Advertisement

Medication-Related Acute Care Admission and Inappropriate Polypharmacy of Nursing Home Residents

  • Woo-Youn Kim
    Affiliations
    Department of Pharmacy, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea

    College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
    Search for articles by this author
  • Yewon Suh
    Affiliations
    Department of Pharmacy, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea

    College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
    Search for articles by this author
  • Young-Mi Ah
    Affiliations
    College of Pharmacy, Yeungnam University, Gyeongsangbuk-do, Republic of Korea
    Search for articles by this author
  • Jung-Yeon Choi
    Affiliations
    Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
    Search for articles by this author
  • Kwang-il Kim
    Correspondence
    Address correspondence to Kwang-il Kim, MD, PhD, Department of Internal Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; and Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; or Ju-Yeun Lee, PhD, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
    Affiliations
    Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea

    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Ju-Yeun Lee
    Correspondence
    Address correspondence to Kwang-il Kim, MD, PhD, Department of Internal Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; and Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; or Ju-Yeun Lee, PhD, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
    Affiliations
    Department of Pharmacy, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea

    College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
    Search for articles by this author
Published:December 16, 2022DOI:https://doi.org/10.1016/j.jamda.2022.11.011

      Abstract

      Objectives

      To evaluate the prevalence of medication-related admissions (MRAs) and their association with potentially inappropriate medications (PIMs) used by nursing home residents admitted to the geriatric center of a tertiary hospital.

      Design

      Cross-sectional study.

      Setting and Participants

      Older patients admitted from nursing homes to the geriatric center of the Seoul National University Bundang Hospital who had undergone comprehensive geriatric assessment from January 1, 2016, to December 31, 2020.

      Methods

      MRAs were determined and verified using a previously described MRA adjudication guide. The PIMs in the preadmission medication lists were identified according to each of the following criteria (as well as the combined criteria), the Beers, NORGEP-NH, STOPP/START-NH, and STOPPFrail criteria. Medication use factors associated with MRAs were analyzed using multivariate logistic regression.

      Results

      Among the 304 acute care admissions, 32.2% were MRAs. The main cause of MRAs was acute kidney injury related with use of renin-angiotensin system inhibitors. Approximately 81% of the patients used at least 1 PIM according to the combined criteria. The use of 1 or more PIMs, renin-angiotensin system inhibitors, diuretics, nonsteroidal anti-inflammatory drugs, and benzodiazepines was significantly associated with MRAs. The combined criteria were able to predict MRAs better than the individual criteria.

