Analysis of medication management system data to determine potentially inappropriate medication use and hospitalization among older adults living in residential care homes for the elderly population

Abstract

Objectives: Many older adults living in Resident Care Homes for the Elderly (RCHEs) are at risk of polypharmacy and the use of potentially inappropriate medication (PIM). Few studies have evaluated the prevalence and consequences of PIM use among older adults living in RCHEs. The objectives of this study are (1) to evaluate the prevalence of PIM use in 29 RCHEs in Hong Kong, and (2) to investigate the association between PIM use and hospitalization in this population.

Methods: This is a prospective, observational, cohort study which utilized final-administered medication data from RCHEs that participated in a medication management program. Data on the medications administered to all residents living in the participating RCHEs were extracted from the SafeMed Medication Management System (SMMS^®), which is a purpose-built Information Technology supporting the entire medication management process at RCHEs. The outcome of interest is the 12-month period prevalence of PIM use (January 1 to December 31, 2023), which was obtained by comparing the medication data with the 2023 Beers criteria. Hospital admissions during the study period were extracted from the SMMS^®.Multivariable logistic regression was conducted to investigate the association between PIM use and hospital admissions.

Results: We included 6,346 residents (age 82.9 ± 8.6 years; female 61.9%). The average number of current medications was 6.8 ± 7.4. Over half (51.5%) of residents had polypharmacy (≥ 5 medications). The 12-month period prevalence of PIM use was 34.5%. Among the residents with PIMs, 65.1%, 25.5% and 9.4% used 1, 2 and > 2 PIMs, respectively. Residents with PIMs were associated with higher rates of hospitalization (Odds Ratio [OR] 1.73, 95% confidence interval [CI] 1.54 to 1.69), after adjusting for age, sex and comorbidities. The number of PIMs was significantly associated with higher risk of hospitalization (OR: 2.17, 95% CI: 1.82 to 2.59 for > 1 PIMs vs. 0).

Conclusions: The use of PIM was observed in one-third of older adults living in RCHEs, and was associated with an increased risk of hospitalization. Our findings highlighted the urgent need for strategies to improve clinicians' awareness of PIMs and their adverse impact, and to implement pharmacist-led medication reviews in RCHEs.

Keywords: Beers Criteria; Medication review; Nursing home; Older adults; Pharmacists; Polypharmacy; Potentially inappropriate medication; Residential care homes.

Fig. 1

*The risk scores for 15 distinct adverse drug reactions (ADR) among 2,387 residents with hyper-polypharmacy (i.e. taking ≥ 10 medications) *The x-axis represents the 15 types of adverse drug reactions as outlined by the Cumulative Toxicity Tool of the Polypharmacy Guidance 2018, while the y-axis represents the cumulative risk scores. Each square denotes the specific risk score, and the number within each square indicates the number of patients at that risk score level. A darker color indicates a higher number of residents bearing that risk score level CNS depression: central nervous system depression; CV events: cardiovascular events