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Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalisation in a cohort of community-dwelling oldest old.

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Wauters, Maarten Elseviers, Monique Vaes, Bert [UCL] Degryse, Jean-Marie [UCL] Dalleur, Olivia [UCL] Azermai, Majda

(eng) AIMS: Little is known about the impact of inappropriate prescribing (IP) in community-dwelling adults, aged 80 years and older. The prevalence at baseline (November 2008September 2009) and impact of IP (misuse and underuse) after 18 months on mortality and hospitalization in a cohort of community-dwelling adults, aged 80 years and older (n = 503) was studied. METHODS: Screening Tool of Older People's Prescriptions (STOPP-2, misuse) and Screening Tool to Alert to Right Treatment (START-2, underuse) criteria were cross-referenced and linked to the medication use (in Anatomical Therapeutic Chemical coding) and clinical problems. Survival analysis until death or first hospitalization was performed at 18 months after inclusion using Kaplan-Meier, with Cox regression to control for covariates. RESULTS: Mean age was 84.4 (range 80-102) years. Mean number of medications prescribed was 5 (range 0-16). Polypharmacy (≥5 medications, 58%), underuse (67%) and misuse (56%) were high. Underuse and misuse coexisted in 40% and were absent in 17% of the population. A higher number of prescribed medications was correlated with more misused medications (rs = .51, P < 0.001) and underused medications (rs = .26, P < 0.001). Mortality and hospitalization rate were 8.9%, and 31.0%, respectively. After adjustment for number of medications and misused medications, there was an increased risk of mortality (HR 1.39, 95% CI 1.10, 1.76) and hospitalization (HR 1.26, 95% CI 1.10, 1.45) for every additional underused medication. Associations with misuse were less clear. CONCLUSION: IP (polypharmacy, underuse and misuse) was highly prevalent in adults, aged 80 years and older. Surprisingly, underuse and not misuse had strong associations with mortality and hospitalization.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès restreint
Publication date 2016
Language Anglais
Journal information "British Journal of Clinical Pharmacology" - Vol. 15, no. 5, p. 20-30 (2016)
Peer reviewed yes
Publisher Wiley-Blackwell Publishing Ltd. ((United Kingdom) Oxford)
issn 0306-5251
e-issn 1365-2125
Publication status Publié
Affiliations UCL - SSS/IRSS - Institut de recherche santé et société
UCL - SSS/LDRI - Louvain Drug Research Institute
UCL - (SLuc) Département de pharmacie
Keywords Aged 80 years and over ; Hospitalization ; Inappropriate prescribing ; Mortality ; Polypharmacy ; Primary care
Links
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Bibliographic reference Wauters, Maarten ; Elseviers, Monique ; Vaes, Bert ; Degryse, Jean-Marie ; Dalleur, Olivia ; et. al. Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalisation in a cohort of community-dwelling oldest old.. In: British Journal of Clinical Pharmacology, Vol. 15, no. 5, p. 20-30 (2016)
Permanent URL http://hdl.handle.net/2078.1/175849