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Meta-Analysis
. 2021 Nov;87(11):4150-4172.
doi: 10.1111/bcp.14870. Epub 2021 May 18.

Potentially inappropriate prescribing and its associations with health-related and system-related outcomes in hospitalised older adults: A systematic review and meta-analysis

Alemayehu B Mekonnen  1 , Bernice Redley  1   2 , Barbora de Courten  3 , Elizabeth Manias  1
Affiliations
Meta-Analysis

Potentially inappropriate prescribing and its associations with health-related and system-related outcomes in hospitalised older adults: A systematic review and meta-analysis

Alemayehu B Mekonnen et al. Br J Clin Pharmacol. 2021 Nov.

Abstract

Aims: To synthesise associations of potentially inappropriate prescribing (PIP) with health-related and system-related outcomes in inpatient hospital settings.

Methods: Six electronic databases were searched: Medline Complete, EMBASE, CINAHL, PyscInfo, IPA and Cochrane library. Studies published between 1 January 1991 and 31 January 2021 investigating associations between PIP and health-related and system-related outcomes of older adults in hospital settings, were included. A random effects model was employed using the generic inverse variance method to pool risk estimates.

Results: Overall, 63 studies were included. Pooled risk estimates did not show a significant association with all-cause mortality (adjusted odds ratio [AOR] 1.10, 95% confidence interval [CI] 0.90-1.36; adjusted hazard ratio 1.02, 83% CI 0.90-1.16), and hospital readmission (AOR 1.11, 95% CI 0.76-1.63; adjusted hazard ratio 1.02, 95% CI 0.89-1.18). PIP was associated with 91%, 60% and 26% increased odds of adverse drug event-related hospital admissions (AOR 1.91, 95% CI 1.21-3.01), functional decline (AOR 1.60, 95% CI 1.28-2.01), and adverse drug reactions and adverse drug events (AOR 1.26, 95% CI 1.11-1.43), respectively. PIP was associated with falls (2/2 studies). The impact of PIP on emergency department visits, length of stay, and health-related quality of life was inconclusive. Economic cost of PIP reported in 3 studies, comprised various cost estimation methods.

Conclusions: PIP was significantly associated with a range of health-related and system-related outcomes. It is important to optimise older adults' prescriptions to facilitate improved outcomes of care.

Keywords: Beers criteria; STOPP/START; inappropriate medication; inappropriate prescribing; medication therapy management; prescribing omissions.

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Conflict of interest statement

There are no competing interests to declare.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the selection process
FIGURE 2
FIGURE 2
(A) Forest plot of adjusted odds ratio for an association between PIP users (compared with nonusers) and all‐cause mortality. (B) Forest plot of adjusted odds ratio for an association between the numbers of PIPs (measured as continuous variable) and all‐cause mortality. (C) Forest plot of adjusted hazard ratios for an association between PIP and all‐cause mortality. Studies with ≥2 outcome data using various tools are shown with the type of tool. AORs, adjusted odds ratios; AHRs, adjusted hazard ratios; PIP, potentially inappropriate prescribing
FIGURE 3
FIGURE 3
(A) Forest plot of adjusted odds ratios for an association between PIP (measured dichotomously) and all‐cause hospital readmission. (B) Forest plot of adjusted hazard ratio for an association between PIP and all‐cause hospital readmission. Studies with ≥2 outcome data using various tools are shown with the type of tool. AORs, adjusted odds ratios; AHRs, adjusted hazard ratios; PIP, potentially inappropriate prescribing
FIGURE 4
FIGURE 4
(A) Forest plot of adjusted OR for the association between PIPs (measured dichotomously) and ADE‐related hospital admissions. (B) Forest plot of adjusted OR for the association between PIMs and ADRs/ADEs. (C) Forest plot of adjusted odds ratio for the association between PIMs (measured as a continuous variable) and ADRs/ADEs. Studies with ≥2 outcome data using various tools are shown with the type of tool. AORs, adjusted odds ratios; AHRs, adjusted hazard ratios; PIP, potentially inappropriate prescribing
FIGURE 5
FIGURE 5
Forest plot of adjusted odds ratio for the association between PIPs (dichotomous) and functional decline. Studies with ≥2 outcome data using various tools are shown with the type of tool. AORs, adjusted odds ratios; PIP, potentially inappropriate prescribing
See this image and copyright information in PMC

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