Relationship Between Potentially Inappropriate Medications And The Risk Of Hospital Readmission And Death In Hospitalized Older Patients

Figures & data

Table 1 Baseline And Clinical Characteristics Identified Using The Beers Criteria And Chinese Criteria

Characteristics	Total(n = 508)	Beers Criteria		P value	Chinese Criteria		P value
		PIM 352 (69.3%)	Non-PIM 156		PIM 339 (66.7%)	Non-PIM 169
Age, year	84.2 ± 5.9	84.6 ± 5.7	83.3 ± 6.3	0.024	84.5 ± 5.6	83.6 ± 6.4	0.117
Male sex	312 (61.4)	208 (59.1)	104 (66.7)	0.114	196 (57.8)	116 (68.6)	0.020
Body mass index, kg/m^2	23.9 ± 3.9	23.8 ± 3.9	24.5 ± 3.8	0.076	23.9 ± 4.0	24.2 ± 3.5	0.496
CCI	7 (5–9)	7 (6–9)	7 (5–8)	0.037	7 (6–9)	7 (5–8)	0.055
Length of stay in hospital, day	14 (11–18)	15 (12–18)	13 (10–16)	<0.001	15 (12–18)	13 (10–16)	<0.0001
Number of PIMs	–	1 (0–2)	–	–	1 (1–3)	–	–
Death, N	85 (16.7)	65 (18.5)	20 (12.8)	0.124	62 (18.3)	23 (13.6)	0.208
Rehospitalization, N	354 (69.7)	256 (72.7)	98 (62.8)	0.028	242 (71.4)	112 (66.3)	0.260
Number of comorbidities	11 (8–14)	12 (9–15)	9 (7–11)	<0.001	12 (9–14)	10 (7–12)	<0.001
Number of medicines	7 (5–10)	8 (6–11)	5 (4–7)	<0.001	8 (6–11)	6 (4–7)	<0.001
CFS	4 (3–6)	5 (3–6)	4 (3–5)	<0.001	5 (3–6)	4 (3–5)	0.026
CFS < 5, N	267 (52.6)	168 (47.7)	99 (63.5)	0.001	167 (49.3)	100 (59.2)	0.038
CFS ≥ 5, N	241 (47.4)	184 (52.3)	57 (36.5)		172 (50.7)	69 (40.8)
MNASF	13 (11–14)	12 (10–14)	13 (11–14)	0.008	12 (10–14)	13 (11–14)	0.014
0 ≤ MNASF ≤ 7, N	34 (6.7)	24 (7.1)	7 (4.5)	0.043	23 (7.0)	8 (4.9)	0.290
8 ≤ MNASF ≤ 11, N	145 (28.5)	103 (30.4)	33 (21.4)		96 (29.2)	40 (24.4)
12 ≤ MNASF ≤ 14, N	329 (64.8)	212 (62.5)	114 (74.0)		210 (63.8)	116 (70.7)
Living alone, N	68 (13.8)	52 (15.3)	16 (10.4)	0.160	46 (14.0)	22 (13.4)	1.000
ADL	5 (4–6)	5 (4–6)	5 (5–6)	0.001	5 (4–6)	5 (5–6)	0.032
ADL= 6, N	193 (38.0)	117 (34.5)	76 (49.4)	0.002	119 (36.2)	74 (45.1)	0.063
ADL≤ 5, N	315 (62.0)	222 (65.5)	78 (50.6)		210 (63.8)	90 (54.9)
CMMSE	27 (24–29)	27 (24–29)	28 (25–29)	0.052	27 (24–29)	28 (25–29)	0.043
Cognitive impairment, N	295 (58.1)	198 (56.3)	97 (62.2)	0.359	189 (55.8)	106 (62.7)	0.134

Notes: Data are presented as number (%) or mean ± SD or median (interquartile range). The P value is used for comparison by the independent sample t test or Wilcoxon rank-sum tests or Chi-square test.

Abbreviations: ADL, activities of daily living; CCI, Charlson Comorbidity Index; CFS, Clinical Frailty Scale; CMMSE, Chinese version mini-mental state examination; MNASF, short-form mini-nutritional assessment; PIM, potentially inappropriate medication.

Table 2 Beers And Chinese Criteria Concordance

	Beers Criteria Listed		Total	P value
	Non-PIM Patients	PIM Patients
Chinese criteria listed
Non-PIM patients	101 (19.9%)	68 (13.4%)	169 (33.3%)	<0.0001^a
PIM patients	55 (10.8%)	284 (55.9%)	339 (66.7%)	<0.0001^b
Total	156 (30.7%)	352 (69.3%)	508	(Kappa = 0.4440)

Notes: ^aBased on the Chi-square test. ^bBased on the kappa test.

Abbreviation: PIM, potentially inappropriate medication.

Figure 1 Beers and Chinese criteria concordance.

Table 3 Top 10 PIMs Based On The Two Sets Of PIM Criteria

Beers Criteria (N = 352)			Chinese Criteria (N = 339)
Drugs And Items	N	(%)	Drugs And Items	N	(%)
Rabeprazole	150	42.6	Clopidogrel	170	50.1
Estazolam	121	34.4	Estazolam	121	35.7
Hydrochlorothiazide	78	22.2	Lorazepam	57	16.8
Lorazepam	57	16.2	Nicergoline	49	14.5
Terazosin	34	9.7	Insulin	48	14.2
Spironolactone	17	4.8	Warfarin	14	4.1
Frusemide	13	3.7	Theophylline	12	3.5
Zolpidem	10	2.8	Zolpidem	10	2.9
Amiodarone	8	2.3	Amiodarone	8	2.4
Olanzapine	8	2.3	Olanzapine	8	2.4

Table 4 Univariate And Multivariate Cox Proportional-Hazards Models To Determine The Association Of PIM Use With Health Outcomes

Definition Of PIM	Health Outcomes	Univariate		Adjusted
		HR (95% CI)	P value	HR (95% CI)	P value
Beers criteria	Death	1.457 (0.883–2.406)	0.141	1.082 (0.612–1.915)	0.786
	Any admission	1.371 (1.086–1.731)	0.008	1.310 (1.034–1.660)	0.025
Chinese criteria	Death	1.418 (0.878–2.288)	0.153	1.051 (0.605–1.829)	0.859
	Any admission	1.156 (0.924–1.446)	0.206	0.920 (0.719–1.175)	0.503

Notes: Adjusted for age, gender, Charlson’s index, BMI, duration, number of medicines, nutrition status, living alone, ADL sort, and cognitive sort.

Abbreviations: HR, hazard ratio; CI, confidence interval.

Figure 2 Kaplan–Meier curves comparing PIM and non- PIM groups according to Beers and Chinese criteria with health outcomes.

Notes: (A) PIM group according to Chinese criteria and death. (B) PIM group according to Beers criteria and death. (C) PIM group according to Chinese criteria and readmission. (D) PIM group according to Beers criteria and readmission.