Associations between potentially inappropriate prescribing and increased
number of medications with post-discharge health outcomes among
geriatric rehabilitation inpatients: RESORT study
Abstract
Aims: Older adults are vulnerable to medication-related harm mainly due
to high use of medications and inappropriate prescribing. This study
aimed to investigate the associations between inappropriate prescribing
and number of medications identified at discharge from geriatric
rehabilitation with subsequent post-discharge health outcomes. Method:
REStORing health of acutely unwell adulTs (RESORT) is an observational,
longitudinal cohort study of geriatric rehabilitation inpatients.
Potentially inappropriate medications (PIMs) and potential prescribing
omissions (PPOs) were measured at acute admission, and at admission and
discharge from geriatric rehabilitation, using version 2 of the
STOPP/START criteria. Results: 1890 patients (mean age 82.6 ± 8.1 years,
56.3 % females) were included. The use of at least 1 PIMs, or PPOs at
geriatric rehabilitation discharge were not associated with 30-day and
90-day readmission and 3-month and 12-month mortality. Central nervous
system (CNS)/psychotropics and fall risk PIMs were significantly
associated with 30-day hospital readmission (adjusted odds ratio (AOR)
1.53; 95%CI 1.09─2.15), and cardiovascular PPOs with 12-month mortality
(AOR 1.34; 95%CI 1.00─1.78). Increased number of discharge medications
was significantly associated with 30-day (AOR 1.03; 95%CI 1.00─1.07)
and 90-day (AOR 1.06; 95%CI 1.03─1.09) hospital readmissions. The use
and number of PPOs (including vaccine omissions) were associated with
reduced independence in instrumental activities of daily living scores
at 90-days post geriatric rehabilitation discharge. Conclusion: The
number of discharge medications, CNS/psychotropics and fall risk PIMs
were significantly associated with readmission, and cardiovascular PPOs
with mortality. Interventions are needed to improve appropriate
prescribing in geriatric rehabilitation patients to prevent hospital
readmission and mortality.