Clinical Interventions in Aging (Nov 2019)
Prevalence, Determinants And Associated Risk Of Potentially Inappropriate Prescribing For Older Adults In Qatar: A National Retrospective Study
Abstract
Ameena Alyazeedi,1 Ahmed Fouad Algendy,2 Mohamed Sharabash,3 Ahmed Karawia4 1Pharmacy Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar; 2Clinical Pharmacy, Geriatric Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar; 3Clinical Pharmacy, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar; 4Pharmacy Informatics and Inventory, Rumailah Hospital, Hamad Medical Corporation, Doha, QatarCorrespondence: Ahmed Fouad AlgendyPharmacy Department, Rumailah Hospital, Hamad Medical Corporation, PO 3050, Doha, QatarTel +97470094424Fax +97444397600Email [email protected]: To assess the prevalence and associated risk of potentially inappropriate prescribing (PIP) in older adults.Methods: This was a national 3-year retrospective study of outpatient older adults exposed to potentially inappropriate medication (PIM) or polypharmacy. We used the Beers Criteria 2019 list to identify PIM to be avoided in older adults. We define moderate polypharmacy (MoP) and major polypharmacy (MaP) as using 6–10 or >10 chronic medications, respectively. Determinants of PIP included patients’ demographics, lab results, medications, comorbidities, and home healthcare services. We used Chi-square (for categorical variables), Unpaired t-test and ANOVA (for continuous variables as applicable) to assess the association of these determinants with PIP. Univariate followed by multivariate logistic regression models were used to get the crude and adjusted odds ratios of exposure to PIM or polypharmacy within patients who had emergency department (ED) admissions, bone fractures, falls, or constipation, compared to those who had not.Results: 3537 patients were included. 62.6%, 40.4%, and 27.2% were exposed to PIM, MoP and MaP, respectively. Determinants of PIP included age, gender, ethnicity, weight, kidney function, sodium levels, hypertension, diabetes, heart failure, CAD, and home healthcare services (all with p-value < 0.05). PIM was associated with risk of ED admission, bone fracture and constipation with adjusted OR (p-values) of 1.27 (0.002), 1.33 (0.005), and 1.40 (<0.001), respectively. MoP was associated with the risk of ED admission, bone fracture, and constipation, with adjusted OR (p-values) of 1.27 (0.012), 1.34 (0.019), and 1.47 (<0.001), respectively. MaP was associated with a higher risk of ED admission, bone fracture, falls, and constipation with adjusted OR (p-values) of 1.46 (0.001), 1.59 (0.002), 1.39 (0.023), and 2.07 (<0.001), respectively.Conclusion: PIP is common and is associated with an increased risk of poor clinical outcomes in older adults.Keywords: polypharmacy, Beers 2019, falls, constipation, emergency admission, fracture
