A Prospective Study on Potentially Inappropriate Drug Use and All-Cause Mortality in Community-Dwelling Older Adults

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2025-08-11 DOI:10.1111/jgs.70002

Liat Orenstein, Angela Chetrit, Keren Laufer, Rachel Dankner

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引用次数: 0

Abstract

Background

Potentially inappropriate prescribing (PIP), encompassing potentially inappropriate medications (PIMs) and prescribing omissions (PPOs), is prevalent among older adults and consistently associated with adverse health outcomes. However, evidence on its impact on mortality remains limited. We examined the associations of PIMs and PPOs with long-term mortality in a cohort of community-dwelling older adults.

Methods

One thousand two hundred and ten participants from the third follow-up (1999–2007) of a longitudinal prospective cohort study were followed for mortality until 03/2022. PIMs and PPOs were identified using the 2023 Beers and the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) v3 criteria. Cox proportional hazards and Fine–Gray subdistribution hazard models assessed associations between PIP and all-cause and non-cancer mortality, respectively, adjusting for sociodemographic, lifestyle, and health-related factors.

Results

Overall, 81.2% of participants were exposed to > 1 problem: 52.6% and 45.0% to PIMs based on Beers and STOPP criteria, respectively, and 59.3% to PPOs. In multivariable analysis, exposure to ≥ 2 PIMs was associated with increased all-cause mortality for Beers (HR = 1.31, 95% CI: 1.04–1.69) and STOPP (HR = 1.25, 95% CI: 1.00–1.55) criteria. An interaction between PIMs (Beers criteria) and self-rated health (SRH) indicated stronger associations for those with “excellent/good” baseline SRH, compared to those with “poor/very poor” SRH (p-for-interaction = 0.030). Use of ≥ 2 PIMs was also associated with a 1.4-fold increased non-cancer mortality risk for both tools. Exposure to ≥ 2 PPOs was associated with a 1.8-fold increase in all-cause mortality risk (HR = 1.84, 95% CI: 1.24–2.72), while associations were stronger in men (p-for-interaction = 0.012). Exposure to 1 or ≥ 2 PPOs was also associated with 1.3 and 2.0-fold increased non-cancer mortality risk, respectively.

Conclusions

PIP is prevalent and is associated with increased long-term mortality among community-dwelling older adults. Addressing PIMs in healthier older individuals and reducing PPOs in clinical practice is critical. Sex-specific pharmaceutical guidelines are warranted.

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社区居住老年人潜在不当用药和全因死亡率的前瞻性研究。

背景：潜在不适当处方（PIP），包括潜在不适当药物（pim）和处方遗漏（PPOs），在老年人中普遍存在，并始终与不良健康结局相关。然而，关于其对死亡率影响的证据仍然有限。我们在一个社区老年人队列中研究了PIMs和PPOs与长期死亡率的关系。方法：从纵向前瞻性队列研究的第三次随访（1999-2007）中随访了1,210名参与者的死亡率，直到2022年3月。使用2023 Beers和老年人潜在不当处方筛查工具/提醒医生正确治疗筛查工具（STOPP/START） v3标准确定PIMs和PPOs。Cox比例风险和Fine-Gray亚分布风险模型分别评估了PIP与全因死亡率和非癌症死亡率之间的关系，并对社会人口统计学、生活方式和健康相关因素进行了调整。结果：总体而言，81.2%的参与者暴露于>1问题：52.6%和45.0%的参与者暴露于基于Beers和STOPP标准的pim， 59.3%的参与者暴露于PPOs。在多变量分析中，暴露于≥2个pim与Beers （HR = 1.31, 95% CI: 1.04-1.69）和STOPP （HR = 1.25, 95% CI: 1.00-1.55）标准的全因死亡率增加相关。pim （Beers标准）和自评健康（SRH）之间的相互作用表明，与SRH“差/很差”的人相比，基线SRH“优秀/良好”的人有更强的关联（相互作用p = 0.030）。使用≥2个pim还与两种工具的非癌症死亡风险增加1.4倍相关。暴露于≥2个PPOs与全因死亡风险增加1.8倍相关（HR = 1.84, 95% CI: 1.24-2.72），而男性的相关性更强（相互作用p = 0.012）。暴露于1个或≥2个PPOs也分别与非癌症死亡风险增加1.3倍和2.0倍相关。结论：PIP在社区居住的老年人中普遍存在，并与长期死亡率增加有关。在临床实践中解决健康老年人的PIMs问题和减少PPOs至关重要。针对性别的药物指南是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.