Effects of hyperpolypharmacy and potentially inappropriate medications (PIMs) on functional decline in older patients discharged from acute care hospitals

Background: PIM-Taiwan criteria were first established in 2010 for potentially inappropriate medications (PIMs). Currently, updating of PIM criteria is mandatory because of newly established evidence and newly developed medications. This study aims to evaluate the prevalence of PIM based on country-specific PIM criteria and factors associated with PIM use by applying 2010 version and newly updating PIM-Taiwan criteria in a cohort with polypharmacy. Methods: The baseline data of Medication Safety Review Clinic Taiwan (MSRC–Taiwan) study were used to investigate the prevalence of PIMs. Older patients (aged ⩾65 years) who were either having polypharmacy or visited ⩾3 different physicians were enrolled between August and October 2007. Bivariate analysis and multivariate logistic regressions were used to evaluate the factors associated with PIM use. Results: The prevalence of having at least one PIM was 46.1% for 2010 version and increased to 74.6% for 2018 version. The average number of PIMs generally to be avoided per patient also increased for 2018 version (0.2 versus 1.2, p < 0.0001). In contrast, the average number of PIMs considering chronic conditions per patient decreased (0.6 versus 0.3, p < 0.001). The associated chronic conditions of PIM users were distinct between 2010 and 2018 version. The major leading PIMs were benzodiazepines (BZDs) in both versions of criteria. Conclusions: As there were significant differences in medication lists between PIM-Taiwan version 2010 and 2018, the prevalence of PIM and factors associated with PIM users varied accordingly. Physicians should pay special attention before prescribing BZDs which keep being the major leading PIM.

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An analysis of equity in treatment of hip fractures for older patients with dementia in acute care hospitals: observational study using nationwide hospital claims data in Japan

BMC Health Services Research ◽

10.1186/s12913-020-05690-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Shinichi Tomioka ◽

Megumi Rosenberg ◽

Kiyohide Fushimi ◽

Shinya Matsuda

Keyword(s):

Hip Fracture ◽

Older People ◽

Acute Care ◽

Waiting Time ◽

Older Patients ◽

Acute Care Hospitals ◽

Care Quality ◽

Severe Dementia ◽

People With Dementia ◽

Acute Care Settings

Abstract Background Globally, and particularly in countries with rapidly ageing populations like Japan, there are growing concerns over the heavy burden of ill health borne by older people, and the capacity of the health system to ensure their access to quality care. Older people with dementia may face even greater barriers to appropriate care in acute care settings. Yet, studies about the care quality for older patients with dementia in acute care settings are still few. The objective of this study is to assess whether dementia status is associated with poorer treatment by examining the association of a patient’s dementia status with the probability of receiving surgery and the waiting time until surgery for a hip fracture in acute care hospitals in Japan. Methods All patients with closed hip fracture were extracted from the Diagnosis Procedure Combination (DPC) database between April 2014 and March 2018. After excluding complicated cases, we conducted regressions with multilevel models. We used two outcome measures: (i) whether the patient received a surgery or was treated by watchful waiting; and (ii) number of waiting days until surgery after admission. Results Two hundred fourteen thousand six hundred one patients discharged from 1328 hospitals were identified. Among them, 159,173 patients received surgery. Both 80–89 year-olds (OR 0.87; 95% CI, 0.84, 0.90) and those 90 years old and above (OR 0.67; 95% CI, 0.65, 0.70) had significantly lower odds ratios for receiving surgery compared to 65–79 year-olds. Those with severe dementia had a significantly greater likelihood of receiving surgery compared to those without dementia (OR 1.21; 95% CI, 1.16, 1.25). Patients aged 90 years old and above had shorter waiting time for surgery (Coef. -0.06; 95% CI, − 0.11, − 0.01). Mild dementia did not have a statistically significant impact on the number of waiting days until surgery (P = 0.34), whereas severe dementia was associated with shorter waiting days (Coef. -0.08; 95% CI, − 0.12, − 0.03). Conclusions These findings suggest physicians may be taking proactive measures to preserve physical function for those with severe dementia and to avoid prolonged hospitalization although there are no formal guidelines on prioritization for the aged and dementia patients.

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Adherence to Beers Criteria in Geriatrics: A Retrospective Study in a Saudi Teaching Hospital

Geriatrics ◽

10.3390/geriatrics5040097 ◽

2020 ◽

Vol 5 (4) ◽

pp. 97

Author(s):

Samah Alshehri ◽

Mohannad Alshibani ◽

Ghaydaa Magboul ◽

Albandari Albandar ◽

Roaa Nasser ◽

...

