Prevalence of and Risk Factors for Drug-Related Readmissions in Older Adults: A Systematic Review and Meta-Analysis.

IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY
Drugs & Aging Pub Date : 2024-01-01 Epub Date: 2023-10-21 DOI:10.1007/s40266-023-01076-8
Narisha Prasad, Edward C Y Lau, Ilsa Wojt, Jonathan Penm, Zhaoli Dai, Edwin C K Tan
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引用次数: 0

Abstract

Background: Older adults are at an increased risk of drug-related problems, especially following discharge from hospital. Drug-related readmissions place a large burden on the patient and the healthcare system. However, previous studies report inconsistent results on the prevalence and associated risk factors for drug-related hospital readmissions in older adults.

Objectives: We aimed to assess the prevalence of drug-related readmissions in older adults aged 65 years and older and investigate the drug classes, preventability and risk factors most associated with these readmissions.

Methods: A systematic review and meta-analysis were undertaken to answer our objectives. A search of four databases (MEDLINE, Embase, CINAHL and Scopus) was conducted. Three authors independently performed title and abstract screening, full-text screening and data extraction of all included studies. A meta-analysis was conducted to calculate the pooled prevalence of drug-related readmissions across all studies, and a subgroup analysis was performed to explore heterogeneity among studies reporting on adverse drug reaction-related readmissions.

Results: A total of 1978 studies were identified in the initial search, of which four studies were included in the final synthesis. Three studies focused on readmissions due to adverse drug reactions and one study focused on readmissions due to drug-related problems. A pooled prevalence of 9% (95% confidence interval 2-18) was found for drug-related readmissions across all studies, and a pooled prevalence of 6% (95% confidence interval 4-10) was found for adverse drug reaction-related readmissions. Three studies explored the preventability of readmissions and 15.4-22.2% of cases were deemed preventable. The drug classes most associated with adverse drug reaction readmissions included anticoagulants, antibiotics, psychotropics and chemotherapy agents. Polypharmacy (the use of five or more medications) and several comorbidities such as cancer, liver disease, ischaemic heart disease and peptic ulcer disease were identified as risk factors for drug-related readmissions.

Conclusions: Almost one in ten older adults discharged from hospital experienced a drug-related hospital readmission, with one fifth of these deemed preventable. Several comorbidities and the use of polypharmacy and high-risk drugs were identified as prominent risk factors for readmission. Further research is needed to explore possible causes of drug-related readmissions in older adults for a more guided approach to the development of effective medication management interventions.

Abstract Image

老年人药物相关阅读的患病率和危险因素:系统综述和荟萃分析。
背景:老年人患药物相关问题的风险增加,尤其是出院后。与药物相关的再次入院给患者和医疗系统带来了巨大负担。然而,先前的研究报告了老年人再次入院与药物相关的患病率和相关风险因素的不一致结果。目的:我们旨在评估65岁及以上老年人药物相关再入院的患病率,并调查与这些再入院最相关的药物类别、可预防性和风险因素。方法:采用系统综述和荟萃分析来回答我们的目标。检索了四个数据库(MEDLINE、Embase、CINAHL和Scopus)。三位作者分别对所有纳入的研究进行了标题和摘要筛选、全文筛选和数据提取。进行了一项荟萃分析,以计算所有研究中药物相关再入院的合并患病率,并进行了亚组分析,以探索报告药物不良反应相关再入院研究的异质性。结果:在最初的搜索中总共确定了1978项研究,其中4项研究被纳入最终综合。三项研究集中于因药物不良反应而再次入院,一项研究集中在因药物相关问题而再次入院。在所有研究中,药物相关再入院的合并患病率为9%(95%置信区间2-18),与药物不良反应相关的再入院的综合患病率为6%(95%置信间隔4-10)。三项研究探讨了再次入院的可预防性,15.4-22.2%的病例被认为是可预防的。与药物不良反应再入院最相关的药物类别包括抗凝剂、抗生素、精神药物和化疗药物。多药治疗(使用五种或五种以上药物)和几种合并症,如癌症、肝病、缺血性心脏病和消化性溃疡病,被确定为药物相关再入院的危险因素。结论:近十分之一的出院老年人经历了与毒品有关的再次入院,其中五分之一被认为是可以预防的。一些合并症以及多药和高风险药物的使用被确定为再次入院的主要风险因素。需要进一步的研究来探索老年人药物相关再入院的可能原因,以便制定更具指导性的方法来制定有效的药物管理干预措施。
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来源期刊
Drugs & Aging
Drugs & Aging 医学-老年医学
CiteScore
5.50
自引率
7.10%
发文量
68
审稿时长
6-12 weeks
期刊介绍: Drugs & Aging delivers essential information on the most important aspects of drug therapy to professionals involved in the care of the elderly. The journal addresses in a timely way the major issues relating to drug therapy in older adults including: the management of specific diseases, particularly those associated with aging, age-related physiological changes impacting drug therapy, drug utilization and prescribing in the elderly, polypharmacy and drug interactions.
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