Role of potentially inappropriate medication use in rehabilitation outcomes for geriatric patients after strokes

Abstract

Aim: The effect of the use of potentially inappropriate medications (PIM) on mortality and functional outcome after strokes is unclear in Japan. The aim of the present study was to establish whether treatment with PIM affects functional improvements among geriatric patients convalescing after strokes.

Methods: This retrospective longitudinal study included consecutive geriatric patients admitted and discharged from convalescent rehabilitation wards for stroke between 2010 and 2016. Demographic data, laboratory data and the Functional Independence Measure (FIM) were analyzed. We used the 2015 American Geriatrics Society Beers Criteria to screen for PIM, and the primary outcome was motor FIM gain. Multivariate regression analysis was carried out to analyze the relationship between PIM use and functional recovery.

Results: In total, 272 participants (102 men, 170 women; median age 79 years, interquartile range 72-85 years) were included in the present study. Multivariate regression analysis of motor FIM gain, adjusting for confounding factors, showed that PIM use was independently and negatively correlated with motor FIM gain. In particular, anticholinergic drugs (such as antipsychotics, antidepressants and first-generation antihistamines) were significantly increased from admission to discharge.

Conclusion: Increased PIM use during hospitalization might be a predictor of reduced functional improvement in geriatric patients after strokes. Geriatr Gerontol Int 2018; 18: 321-328.

Keywords: Beers criteria 2015; convalescent rehabilitation ward; functional independence measure; potentially inappropriate medications; stroke.