Are high-care nursing home residents at greater risk of unplanned hospital admission than other elderly patients when exposed to Beers potentially inappropriate medications?

S.D. Price, D'Arcy Holman, Frank Sanfilippo, Jon Emery

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8 Citations (Scopus)
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Abstract

Aim
To compare the risk of unplanned hospitalization in high-care nursing home residents taking Beers potentially inappropriate medications (PIM) against that of other elderly.
Methods
Using an enhanced case–time–control design and conditional logistic regression applied to the pharmaceutical claims and other linked data of 245 436 Western Australians aged ≥65 years (1993–2005), the study derived odds ratios for unplanned hospitalization in each group, from which attributable fractions, numbers, proportions and rates of PIM-related admissions were derived.
Results
Overall, 383 150 unplanned hospitalizations were identified. PIM exposure was associated with a similar proportional increase in unplanned hospitalizations in high-care nursing home residents as in other older people; adjusted OR 1.21 (95% CI 1.10–1.34; attributable fraction 17.5%) versus OR 1.19 (95% CI 1.16–1.21; attributable fraction 15.7%). However, high-care nursing home residents had much higher estimated rates of hospitalizations attributed to Beers medications than other elderly (3951 vs 1394 per 100 000 person-years). The relative risk of unplanned hospitalization rose similarly in both groups with increasing numbers of different PIM taken (OR 5.1 for 10 vs 0 PIM), but was affected more markedly by 3-month PIM consumption in nursing home residents (OR 4.85, 95% CI 2.40–9.83 for 900 vs 0 PIM daily doses) than in other older adults (OR 2.10, 95% CI 1.73–2.55).
Conclusions
High-care nursing home residents do not appear to have a greater relative risk of unplanned hospitalization when given PIM, but do incur a higher absolute burden than other older adults. Physicians should exert caution with Beers medications in all older patients, restricting the number of different PIM and PIM quantity prescribed whenever possible. Geriatr Gerontol Int 2014; 14: 934–941. [Correction added on 21 March 2014, after first online publication: in the ‘Results’ section of the Abstract , the rate of 115 per 100 000 was changed to 1394 per 100 000 person-years.]
Original languageEnglish
Pages (from-to)934-941
JournalGeriatrics & Gerontology International
Volume14
Issue number4
DOIs
Publication statusPublished - 18 Oct 2014

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