      Conclusions and Implications

      Approximately one-third of acute admissions of nursing home residents may be MRAs. Interventions for the optimal use of medication among nursing home residents are needed.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • OECD
        Health at a Glance 2021: OECD Indicators.
        https://doi.org/10.1787/ae3016b9-en
        Date: 2021
        Date accessed: June 22, 2022
        • National Health Insurance Service
        2021 Long Term Care Insurance Statistical Yearbook.
        • Hsu H.F.
        • Chen K.M.
        • Belcastro F.
        • et al.
        Polypharmacy and pattern of medication use in community-dwelling older adults: a systematic review.
        J Clin Nurs. 2021; 30: 918-928
        • Boparai M.K.
        • Korc-Grodzicki B.
        Prescribing for older adults.
        Ann Glob Health. 2011; 78: 613-626
        • Gurwitz J.
        Medication safety in nursing homes: what's wrong and how to fix it.
        • Ruths S.
        • Straand J.
        • Nygaard H.A.
        Multidisciplinary medication review in nursing home residents: what are the most significant drug-related problems? The Bergen District Nursing Home (BEDNURS) study.
        BMJ Qual Saf. 2003; 12: 176-180
        • Pazan F.
        • Wehling M.
        Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences.
        Eur Geriatr Med. 2021; 12: 443-452
      1. World Health Organization.
        https://www.who.int/publications/i/item/WHO-UHC-SDS-2019.11
        Date: 2019
        Date accessed: August 31, 2022
        • Spinewine A.
        • Schmader K.E.
        • Barber N.
        • et al.
        Appropriate prescribing in elderly people: how well can it be measured and optimised?.
        Lancet. 2007; 370: 173-184
        • Masnoon N.
        • Shakib S.
        • Kalisch-Ellett L.
        • et al.
        What is polypharmacy? A systematic review of definitions.
        BMC Geriatr. 2017; 17: 230
        • Lau D.T.
        • Kasper J.D.
        • Potter D.E.
        • et al.
        Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents.
        Arch Intern Med. 2005; 165: 68-74
        • Morin L.
        • Laroche M.L.
        • Texier G.
        • et al.
        Prevalence of Potentially Inappropriate Medication Use in Older Adults Living in Nursing Homes: A Systematic Review.
        J Am Med Dir Assoc. 2016; 17: 862.e1-862.e9
        • Park K.H.
        • Yang Y.M.
        • Yoo J.C.
        • et al.
        Comparative Analysis Of Anticholinergics Prescribed To Elderly Patients At A Korean Long-Term Care Facility According To Beers Criteria 2003, 2012, And 2015 And Anticholinergic-Burden Rating Scales: a Cross-Sectional Retrospective Study.
        Clin Interv Aging. 2019; 14: 1963-1974
        • Kim S.-O.
        • Jang S.
        • Kim C.-M.
        • et al.
        Consensus validated list of potentially inappropriate medication for the elderly and their prevalence in South Korea.
        Int J Gerontol. 2015; 9: 136-141
        • Kim J.-C.
        • Hwang S.-E.
        • Cho H.-M.
        • et al.
        Potentially Inappropriate Medication Use in Older Adults living in Long-term care facilities in Korea.
        . 2015; 5: 277-282
        • Ga H.
        Long-Term Care System in Korea.
        Ann Geriatr Med Res. 2020; 24: 181-186
        • By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel
        American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults.
        J Am Geriatr Soc. 2019; 67: 674-694
        • O'Mahony D.
        • O'Sullivan D.
        • Byrne S.
        • et al.
        STOPP/START criteria for potentially inappropriate prescribing in older people: version 2.
        Age Ageing. 2015; 44: 213-218
        • Nyborg G.
        • Straand J.
        • Klovning A.
        • et al.
        The Norwegian General Practice--nursing home criteria (NORGEP-NH) for potentially inappropriate medication use: a web-based Delphi study.
        Scand J Prim Health Care. 2015; 33: 134-141
        • Khodyakov D.
        • Ochoa A.
        • Olivieri-Mui B.L.
        • et al.
        Screening tool of older person's prescriptions/screening tools to alert doctors to right treatment medication criteria modified for U.S. Nursing Home Setting.
        J Am Geriatr Soc. 2017; 65: 586-591
        • Curtin D.
        • Gallagher P.
        • O'Mahony D.
        Deprescribing in older people approaching end-of-life: development and validation of STOPPFrail version 2.
        Age Ageing. 2021; 50: 465-471
        • Price S.D.
        • Holman C.D.
        • Sanfilippo F.M.
        • et al.
        Are high-care nursing home residents at greater risk of unplanned hospital admission than other elderly patients when exposed to Beers potentially inappropriate medications?.
        Geriatr Gerontol Int. 2014; 14: 934-941
        • Thevelin S.
        • Spinewine A.
