Potentially inappropriate prescribing and its associations with health-related and system-related outcomes in hospitalised older adults: A systematic review and meta-analysis

Alemayehu Mekonnen, Bernice Redley, Barbora de Courten, Elizabeth Manias

Research output: Contribution to journalReview ArticleResearchpeer-review

3 Citations (Scopus)

Abstract

Aims: To synthesise associations of potentially inappropriate prescribing (PIP) with health-related and system-related outcomes in inpatient hospital settings. Methods: Six electronic databases were searched: Medline Complete, EMBASE, CINAHL, PyscInfo, IPA and Cochrane library. Studies published between 1 January 1991 and 31 January 2021 investigating associations between PIP and health-related and system-related outcomes of older adults in hospital settings, were included. A random effects model was employed using the generic inverse variance method to pool risk estimates. Results: Overall, 63 studies were included. Pooled risk estimates did not show a significant association with all-cause mortality (adjusted odds ratio [AOR] 1.10, 95% confidence interval [CI] 0.90–1.36; adjusted hazard ratio 1.02, 83% CI 0.90–1.16), and hospital readmission (AOR 1.11, 95% CI 0.76–1.63; adjusted hazard ratio 1.02, 95% CI 0.89–1.18). PIP was associated with 91%, 60% and 26% increased odds of adverse drug event-related hospital admissions (AOR 1.91, 95% CI 1.21–3.01), functional decline (AOR 1.60, 95% CI 1.28–2.01), and adverse drug reactions and adverse drug events (AOR 1.26, 95% CI 1.11–1.43), respectively. PIP was associated with falls (2/2 studies). The impact of PIP on emergency department visits, length of stay, and health-related quality of life was inconclusive. Economic cost of PIP reported in 3 studies, comprised various cost estimation methods. Conclusions: PIP was significantly associated with a range of health-related and system-related outcomes. It is important to optimise older adults' prescriptions to facilitate improved outcomes of care.

Original languageEnglish
Number of pages23
JournalBritish Journal of Clinical Pharmacology
DOIs
Publication statusAccepted/In press - 18 May 2021

Keywords

  • Beers criteria
  • inappropriate medication
  • inappropriate prescribing
  • medication therapy management
  • prescribing omissions
  • STOPP/START

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