outcomes.

Method: RESORT (REStORing health of acutely unwell adulTs) is an observational, longitudinal cohort study of geriatric rehabilitation inpatients. Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were measured at acute admission, and at admission and discharge from geriatric rehabilitation, using Version 2 of the STOPP/START criteria.

Results: In total, 1890 (mean age 82.6 ± 8.1 years, 56.3% female) were included. The use of at least 1 PIM or PPO at geriatric rehabilitation discharge was not associated with 30-day and 90-day readmission and 3-month and 12-month mortality. Central nervous system/psychotropics and fall risk PIMs were significantly associated with 30-day hospital readmission (adjusted odds ratio [AOR] 1.53; 95% confidence interval [CI] 1.09-2.15), and cardiovascular PPOs with 12-month mortality (AOR 1.34; 95% CI 1.00-1.78). Increased number of discharge medications was significantly associated with 30-day (AOR 1.03; 95% CI 1.00-1.07) and 90-day (AOR 1.06; 95% CI 1.03-1.09) hospital readmissions. The use and number of PPOs (including vaccine omissions) were associated with reduced independence in instrumental activities of daily living scores at 90-days after geriatric rehabilitation discharge.

Conclusion: The number of discharge medications, central nervous system/psychotropics and fall risk PIMs were significantly associated with readmission, and cardiovascular PPOs with mortality. Interventions are needed to improve appropriate prescribing in geriatric rehabilitation patients to prevent hospital readmission and mortality.

Keywords: geriatric assessment; hospitals; medication therapy management; older people; potentially inappropriate medication list; rehabilitation.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Aftercare
Aged
Aged, 80 and over
Female
Humans
Inappropriate Prescribing* / prevention & control
Inpatients
Longitudinal Studies
Male
Outcome Assessment, Health Care
Patient Discharge*