        • Beuscart J.B.
        • et al.
        Development of a standardized chart review method to identify drug-related hospital admissions in older people.
        Br J Clin Pharmacol. 2018; 84: 2600-2614
        • Price S.D.
        • Holman C.D.
        • Sanfilippo F.M.
        • et al.
        Association between potentially inappropriate medications from the Beers criteria and the risk of unplanned hospitalization in elderly patients.
        Ann Pharmacother. 2014; 48: 6-16
        • Leendertse A.J.
        • Van Den Bemt P.M.
        • Poolman J.B.
        • et al.
        Preventable hospital admissions related to medication (HARM): cost analysis of the HARM study.
        Value Health. 2011; 14: 34-40
        • Lavan A.H.
        • Gallagher P.
        Predicting risk of adverse drug reactions in older adults.
        Ther Adv Drug Saf. 2016; 7: 11-22
        • Zerah L.
        • Henrard S.
        • Thevelin S.
        • et al.
        Performance of a trigger tool for detecting drug-related hospital admissions in older people: analysis from the OPERAM trial.
        Age Ageing. 2022; 51
        • Ellis G.
        • Whitehead M.A.
        • Robinson D.
        • et al.
        Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials.
        BMJ. 2011; 343: d6553
        • Kim S.W.
        • Han H.S.
        • Jung H.W.
        • et al.
        Multidimensional frailty score for the prediction of postoperative mortality risk.
        JAMA Surg. 2014; 149: 633-640
        • World Health Organization
        The use of the WHO-UMC system for standardised case causality assessment.
        • Jun K.
        • Hwang S.
        • Ah Y.M.
        • et al.
        Development of an Anticholinergic Burden Scale specific for Korean older adults.
        Geriatr Gerontol Int. 2019; 19: 628-634
        • Chae H.W.
        • Kim Y.
        • Suh Y.
        • et al.
        Prevalence of potentially inappropriate medications based on the STOPPFrail criteria in frail older patients with limited life expectancy: a cross-sectional study.
        BMC Geriatr. 2022; 22: 367
        • Magdelijns F.J.
        • Van Avesaath R.
        • Pijpers E.
        • et al.
        Health-care-related adverse events leading to admission in older individuals: incidence, predictive factors and consequences.
        Eur J Public Health. 2016; 26: 743-748
        • Kemal L.K.
        • Shewaga T.G.
        • Sema F.D.
        Drug-Related Hospital Admissions and Associated Factors among Adults Admitted to Felege Hiwot Comprehensive and Specialized Hospital, North West Ethiopia.
        J Environ Public Health. 2022; (6767488): 2022
        • Ayalew M.B.
        • Tegegn H.G.
        • Abdela O.A.
        Drug Related Hospital Admissions; A Systematic Review of the Recent Literatures.
        Bull Emerg Trauma. 2019; 7: 339-346
        • Oscanoa T.J.
        • Lizaraso F.
        • Carvajal A.
        Hospital admissions due to adverse drug reactions in the elderly. A meta-analysis.
        Eur J Clin Pharmacol. 2017; 73: 759-770
        • Lemoyne S.E.
        • Herbots H.H.
        • De Blick D.
        • et al.
        Appropriateness of transferring nursing home residents to emergency departments: a systematic review.
        BMC Geriatr. 2019; 19: 17
        • Liapikou A.
        • Cilloniz C.
        • Torres A.
        Drugs that increase the risk of community-acquired pneumonia: a narrative review.
        Expert Opin Drug Saf. 2018; 17: 991-1003
        • Gurwitz J.H.
        • Field T.S.
        • Harrold L.R.
        • et al.
        Incidence and preventability of adverse drug events among older persons in the ambulatory setting.
        JAMA. 2003; 289: 1107-1116
        • Feidakis A.
        • Panagiotou M.-R.
        • Tsoukakis E.
        • et al.
        Impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers on acute kidney injury in emergency medical admissions.
        J Clin Med. 2021; 10: 412
        • Winit-Watjana W.
        • Sakulrat P.
        • Kespichayawattana J.
        Criteria for high-risk medication use in Thai older patients.
        Arch Gerontol Geriatr. 2008; 47: 35-51
        • Vatcharavongvan P.
        • Puttawanchai V.
        Potentially inappropriate medications among the elderly in primary care in Thailand from three different sets of criteria.
        Pharm Pract (Granada). 2019; 17: 1494
        • Schneider R.
        • Reinau D.
        • Schur N.
        • et al.
        Drug prescription patterns, polypharmacy and potentially inappropriate medication in Swiss nursing homes: a descriptive analysis based on claims data.
        Swiss Med Wkly. 2019; 149: w20126
        • Fournier A.
        • Anrys P.
        • Beuscart J.B.
        • et al.
        Use and deprescribing of potentially inappropriate medications in frail nursing home residents.
        Drugs Aging. 2020; 37: 917-924