Inappropriate, Omitted Rx Common at Discharge for Older Adults

A study published in the British Journal of Clinical Pharmacology found potentially dangerous prescriptions are common at the time when older adults are released from hospitals, with 83.8 percent of 259 older adults receiving at least one potentially inappropriate medication (PIM) or having a potential prescribing omission (PPO), reports Medscape . "PIMs and PPOs identified using the Screening Tool of Older Person's Prescriptions/Screening Tool to Alert Doctors to the Right Treatment (STOPP/START) have been associated with increased frequency of adverse drug reactions, increased morbidity and mortality, and reduced quality of life," note the researchers. "Interventional studies applying these criteria to reduce PIMs and PPOs have reported reduced incidence of adverse drug events, falls, and delirium with reduced duration of hospitalization and healthcare costs." When they were released, the study subjects had an average of 5.4 comorbidities. They were prescribed an average of 9.3 distinct medications when they were released, with 88.8 percent receiving five or more distinct medications and 44 percent receiving 10 or more distinct medications. Subjects had an average of two re-hospitalizations, and 50.2 percent died during follow-up. Persons who had more than five medications prescribed were more than twice as likely to have PIMs and more than three times as likely to have PPOs, versus those prescribed fewer than five medications. Those with a PIM were twice as likely to have three or more re-hospitalizations and those with PPOs also were more likely to die. "It is possible that the failure to commence evidence-based therapies may result in increased morbidity and mortality or that in a population with high inherent mortality and poor prognosis prescribers are less willing to add to their medication burden," the researchers suggest.