Keyword(s):

Retrospective Study ◽

Older Patients ◽

Adverse Drug Events ◽

Healthcare Providers ◽

Tertiary Hospital ◽

Beers Criteria ◽

Potentially Inappropriate Medications ◽

Inflammatory Drugs ◽

The Mean ◽

Inappropriate Medications

Background: The aging process makes geriatric populations more prone to various chronic diseases. Such diseases require older patients to be on more medications than any other age group and make them more susceptible to adverse drug events related to potentially inappropriate medications (PIMs). Aim: To identify the prevalence of potentially inappropriate medications among older people and explore the most commonly prescribed PIMs in hospitalized patients. Design and Setting: A retrospective study conducted in a large tertiary hospital among patients hospitalized in a 4 year period from January 2015 to December 2018. Methods: The 2019 Beers Criteria were used to assess PIMs in all inpatient prescribed medications focusing on the first class (i.e., drug/drug class to be avoided in older adults). Results: The mean age was 75.17 ± 7.66 years. A total of 684 (80.6%) patients were prescribed at least one medication listed in the first-class category of the 2019 Beers Criteria. Top five drugs were proton pump inhibitors (40.3%), nonsteroidal anti-inflammatory drugs (10.2%), metoclopramide (9.3%), benzodiazepines (8.4%), and insulin (5.4%). Conclusions: The prevalence of PIMs is high among older patients admitted to the hospital. More efforts are needed to investigate the potential reasons and develop action plans to improve concordance to Beers Criteria among healthcare providers.

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Communication behavior of cognitively impaired older inpatients

Zeitschrift für Gerontologie und Geriatrie ◽

10.1007/s00391-019-01623-2 ◽

2019 ◽

Vol 52 (S4) ◽

pp. 264-272

Author(s):

Eva-Luisa Schnabel ◽

Hans-Werner Wahl ◽

Susanne Penger ◽

Julia Haberstroh

Keyword(s):

Cognitive Impairment ◽

Psychometric Properties ◽

Acute Care ◽

Older Patients ◽

Hospital Setting ◽

Acute Care Hospital ◽

Acute Care Hospitals ◽

Well Being ◽

Communication Behavior ◽

Care Hospital

Abstract Background and objective Acutely ill older patients with cognitive impairment represent a major subgroup in acute care hospitals. In this context, communication plays a crucial role for patients’ well-being, healthcare decisions, and medical outcomes. As validated measures are lacking, we tested the psychometric properties of an observational instrument to assess Communication Behavior in Dementia (CODEM) in the acute care hospital setting. As a novel feature, we were also able to incorporate linguistic and social-contextual measures. Material and methods Data were drawn from a cross-sectional mixed methods study that focused on the occurrence of elderspeak during care interactions in two German acute care hospitals. A total of 43 acutely ill older patients with severe cognitive impairment (CI group, Mage ± SD = 83.6 ± 5.7 years) and 50 without cognitive impairment (CU group, Mage ± SD = 82.1 ± 6.3 years) were observed by trained research assistants during a standardized interview situation and rated afterwards by use of CODEM. Results Factor analysis supported the expected two-factor solution for the CI group, i.e., a verbal content and a nonverbal relationship aspect. Findings of the current study indicated sound psychometric properties of the CODEM instrument including internal consistency, convergent, divergent, and criterion validity. Conclusion CODEM represents a reliable and valid tool to examine the communication behavior of older patients with CI in the acute care hospital setting. Thus, CODEM might serve as an important instrument for researcher and healthcare professionals to describe and improve communication patterns in this environment.

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Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

Medicina ◽

10.3390/medicina54040057 ◽

2018 ◽

Vol 54 (4) ◽

pp. 57 ◽

Cited By ~ 5

Author(s):

Muhammad Sarwar ◽

Sadia Iftikhar ◽

Muhammad Sarfraz

Keyword(s):

