A study looking at the use of potentially inappropriate medications (PIMs) in hospitalised adults aged 75 and over has highlighted the need for multidisciplinary interventions to review chronic medications in these patients.
The study found that the overall prevalence of PIMs was moderate but varied considerably between hospitals and also revealed a potential missed opportunity to optimise medication use within this setting.
The retrospective descriptive observational study involved 4,183 patients (53.2% women) across 16 hospitals in Spain. All the participants were admitted between 10-16 May 2021. The list of PIMs was based on the Beers, STOPP-START, EU-PIM and PRISCUS criteria and patient medication data came from the pharmacy databases of the participating hospitals.
Nearly a quarter of the patients studied (23.5%, n = 1,126) were taking PIMs. A total of 1,407 PIMs representing 35 different drugs were detected, with midazolam, dexketoprofen, diazepam and doxazosin being the most commonly overprescribed medications. Medication tended to be more overprescribed in women than men, with the only exceptions being doxazosin and pentoxifylline.
The prevalence of PIMs ranged between 10% and 42.5% across different hospitals, and there was significant variation across departments, with internal medicine (N = 269) and emergency departments (N = 150) having the highest rates of PIMs use.
At discharge, only 4.9% of the PIMs initiated during the hospital stay were still prescribed, which fell to 2.6% after one month, reflecting an appropriate management of PIMs in these patients.
Over a third of PIMs (36%) were initiated before hospital admission, and in 75% of cases, the prescriber was a primary care clinician. Pre-admission medications were generally maintained during hospitalisation and after discharge, with 38% of PIMs still present at hospital discharge and 36% present at one month.
This finding prompted the researchers to suggest that the hospital admission period could be an appropriate setting in which to review chronic medications taken by older patients.
The researchers concluded that their findings underscore the need for multidisciplinary interventions to optimise pharmaceutical treatment in older adults in a hospital setting to reduce the consequences of PIMs in these patients.
Reference
Puig, T et al. Prevalence of potentially inappropriate medications and prescription dynamics in elderly hospitalized patients in Spain. BMC Geriatr 2024; Sept 30: DOI: 10.1186/s12877-024-05308-3.
