1 Risk of Emergency Department Revisit or Hospitalization in Older Adults Discharged With Potentially Inappropriate Medications: A Retrospective Cohort Study

Abstract

Vulnerable elderly patients are prone to multiple co-morbidities that warrant the need for several long-term prescriptions or “polypharmacy.” Polypharmacy strongly correlates with higher risk of prescribing potentially inappropriate medications (PIMs). In 1991 Mark H. Beers, a geriatrician, led the first published consensus on guidelines for PIMs commonly prescribed nationwide (Beers criteria). Geriatric emergency physicians’ question if Beers criteria are equally as effective in an emergency department (ED) setting where prescriptions are intended for short term use only. In other words, do short-term PIMs pose the same risks of ED returns and hospitalization as PIMs prescribed for 3 months or longer? To determine whether PIMs prescribed to older adults discharged from the ED increases the risk of subsequent ED revisits or hospital admissions within 3 and 30 days from ED discharge. A retrospective cohort observational study of adults 65 years and older discharged with prescription(s) from the Mount Sinai Hospital ED in New York City, January 2012 to November 2015. Hospital electronic medical records were identified for unique subjects prescribed PIMs at ED discharge versus those prescribed non PIMs from 2012 to 2015. PIMs are defined following the 2015 Beers criteria. For ED returns to hospitals other than Mount Sinai, patient records were linked up to their Medicare claims 30 days following their index visit. Primary outcomes were frequency and incident rates of ED revisits and hospitalization within 3 and 30 days (D) post index ED discharge. Secondary outcomes were rates and reasons of hospital admissions over 3 and 30 days in both groups. Descriptive and bivariate analysis, including Chi-square test, are currently underway. A total of 31,521 unique patients made a total of 71,484 ED visits during the study period. Mean age was 76.1 years (8.52 SD), 57.44% were female. Of these, 7,659(20.45%) were discharged from the ED with a medication prescription: 1,567 (20.46%) were considered PIM prescriptions (vs. 79.54% were non-PIMs). There were 39,962 return visits to Mount Sinai Hospital (MSH), 55.9%. 112 patients died during the study period. Though extensively reported in geriatric care literature, studies on PIM prescriptions that focus on the short term yet urgent ED setting are rare. This study addresses a hotly debated topic in geriatric emergency practice today.