Older People ◽

Older Patients ◽

Formal Education ◽

Cross Sectional Study ◽

Education Level ◽

P Value ◽

Potentially Inappropriate Medications ◽

Sectional Study ◽

Cross Sectional ◽

Inappropriate Medications

Objective: To evaluate influence of education level of older patients on polypharmacy, potentially inappropriate medications (PIMs) listed in Beer’s Criteria, and unplanned hospitalization. Methods: A cross-sectional study was conducted among older people aged ≥65 years between 1 December 2017 and 28 February 2018. For data analysis, descriptive statistics and logistic regression analysis were employed. Results: Among 385 older patients, 88.8% were prescribed PIMs and 56.4% underwent PIMs associated unplanned hospitalization. Older people were less exposed to polypharmacy or excessive polypharmacy as their education levels increased (no formal education vs. primary vs. secondary vs. tertiary, 74% vs. 69.8% vs. 60.5% vs. 58.1%). Patients having higher education were also accompanied by significantly lower prescription of PIMs (no formal education vs. primary vs. secondary vs. tertiary, 96% vs. 87.3% vs. 84.5% vs. 79.1%) as well as unplanned hospitalization (no formal education vs. primary vs. secondary vs. tertiary, 64.7% vs. 76.2% vs. 40.3% vs. 46.5%). Results of regression analysis revealed that no formal education (OR = 1.202, 95% CI = 1.032–2.146, p-value = 0.003) and primary education level (OR = 1.175, 95% CI = 1.014–1.538, p-value = 0.039) were significantly associated with the use of polypharmacy among older people. On the other hand, no formal education was significantly associated with the prescription of PIMs (OR = 1.898, 95% CI = 1.151–2.786, p-value = 0.007). Furthermore, older people with no formal education (OR = 1.402, 95% CI = 1.123–1.994, p-value = 0.010) and primary education level (OR = 1.775, 95% CI = 1.281–3.018, p-value = <0.001) were significantly more likely to undergo unplanned hospitalization. Conclusions: Patients having low literacy level are more likely to receive PIMs, polypharmacy, and undergo unplanned hospitalization in comparison to highly educated patients. Hence, promotion of health literacy for patients is crucial to overcome these problems.

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Frailty Index and functional level upon admission predict hospital outcomes: an interRAI-based cohort study of older patients in post-acute care hospitals

BMC Geriatrics ◽

10.1186/s12877-020-01550-7 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Hanna Kerminen ◽

Heini Huhtala ◽

Pirkko Jäntti ◽

Jaakko Valvanne ◽

Esa Jämsen

Keyword(s):

Cohort Study ◽

Acute Care ◽

Older Patients ◽

Frailty Index ◽

Acute Care Hospitals ◽

Functional Level ◽

Hospital Outcomes ◽

Post Acute Care

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Migrant care workers and rehospitalization among older patients discharged from acute care hospitals

Geriatrics and Gerontology International ◽

10.1111/ggi.12254 ◽

2014 ◽

Vol 15 (2) ◽

pp. 196-203 ◽

Cited By ~ 5

Author(s):

Sergio Fusco ◽

Andrea Corsonello ◽

Carlos Chiatti ◽

Paolo Fabbietti ◽

Giovanni Salerno ◽

...

Keyword(s):

Acute Care ◽

Older Patients ◽

Acute Care Hospitals ◽

Care Workers

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Prognostic Significance of the Short Physical Performance Battery in Older Patients Discharged from Acute Care Hospitals

Rejuvenation Research ◽

10.1089/rej.2011.1215 ◽

2012 ◽

Vol 15 (1) ◽

pp. 41-48 ◽

Cited By ~ 35

Author(s):

Andrea Corsonello ◽

Fabrizia Lattanzio ◽

Claudio Pedone ◽

Sabrina Garasto ◽

Irma Laino ◽

...

Keyword(s):

Acute Care ◽

Physical Performance ◽

Older Patients ◽

Prognostic Significance ◽

Acute Care Hospitals ◽

Short Physical Performance Battery

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Older people presenting to acute care hospitals

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0034 ◽

2017 ◽

pp. 247-254

Author(s):

Roger Y. M. Wong

Keyword(s):

Adverse Events ◽

Older People ◽

Acute Care ◽

Best Practice ◽

Functional Decline ◽

Acute Care Hospitals ◽

Models Of Care ◽

Hospital Length Of Stay ◽

Post Discharge ◽

Point Of Entry

Older people presenting to acute care hospitals are at risk of developing adverse events. Comprehensive geriatric assessment (CGA) in acute care provides standardized assessment and management of geriatric problems. The emergency department is a common point of entry, and strategies that focus on enhancing expertise, equipment, policies, and protocols are helpful. The geriatric consultation service model is commonly deployed, and the geriatric evaluation and management unit (GEMU) is a common ward-based model. The acute care for elders (ACE) unit model is associated with fewer adverse events, less functional decline, shorter hospital length of stay, lower institutionalization risk, and lower cost. The senior friendly hospital (SFH) model requires further studies to confirm its effectiveness. A number of geriatric post-discharge liaison services can smooth the transition of older people returning to the community. Overall these models of care are not mutually exclusive, but together they comprise the best practice for older people.

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