Background and importance Medication is potentially inappropriate when the risk of adverse effects is greater than the clinical benefit, especially when safer and/or more effective treatments are available.
Aim and objectives To analyse potentially inappropriate prescriptions (PIPs) and potential prescribing omissions (PPOs) in elderly patients hospitalised for trauma and/or orthopaedic surgery.
Material and methods A prospective observational study (15 August 2018–15 February 2019) was conducted in the trauma/orthopaedic surgery department of a general hospital. Inclusion criteria were age ≥65 years, ≥3 chronic medications and interview with a pharmacist for reconciliation of home medication at hospital admission. Study variables were sex, age, number of comorbidities, number and type of chronic medications, place of residence (home, or residential/health centre (R/HC)) and reason for admission and its type (elective/urgent). Medications were categorised using the anatomical therapeutic chemical classification system. STOPP-START criteria were used to detect PIPs and PPOs. Binary logistic regression analysis was conducted to identify factors related to PIPs and POPs.
Results The study included 114 patients (6.4% women, mean age 79.8±7.9 years, 3.2±2.2 comorbidities/patient, 7.9±3.6 medications/patient; 6.1% in R/HC). The main reason for admission was hip fracture (45.6%); 57.9% of admissions were urgent and due to falls. Among the 898 chronic medications evaluated, 15.8% were a PIP or PPO. The most frequently implicated anatomic groups were: A—alimentary tract/metabolism (24.9%), C—cardiovascular (24.2%) and N—nervous system (24.1%). We detected 131 PIPs in 72 patients (63.2%), including: STOPP-A1, medication without indication (18.3%), mainly (75%) proton pump inhibitors (PPIs); STOPP-A2, treatment longer than recommended (17.6%); STOPP-A3, duplication (9.2%); STOPP-K1, benzodiazepine in falls (7.6%); and STOPP-D5, benzodiazepines >4 weeks (6.1%), among others. We detected 15 PPOs in 13 patients (11.4%), including: START-D1, gastroprotection with PPI (33.3%); START-E3, calcium/vitamin D in osteoporosis (26.7%); START-H2, laxative with opioid (20.0%); and START-E5, vitamin D in elderly after fall (6.7%), among others. The number of chronic medications per patient was the sole factor associated with PIPs and/or PPOs (OR=1.49 (95% CI 1.17–1.89), p=0.001).
Conclusion and relevance PIPs were highly prevalent among elderly trauma patients; they were more frequent than PPOs and mainly attributable to polymedication. The medications most frequently associated with PIPs were PPIs and benzodiazepines, which can increase the risk of falls and hip fractures.
References and/or acknowledgements 1. Delgado-Silveira. Rev Esp Geriatr Gerontol 2015.
No conflict of interest.
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