The Impact of Potentially Inappropriate Medications and Polypharmacy on 3-Month Hospital Readmission among Older Patients: A Retrospective Cohort Study from Malaysia
Abstract
:1. Introduction
2. Methodology
2.1. Setting
2.2. Design and Study Population
2.3. Sample Size Calculation
2.4. Data Collection
2.5. Data Measurement
2.6. Outcome Measures
2.7. Statistical Analysis
3. Results
3.1. Characteristics of the Study Population
3.2. Patients’ Medical Profiles
3.3. PIMs Use
3.4. Hospital Readmission within Three Months and Its Risk Factors
4. Discussion
5. Limitations and Strengths
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Patients Discharged with PIMs (n: 300) | Patients Discharged without PIMs (n: 300) | p Value |
---|---|---|---|
Age, (median [IQR]) | 70 (10) | 69 (10) | 0.074 |
Race, n (%) | |||
Malay | 266 (88.67) | 266 (88.67) | 1.000 |
Other races | 34 (11.33) | 34 (11.33) | |
Gender, n (%) | |||
Male | 265 (88.33) | 267 (89) | 0.797 |
Female | 35 (11.67) | 33 (11) | |
Comorbidities, n (%) | |||
Hypertension | 225 (75) | 204 (68) | |
Diabetes Mellitus | 164 (54.67) | 153 (51) | |
Dyslipidemia | 117 (39) | 111 (37) | |
Chronic kidney disease | 60 (20) | 51 (17) | |
CCI (median [IQR]) | 5 (2) | 5 (2) | 0.443 |
Creatinine clearance (361 patients), (n [%]) | |||
>60 mL/min | 127 (68.3) | 117 (66.9) | 0.630 |
<60 mL/min | 59 (31.7) | 58 (33.1) | |
Days of hospital stay (median [IQR]) | 5.5 (6) | 5 (5) | 0.223 |
Number of medications at discharge (median [IQR]) | 6 (3) | 5 (4) | <0.001 |
Polypharmacy status, n (%) | |||
No polypharmacy | 74 (24.7) | 135 (45) | <0.001 |
Polypharmacy | 193 (57.6) | 142 (47.3) | |
Hyperpolypharmacy | 33 (11) | 23 (7.7) |
Type of PIM | Name of Medication | Prevalence, n (%) |
---|---|---|
Medications that should be avoided in all older adults | Metoclopramide | 9 (2.59) |
PPI (used for >12 weeks) | 25 (7.20) | |
Digoxin for first-line treatment for AF | 2 (0.58) | |
Peripheral alpha-1 blockers for treatment of hypertension | 25 (7.20) | |
Sliding scale insulin | 4 (1.15) | |
Amitriptyline | 2 (0.58) | |
Medications with strong anticholinergic properties (Prochlorperazine-Trihexyphenidyl) | 5 (1.47) | |
Benzodiazepines | 10 (2.88) | |
First-generation antihistamines | 11 (3.17) | |
NSAIDs for chronic use | 1 (0.28) | |
Medications that should be avoided due to drug–disease or drug–syndrome interactions | Celecoxib (used in patients with symptomatic heart failure) | 1 (0.28) |
Medications that should be used with caution | Rivaroxaban | 39 (11.24) |
Aspirin (as a primary prevention of CVDs) | 116 (33.43) | |
Dabigatran | 4 (1.15) | |
Tramadol | 46 (13.25) | |
Sulfamethoxazole-trimethoprim | 2 (0.58) | |
Medications that should not be used with other commonly used medications (drug–drug interactions) | Pregabalin-morphine | 1 (0.28) |
Gabapentin-tramadol | 1 (0.28) | |
Ciprofloxacin-theophylline | 2 (0.58) | |
Medications that should be avoided or dose-adjusted due to renal impairment | Apixaban | 6 (1.73) |
Enoxaparin | 1 (0.28) | |
Spironolactone | 6 (1.73) | |
Levetiracetam | 2 (0.58) | |
Colchicine | 4 (1.15) | |
Rivaroxaban | 12 (3.45) | |
Pregabalin | 3 (0.86) | |
Gabapentin | 1 (0.28) | |
Tramadol | 6 (1.73) | |
Total | 347 |
Variable | Hospital Readmission | p Value | |
---|---|---|---|
Yes n (%) | No n (%) | ||
Age category | |||
60–69 years | 71 (24.7) | 216 (75.3) | 0.241 |
70–79 years | 64 (27.4) | 170 (72.6) | |
80–89 years | 12 (17.9) | 55 (82.1%) | |
90–99 years | 5 (41.7) | 7 (58.3) | |
Gender | |||
Male | 142 (26.7) | 390 (73.3) | 0.032 |
Female | 10 (14.7) | 58 (85.3) | |
Race | |||
Malay | 136 (25.6) | 396 (74.4) | 0.716 |
Non-Malay | 16 (23.5) | 52 (76.5) | |
Polypharmacy status at discharge | |||
No polypharmacy | 48 (23) | 161 (77) | 0.08 |
Polypharmacy | 83 (24.8) | 252 (75.2) | |
Hyperpolypharmacy | 21 (37.5) | 35 (62.5) | |
Having PIMs at discharge | |||
Yes | 75 (25) | 225 (75) | 0.851 |
No | 77 (25.7) | 223 (74.3) | |
ClCr level * | |||
<60 mL/min | 74 (30.3) | 170 (69.7) | 0.124 |
>60 mL/min | 45 (38.5) | 72 (61.5) |
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Akkawi, M.E.; Abd Aziz, H.H.; Fata Nahas, A.R. The Impact of Potentially Inappropriate Medications and Polypharmacy on 3-Month Hospital Readmission among Older Patients: A Retrospective Cohort Study from Malaysia. Geriatrics 2023, 8, 49. https://doi.org/10.3390/geriatrics8030049
Akkawi ME, Abd Aziz HH, Fata Nahas AR. The Impact of Potentially Inappropriate Medications and Polypharmacy on 3-Month Hospital Readmission among Older Patients: A Retrospective Cohort Study from Malaysia. Geriatrics. 2023; 8(3):49. https://doi.org/10.3390/geriatrics8030049
Chicago/Turabian StyleAkkawi, Muhammad Eid, Hani Hazirah Abd Aziz, and Abdul Rahman Fata Nahas. 2023. "The Impact of Potentially Inappropriate Medications and Polypharmacy on 3-Month Hospital Readmission among Older Patients: A Retrospective Cohort Study from Malaysia" Geriatrics 8, no. 3: 49. https://doi.org/10.3390/geriatrics8030049