Inappropriate Drug Use Among Hospitalized Older Adults
Inappropriate Drug Use Among Hospitalized Older Adults
Background Beers criteria and screening tool of older person's prescriptions (STOPP) criteria are widely used to assess potentially inappropriate drug use (PIDU).
Objective the aims of the present study are (i) to assess the prevalence of PIDU based on 2012 Beers criteria and STOPP criteria and (ii) to determine the impact of PIDU, as defined by these criteria, on health outcomes among older in-hospital patients.
Design prospective observational study.
Setting and subjects a total of 871 in-hospital patients participating to the CRIteria to Assess Appropriate Medication Use among Elderly Complex Patients project.
Methods outcome measures were (i) adverse drug reactions (ADR); (ii) decline in functional status; (iii) combined outcome (ADR or declined in functional status).
Results the prevalence of PIDU was 58.4% applying Beers criteria, 50.4% applying STOPP criteria and 75.0% combining both sets of criteria. PIDU defined based on STOPP criteria was significantly associated with ADR [odds ratio (OR) 2.36; 95% confidence interval (CI) 1.10–5.06], and decline in physical function (OR: 2.00; 95% CI: 1.10–3.64), while, despite a positive trend, no significant association was observed for Beers criteria or the combination of both criteria. The combined outcome was significantly associated with PIDU defined based on Beers (OR: 1.74; 95% CI: 1.06–2.85), STOPP criteria (OR: 2.14; 95% CI: 1.32–3.47) or both (OR 2.02; 95% CI: 1.06–3.84).
Conclusions PIDU is common in hospitalised older adults and the combination of Beers and STOPP criteria might lead to the identification of a larger number of cases of PIDU than the application of a single set of criteria. STOPP criteria significantly predict all in-hospital outcomes considered, while Beers criteria were significantly associated with the combined outcome only.
In Western countries, adverse drug reactions (ADR) are an important medical problem, resulting in 3–5% of all hospital admissions, accounting for 5–10% of in-hospital costs and being associated with a substantial increase in morbidity and mortality. The use of inappropriate drugs, defined as drugs in which the risk outweighs the benefit, is a major factor influencing the likelihood of ADR and negative health outcomes, potentially leading to an increased rate of functional impairment and mortality among the elderly. Such negative effects associated with inappropriate drug use might be particularly relevant among hospitalised older adults, who are usually 'frail' and present with acute diseases, which may increase their susceptibility to adverse medication effects and raise the severity of drug related illnesses. Since 1991 Beers et al. have developed a comprehensive set of explicit criteria to identify potentially inappropriate drug use (PIDU), with the intent of providing a useful tool for assessing the quality of prescribing in older persons, which cannot however represent substitutes for careful clinical consideration by physicians. These criteria were recently updated by the work of an interdisciplinary panel of experts in geriatric care and pharmacotherapy supported by the American Geriatrics Society. An important criticism of the Beers criteria is their restricted applicability to Europe, since several drugs in the Beers list were not approved in most European countries. For this reason, more recently, the screening tool of older person's prescriptions (STOPP) criteria was developed. These criteria are being increasingly used in Europe and are to some extent considered to be the 'European Beers criteria'.
So far, few studies have evaluated the prevalence and the risk of negative health outcomes associated with PIDU as assessed by these two sets of criteria in hospitalised older adults. Therefore, the aims of the present study are (i) to assess the prevalence of PIDU based on Beers and STOPP criteria and (ii) to determine the impact of PIDU, as defined by these two sets of criteria, on health outcomes of older adults admitted to acute care hospitals.
Abstract and Introduction
Abstract
Background Beers criteria and screening tool of older person's prescriptions (STOPP) criteria are widely used to assess potentially inappropriate drug use (PIDU).
Objective the aims of the present study are (i) to assess the prevalence of PIDU based on 2012 Beers criteria and STOPP criteria and (ii) to determine the impact of PIDU, as defined by these criteria, on health outcomes among older in-hospital patients.
Design prospective observational study.
Setting and subjects a total of 871 in-hospital patients participating to the CRIteria to Assess Appropriate Medication Use among Elderly Complex Patients project.
Methods outcome measures were (i) adverse drug reactions (ADR); (ii) decline in functional status; (iii) combined outcome (ADR or declined in functional status).
Results the prevalence of PIDU was 58.4% applying Beers criteria, 50.4% applying STOPP criteria and 75.0% combining both sets of criteria. PIDU defined based on STOPP criteria was significantly associated with ADR [odds ratio (OR) 2.36; 95% confidence interval (CI) 1.10–5.06], and decline in physical function (OR: 2.00; 95% CI: 1.10–3.64), while, despite a positive trend, no significant association was observed for Beers criteria or the combination of both criteria. The combined outcome was significantly associated with PIDU defined based on Beers (OR: 1.74; 95% CI: 1.06–2.85), STOPP criteria (OR: 2.14; 95% CI: 1.32–3.47) or both (OR 2.02; 95% CI: 1.06–3.84).
Conclusions PIDU is common in hospitalised older adults and the combination of Beers and STOPP criteria might lead to the identification of a larger number of cases of PIDU than the application of a single set of criteria. STOPP criteria significantly predict all in-hospital outcomes considered, while Beers criteria were significantly associated with the combined outcome only.
Introduction
In Western countries, adverse drug reactions (ADR) are an important medical problem, resulting in 3–5% of all hospital admissions, accounting for 5–10% of in-hospital costs and being associated with a substantial increase in morbidity and mortality. The use of inappropriate drugs, defined as drugs in which the risk outweighs the benefit, is a major factor influencing the likelihood of ADR and negative health outcomes, potentially leading to an increased rate of functional impairment and mortality among the elderly. Such negative effects associated with inappropriate drug use might be particularly relevant among hospitalised older adults, who are usually 'frail' and present with acute diseases, which may increase their susceptibility to adverse medication effects and raise the severity of drug related illnesses. Since 1991 Beers et al. have developed a comprehensive set of explicit criteria to identify potentially inappropriate drug use (PIDU), with the intent of providing a useful tool for assessing the quality of prescribing in older persons, which cannot however represent substitutes for careful clinical consideration by physicians. These criteria were recently updated by the work of an interdisciplinary panel of experts in geriatric care and pharmacotherapy supported by the American Geriatrics Society. An important criticism of the Beers criteria is their restricted applicability to Europe, since several drugs in the Beers list were not approved in most European countries. For this reason, more recently, the screening tool of older person's prescriptions (STOPP) criteria was developed. These criteria are being increasingly used in Europe and are to some extent considered to be the 'European Beers criteria'.
So far, few studies have evaluated the prevalence and the risk of negative health outcomes associated with PIDU as assessed by these two sets of criteria in hospitalised older adults. Therefore, the aims of the present study are (i) to assess the prevalence of PIDU based on Beers and STOPP criteria and (ii) to determine the impact of PIDU, as defined by these two sets of criteria, on health outcomes of older adults admitted to acute care hospitals.