Abstract
BackgroundScientific evidence on treatments of chronic diseases in patients 85 years old or older is very limited, as is available information on inappropriate prescription (IP) and its associated factors. The study aimed to describe medicine prescription, potentially inappropriate medicines (PIM) and potentially prescribing omissions (PPO) and their associated factors on this population.MethodsIn the context of an observational, prospective and multicentric study carried out in elderly patients admitted to seven Spanish hospitals for a year, a sub-analysis of those aged 85 years and over was performed. To assess PIMs, the Beers and STOPP criteria were used, and to assess PPOs, the START and the ACOVE-3 criteria were used. To assess factors associated with IP, a multivariate logistic regression analysis was performed. Patients were selected randomly every week on consecutive days from the hospitalization lists.ResultsA total of 336 patients were included in the sub-analysis with a median (Q1-Q3) age of 88 (86–90) years. The median medicines taken during the month prior to admission was 10 (7–13). Forty-seven point two per cent of patients had at least one Beers-listed PIM, 63.3% at least one STOPP-listed PIM, 53.6% at least one START-listed PPO, and 59.4% at least one ACOVE-3-listed PPO. Use of benzodiazepines in patients who are prone to falls (18.3%) and omission of calcium and vitamin D supplements in patients with osteoporosis (13.3%) were the most common PIM and PPO, respectively. The main factor associated with the Beers-listed and the STOPP-listed PIM was consumption of 10 or more medicines (OR = 5.7, 95% CI 1.8-17.9 and OR = 13.4, 95% CI 4.0-44.0, respectively). The main factors associated with the START-listed PPO was a non-community dwelling origin (OR 2.3, 95% CI 1.0-5.0), and multimorbidity (OR1.8, 95% CI 1.0-3.1).ConclusionsPrescribed medicines and PIM and PPO prevalence were high among patients 85 years and over. Benzodiazepine use in those who are prone to falls and omission of calcium and vitamin D in those with osteoporosis were the most frequent PIM and PPO, respectively. Factors associated with PIM and PPO differed with polypharmacy being the most important factor associated with PIM.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0038-8) contains supplementary material, which is available to authorized users.
Highlights
Scientific evidence on treatments of chronic diseases in patients 85 years old or older is very limited, as is available information on inappropriate prescription (IP) and its associated factors
The study methodology has been described in previous papers [15,16] and this is a study focusing on the oldest old patients (85 years or more)
The most frequently prescribed medicine was omeprazole and the main differences compared to the group of patients aged 75 to were a higher prescription of acethylsalicylic acid (38.1% for those years and over versus 29.7% in the group from 75 to 84 years), lorazepam (21.5% versus 15.3%), amlodipine (18.8% versus 13.2%) and paracetamol (51.5% vs. 45.2%) and a lower prescription of acenocoumarol (16.2% versus 26.0%) and simvastatin (16.4% versus 21.7%) (Table 2)
Summary
Scientific evidence on treatments of chronic diseases in patients 85 years old or older is very limited, as is available information on inappropriate prescription (IP) and its associated factors. Health care and appropriate use of medicines in this group is one of the major challenges facing health care systems in these countries [1] In this age group there is often significant multimorbidity [2,3], with limited scientific evidence available on the treatment of various chronic diseases in this aforementioned group [4]. This is due to the lack of high quality evidence on the benefits and safety of treatments for major chronic diseases in this group [5,6], and their exclusion from clinical trials [7,8]. To treat patients in clinical practice, an individualized approach that incorporates a comprehensive geriatric assessment is recommended [4,9,10,11]
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