Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Nov;82(5):1382-1392.
doi: 10.1111/bcp.13055. Epub 2016 Aug 3.

Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalization in a cohort of community-dwelling oldest old

Maarten Wauters  1 , Monique Elseviers  2 , Bert Vaes  3   4 , Jan Degryse  3   4 , Olivia Dalleur  5   6 , Robert Vander Stichele  2 , Thierry Christiaens  2 , Majda Azermai  2
Affiliations

Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalization in a cohort of community-dwelling oldest old

Maarten Wauters et al. Br J Clin Pharmacol. 2016 Nov.

Abstract

Aims: Little is known about the impact of inappropriate prescribing (IP) in community-dwelling adults, aged 80 years and older. The prevalence at baseline (November 2008September 2009) and impact of IP (misuse and underuse) after 18 months on mortality and hospitalization in a cohort of community-dwelling adults, aged 80 years and older (n = 503) was studied.

Methods: Screening Tool of Older People's Prescriptions (STOPP-2, misuse) and Screening Tool to Alert to Right Treatment (START-2, underuse) criteria were cross-referenced and linked to the medication use (in Anatomical Therapeutic Chemical coding) and clinical problems. Survival analysis until death or first hospitalization was performed at 18 months after inclusion using Kaplan-Meier, with Cox regression to control for covariates.

Results: Mean age was 84.4 (range 80-102) years. Mean number of medications prescribed was 5 (range 0-16). Polypharmacy (≥5 medications, 58%), underuse (67%) and misuse (56%) were high. Underuse and misuse coexisted in 40% and were absent in 17% of the population. A higher number of prescribed medications was correlated with more misused medications (rs = .51, P < 0.001) and underused medications (rs = .26, P < 0.001). Mortality and hospitalization rate were 8.9%, and 31.0%, respectively. After adjustment for number of medications and misused medications, there was an increased risk of mortality (HR 1.39, 95% CI 1.10, 1.76) and hospitalization (HR 1.26, 95% CI 1.10, 1.45) for every additional underused medication. Associations with misuse were less clear.

Conclusion: IP (polypharmacy, underuse and misuse) was highly prevalent in adults, aged 80 years and older. Surprisingly, underuse and not misuse had strong associations with mortality and hospitalization.

Keywords: aged 80 years and over; hospitalization; inappropriate prescribing; mortality; polypharmacy; primary care.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Kaplan‐Meier Survival analysis of time to death for groups of underuse (A), and groups of misuse (B)
Figure 2
Figure 2
Kaplan‐Meier survival analysis of time to first hospitalization for groups of underuse (A), and groups of misuse (B)
See this image and copyright information in PMC

References

    1. Laroche M‐L, Charmes J‐P, Nouaille Y, Picard N, Merle L. Is inappropriate medication use a major cause of adverse drug reactions in the elderly? Br J Clin Pharmacol 2007; 63: 177–186. - PMC - PubMed
    1. Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int 2010; 107: 543–551. - PMC - PubMed
    1. Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Prescribing in elderly people. 1. Appropriate prescribing in elderly people : how well can it be measured and optimised? Lancet 2007; 370: 173–184. - PubMed
    1. Payne RA, Abel GA, Avery AJ, Mercer SW, Roland MO. Is polypharmacy always hazardous? A retrospective cohort analysis using linked electronic health records from primary and secondary care. Br J Clin Pharmacol 2014; 77: 1073–1082. - PMC - PubMed
    1. Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med 1991; 151: 1825–1832. - PubMed

Publication types