Study Contradicts Other Research About Potentially Inappropriate Medications Among Older Adults

A group of researchers has published their study on the impact of potentially inappropriate medications on outcomes among recently hospitalized older patients, sharing their surprising findings that those prescribed potentially inappropriate medications were actually less likely to revisit the emergency department (ED) within 30 days.

The findings contradict previous research suggesting inferior outcomes associated with potentially inappropriate medication use.

Across the more than 7000 Medicare beneficiaries discharged from the ED included in the study, 16% of those not receiving a potentially inappropriate medication—a treatment recommended to be avoided by the Beers criteria—revisited the ED within 30 days compared with 12% of patients who were prescribed at least 1 potentially inappropriate medication. There were no differences in ED revisits within the first 3 days following discharge.

Hospital admissions within 30 days were also less prevalent among patients who received potentially inappropriate medications than those who did not (4% vs 7%).

“Gender and race had no impact on our utilization outcome results. Contrary to previous reports, sex did not predict ED revisits or hospital admission in 3 and 30 days in our study cohort,” highlighted the researchers. “For race, we found non-white cohorts were more likely to receive PIMs and more likely to return within 30 days. However, race was not associated with ED revisits nor hospital admissions. Furthermore, literature suggests older age may be a stronger predictor of ED revisits than receiving a PIMs, but we did not find this to be the case.”

Notably, patients who did not receive potentially inappropriate medications had more comorbidities, which was associated with an increased risk of ED revisits and hospital admissions.

However, according to the researchers, these clinical features may not paint the full picture and that other undetected clinical variable may have an impact on the results seen throughout the study.

“If clinical features do not fully explain why fewer patients who received PIM prescriptions revisit the ED or become hospitalized, we may have to look at PIMs from a different angle and reassess our own understanding of their hazards,” noted the researchers. “Growing evidence suggests ED visits and hospitalization rates are associated with the total number of medications prescribed, not PIMs specifically, although we did not find that to be the case.”

Reference

Hammouda N, Vargas-Torres C, Doucette J, Hwang U. Geriatric emergency department revisits after discharge with Potentially Inappropriate Medications: A retrospective cohort study. Am J Emerg Med. 2021;44:148-156. doi: 10.1016/j.ajem.2021.02.004