Prevalence, Determinants And Associated Risk Of Potentially Inappropriate Prescribing For Older Adults In Qatar: A National Retrospective Study

Abstract

Purpose

To assess the prevalence and associated risk of potentially inappropriate prescribing (PIP) in older adults.

Methods

This was a national 3-year retrospective study of outpatient older adults exposed to potentially inappropriate medication (PIM) or polypharmacy. We used the Beers Criteria 2019 list to identify PIM to be avoided in older adults. We define moderate polypharmacy (MoP) and major polypharmacy (MaP) as using 6–10 or >10 chronic medications, respectively. Determinants of PIP included patients’ demographics, lab results, medications, comorbidities, and home healthcare services. We used Chi-square (for categorical variables), Unpaired t-test and ANOVA (for continuous variables as applicable) to assess the association of these determinants with PIP. Univariate followed by multivariate logistic regression models were used to get the crude and adjusted odds ratios of exposure to PIM or polypharmacy within patients who had emergency department (ED) admissions, bone fractures, falls, or constipation, compared to those who had not.

Results

3537 patients were included. 62.6%, 40.4%, and 27.2% were exposed to PIM, MoP and MaP, respectively. Determinants of PIP included age, gender, ethnicity, weight, kidney function, sodium levels, hypertension, diabetes, heart failure, CAD, and home healthcare services (all with p-value < 0.05). PIM was associated with risk of ED admission, bone fracture and constipation with adjusted OR (p-values) of 1.27 (0.002), 1.33 (0.005), and 1.40 (<0.001), respectively. MoP was associated with the risk of ED admission, bone fracture, and constipation, with adjusted OR (p-values) of 1.27 (0.012), 1.34 (0.019), and 1.47 (<0.001), respectively. MaP was associated with a higher risk of ED admission, bone fracture, falls, and constipation with adjusted OR (p-values) of 1.46 (0.001), 1.59 (0.002), 1.39 (0.023), and 2.07 (<0.001), respectively.

Conclusion

PIP is common and is associated with an increased risk of poor clinical outcomes in older adults.

Keywords:

• polypharmacy
• Beers 2019
• falls
• constipation
• emergency admission
• fracture

Acknowledgments

We honestly appreciate the supervision and support received from the Pharmacy and Geriatrics departments in Rumailah Hospital, Hamad Medical Corporation, in the state of Qatar.

Ethics And Approval

This study got an exemption notice from IRB approval as it was a retrospective data analysis. Patients’ data were extracted, de-identified, coded, processed, and stored using a special secured computer to maintain the highest patient confidentiality.

Disclosure

None of the authors received any funds from any company or organization or has any conflict of interest regarding medications or topics discussed in this study.