Prevalence of potentially inappropriate prescribing in community-dwelling older adults: an application of STOPP/START version 3 to The Irish Longitudinal Study on Ageing (TILDA).
Ann Sinéad Doherty, Frank Moriarty, Fiona Boland, Barbara Clyne, Tom Fahey, Rose Anne Kenny, Denis O'Mahony, Emma Wallace
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引用次数: 0
Abstract
Purpose: Potentially inappropriate prescribing includes prescribing potentially inappropriate medicines (PIMs), where risk of medication-related harm may outweigh the clinical benefit(s), and potential prescribing omissions (PPOs), whereby clinically indicated medications are unprescribed without good reason. This study aimed to assess prevalence of PIMs and PPOs (subset of STOPP/START version 3) in older community-dwelling adults and any association with healthcare utilisation and functional decline over time.
Methods: Retrospective cohort study of a nationally representative longitudinal study of ageing in Ireland (n = 3619) (2016-2018). Logistic regressions examined association of patient characteristics with PIMs/PPOs and between prevalent PIMs/PPOs and functional decline. Negative binomial regressions examined association between PIM/PPO with healthcare utilisation over time.
Results: Participants' mean age was 74.2 years (SD 6.99), 53.9% were female and were prescribed a mean of 4.02 (SD 3.16) medications. A total of 1123 (31.0%) participants experienced STOPP PIMs and 1309 (36.2%) START PPOs. STOPP PIMs were associated with increased hospital admissions (adjusted incident rate ratio (aIRR) 1.38, 95% confidence interval (CI) 1.08, 1.75), and functional decline (adjusted odds ratio (aOR) 1.46, 95% CI 1.11, 1.91) at follow-up. Age ≥ 75 years (aOR 1.32, 95% CI 1.10, 1.57) and three or more chronic conditions (aOR 5.19, 95% CI 3.69, 7.31) were significantly associated with START PPOs.
Conclusion: Approximately one-third of study participants experienced STOPP PIMs, associated with an increased risk of hospital admissions and functional decline. START PPOs also occurred in over one-third, associated with increasing age and degree of multimorbidity. Balancing the risk: benefit of medications for older people with multimorbidity remains challenging.
期刊介绍：
European Geriatric Medicine is the official journal of the European Geriatric Medicine Society (EUGMS). Launched in 2010, this journal aims to publish the highest quality material, both scientific and clinical, on all aspects of Geriatric Medicine.
The EUGMS is interested in the promotion of Geriatric Medicine in any setting (acute or subacute care, rehabilitation, nursing homes, primary care, fall clinics, ambulatory assessment, dementia clinics..), and also in functionality in old age, comprehensive geriatric assessment, geriatric syndromes, geriatric education, old age psychiatry, models of geriatric care in health services, and quality assurance.
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