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. 2018 Nov;51(7):813-820.
doi: 10.1007/s00391-017-1328-x. Epub 2017 Oct 25.

Association of potentially inappropriate medications with outcomes of inpatient geriatric rehabilitation : A prospective cohort study

Madeleine Bachmann  1   2 , Jan Kool  1 , Peter Oesch  1 , Marcel Weber  3 , Stefan Bachmann  4   5
Affiliations

Association of potentially inappropriate medications with outcomes of inpatient geriatric rehabilitation : A prospective cohort study

Madeleine Bachmann et al. Z Gerontol Geriatr. 2018 Nov.

Abstract
in English, German

Background: Higher age is associated with multimorbidity, which may lead to polypharmacy and potentially inappropriate medication (PIM).

Objective: To evaluate whether PIM on admission for geriatric inpatient rehabilitation is associated with rehabilitation outcome regarding mobility and quality of life.

Material and methods: A total of 210 patients were included. Medications at hospital admission were analyzed with the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and the number of PIMs individual patients were taking was determined. The study population was then divided into two groups, one with and one without PIM. The main rehabilitation outcomes, quality of life and mobility, were assessed on admission and discharge. Associations between PIM and the main outcomes were analyzed using the two-tailed Student's t-test and Spearman correlations.

Results: In total 131 PIMs were identified by STOPP. Of the patients 91 (43%) were taking at least 1 PIM, and 119 patients (57%) were not taking any PIM. Patients with no PIM had a significantly better quality of life on admission (p < 0.05) and discharge (p < 0.005). The number of PIMs was not associated with the rehabilitation outcomes mobility and quality of life (Spearman's ρ = -0.01, p = 0.89 and ρ = -0.02, p = 0.7, respectively). The quality of life and mobility increased identically in both groups from admission to discharge but the group with PIM did not reach the levels of those without PIM.

Conclusion: The use of PIM may have a negative impact on the quality of life of elderly people but patients with and without PIM achieved comparable improvements in quality of life and mobility. Further studies are required to assess the long-term outcomes of patients taking PIM following inpatient rehabilitation.

Hintergrund: Multimorbidität im höheren Alter kann zu Polypharmazie und potenziell nichtgeeigneter Medikation („potentially inappropriate medication“, PIM) führen.

Ziel: Prüfung eines Zusammenhangs zwischen PIM bei Eintritt in die Rehabilitationsklinik und den Resultaten bezüglich Mobilität und Lebensqualität nach einer stationären geriatrischen Rehabilitation.

Material und Methoden: Es wurden 210 Patienten in die Studie aufgenommen. Die Eintrittsmedikation wurde gemäß den Kriterien des Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) überprüft. Die Studienteilnehmer wurden anschließend in 2 Gruppen zugeordnet, eine mit und eine ohne PIM. Die Haupt-Outcomes Mobilität und Lebensqualität wurden bei Ein- und Austritt erhoben. Zusammenhänge zwischen PIM und den Hauptresultaten wurden statistisch mit dem Student’s t-Test und mithilfe der Spearman-Korrelationen überprüft.

Ergebnisse: Gemäß den STOPP-Kriterien wurden 131 PIM identifiziert. Es wiesen 91 Patienten (43 %) mindestens eine PIM auf, 119 Patienten (57 %) erhielten keine PIM. Patienten ohne PIM hatten eine signifikant bessere Lebensqualität bei Klinikeintritt (p < 0,05) und -austritt (p < 0,005). Die Anzahl der PIM zeigte keinen Zusammenhang mit den Rehabilitation-Outcomes Mobilität und Lebensqualität (Spearman ρ = −0,01, p = 0,89 respektive Spearman ρ = −0,02, p = 0,7). Für beide Gruppen ergab sich eine identische Verbesserung der Mobilität und der Lebensqualität von Ein- zu Austritt, aber die Patienten mit PIM erreichten nicht dieselben Mobilitäts- und Lebensqualitätslevel wie Patienten ohne PIM.

Diskussion: „Potentially inappropriate medication“ kann einen negativen Effekt auf die Lebensqualität älterer Menschen haben, aber Patienten mit und ohne PIM erreichten eine vergleichbare Verbesserung der Lebensqualität und der Mobilität. Weitere Studien sind notwendig um den Langzeiteinfluss von PIM nach einer stationären Rehabilitation zu untersuchen.

Keywords: Mobility; Outcome assessment; Prospective study; Quality of life; Rehabilitation.

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Conflict of interest statement

M. Bachmann, J. Kool, P. Oesch, M. Weber and S. Bachmann declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient recruitment, study flow and data collection. PIM potentially inappropriate medication
Fig. 2
Fig. 2
Improvement in mobility and quality of life (QOL) in the groups without potentially inappropriate medication (PIM) and with PIM at baseline and at discharge. a Changes in mobility in patients with and without PIMs. Y-axis: TUG 1-5 (1= best mobility, 5 unable to perform the test). b Changes in QOL in patients with and without PIMs. Y-axis: EQ5D-Index (1=best level of QOL)
See this image and copyright information in PMC

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