Inappropriate Prescription Common among Older People Post Hospitalization

Older patients were more likely to be given an potentially inappropriate prescription independent of other patient factors, after their admission into hospital.

Inappropriate prescription, irrespective of other factors has become more common among older patients after their admission into the hospital, according to RCSI study.

The study, conducted by the HRB Centre for Primary Care Research based in the Department of General Practice at RCSI (Royal College of Surgeons in Ireland), is published in the current edition of The BMJ.

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‘Identification of ideal treatment options for older people is required to ensure that the risk of inappropriate medications is minimized.’
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RCSI researchers looked at data from general practice records of 38,229 patients (aged ≥65 years) in Ireland from 2012 to 2015. To determine if the prescriptions were potentially inappropriate, they assessed the records using 45 criteria from the Screening Tool for Older Persons’ Prescription (STOPP) version 2.

Commenting on the findings, senior research fellow with the HRB Centre for Primary Care Research at RCSI Dr Frank Moriarty said: "Adults aged 65 years and older are a growing population and represent the largest consumers of prescribed medications.

When caring for older patients in primary care, achieving the balance of maximizing patients’ benefits from medicines while minimizing harms and cost can be challenging.

"Research to date has focused on patient and GP characteristics as risk factors for poor prescribing quality. Our study illustrates the need to consider and address potential adverse effects of hospitalization on prescribing appropriate medication for older patients."

The study found that potentially inappropriate prescribing (PIP) is becoming increasingly prevalent in older people, and hospitalization is independently associated with an increased risk of PIP.

When compared to older people who had not been hospitalized in the past year, the probability of at least one PIP during a year increases by 49% for hospitalized patients after adjusting for other factors, such as the number of prescriptions and type of healthcare cover.

Dr Moriarty said: "Although we adjusted for a range of patient characteristics, there is potential for unmeasured confounding variables, as with any observational study, which may partly or fully explain the results.

"However, many of the common criteria in our study relate to inappropriate duration of use for medicines used for sleep, acid suppression, and anti-inflammatory effect.

Documenting and clearly communicating the intended prescription duration or planned review date would ensure that other clinicians, such as GPs, would have complete information for reviewing and stopping such prescriptions.

It is vital to identify optimal management strategies for older people to ensure the risk of inappropriate medications is minimized following their time in hospitals."

Source-Eurekalert