Inappropriate prescription of drugs, adverse events and basic activities of daily living in elderly

doi:10.15406/ipmrj.2021.06.00278

eISSN: 2574-9838

International Physical Medicine & Rehabilitation Journal

Mini Review Volume 6 Issue 2

Inappropriate prescription of drugs, adverse events and basic activities of daily living in elderly

Fajreldines A,

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Barberis S, Beldarrain B, Urbina M, Lescano M, Bertani P, Pellizzari M

Aleman Hospital, Austral University Hospital, Argentina

Correspondence: Fajreldines A, Aleman Hospital, Austral University Hospital, Argentina, Buenos Aires, Argentina

Received: December 20, 2020 | Published: March 18, 2021

Citation: Fajreldines A, Barberis S, Beldarrain B, et al. Inappropriate prescription of drugs, adverse events and basic activities of daily living in elderly. Int Phys Med Rehab J. 2021;6(2):38-39. DOI: 10.15406/ipmrj.2021.06.00278

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Abstract

Older or elderly adults represent a population exposed to potentially inappropriate prescriptions, since medication is the most widely used intervention. The objective of this work is to analyze the type of medication schemes of the elderly and the relationship with their states of psychological well-being. It is a cross-sectional study.

Results: inappropriate prescription is of the order of 12%, the rate adverse drug events is 7%, the average number of activities of daily living is 3.36.

Conclusion: We have shown that there is a close relationship between the inappropriate medication in the elderly, adverse events and activities of daily living.

Keywords: elderly, inappropriate prescription of medication, adverse drug events, activities of dalily living

Introduction

The expectation of quality of life has increased in recent years and is expected to increase even more. Gender disparities, structural changes in the family and social environment, the number of older people living alone, changes in the burden of disease, drug therapy and the risk of disability, among other factors, indicate the importance of assessing the global health care and the specific problems of this population.¹

There are situations that can cause a worsening of the organic functional capacity of the elderly, such as: medications, illnesses, significant life changes, sudden increase in physical demands.Medications whose risk of adverse drug events (ADE) in the elderly or elderly exceeds expectations of clinical benefits compared to more effective, safe, and available adult alternatives are called potentially inappropriate medications (PIM).²

The index of activities of daily living, that is, the autonomy of the patient in his usual routine is a relevant factor in the perception of his quality of life, and would be related to it.³

Objectives

To analyze the inappropriate prescription, activities of daily living, and adverse drug events of hospitalized elderly according to internationally validated instruments.

Materials & methods

Retrospective observational study. The patients included were adults over 64 years hospitalized in the study center. The study was carried out in a highly complex academic hospital in Argentina. The criteria of Beers 2019,⁴ of inappropriate prescription of drugs, were used. Polypharmacy was considered to be the simultaneous presence of more than 4 drugs according to the WHO definition.⁵ The investigators who analyzed the inappropriate prescriptions were two observers trained in the criteria, both of whom reviewed all cases. Concordance between the two reviewers was assessed with Cohen's Kappa test, obtaining a value of: 0.82 (95% CI 0.73-0.96). The review of medical records using the methodology of triggers to find adverse events to drugs of the Institute for Healthcare Improvement⁶ was used in this study, also by two reviewers.

The burden of disease was assessed with the Charlson index,⁷ which predicts mortality and burden of disease according to preceding pathologies.The ABVD⁸ (basic activities of daily living) index was used to characterize the autonomy of the patient in his personal routine, which has a score of 0-8 (A-H) with A being totally independent and H totally dependent. Corriere,⁹ analyzed a sample of 6.600 patients who consumed benzodiazepines and found exposure to greater morbidity (OR 1.5), with a reduction in the performance of basic activities of daily living (ABVD), (dressing, bathing, walking alone) (OR 1.7), compared to those who did not consume these medications.

In any case, the consumption of certain medications and inappropriate prescribing (PIM) are not the only reasons why the elderly may see their rates of ABVD reduced, since in general chronic pathologies and multiple pathologies are the elements that co- exist in the elderly and this has to do with their levels of ABVD among other factors. The data were loaded into Excel databases and processed with the SPSS 21 package, IBM®.

Results

300 hospitalized patients were studied in the 2016-2018 year. The distribution by sex was: 169 (56.4%) women and 131 (43.6%) men. The mean age was 73.3+18.5 years. Median: 69.12. In the total sample analyzed, 12% (n = 48) showed inappropriate prescription of drugs criteria.The drugs most present in the inappropriate prescription were anticoagulants 12.5% (n = 6), benzodiazepines 25% (n = 12), NSAIDs 56.25% (n = 27), and antipsychotics 6.25% (n = 3). The total number of patients with adverse events were: 21 (7%). The most frequent adverse events were: confusion (n = 2), respiratory depression (n = 3), renal failure (n = 6), electrolyte imbalance (n = 2), bleeding (n = 2), others (n = 6 ).

The average ABVD index was 3.36, being 32.7% (n = 98) of patients totally or almost totally dependent, 26% (n = 78) totally independent and 41.3% (n = 124) of median autonomy (Table 1).

Variable	With PIM	Without PIM	p Value
ABVD A-C	16 (20,25%)	107 (79,75%)	0,001
ABVD D-F	38 (38,8%)	60 (61,2%)	0,005
ABVD G-H	56 (70,8%)	23 (29,2%)	0,002

Table 1 ABVD indices with and without PIM

Of the total number of patients evaluated, 47% (n = 141) need, in addition to pharmacological treatments, both minor and major rehabilitation treatments on a chronic basis.

Of the 300 patients, 143 (47.7%) lived with their family (spouse, children, nephews, grandchildren, etc.), 81 (27%) lived alone or with a non-family caregiver, 76 (25.3%) lived in geriatric (Table 2).

Variable	OR (IC 95%)
Inappropriate precsription	1,47 (1,17-2,87)
ABVD	1,56(1,13-1,86)
Female sex	1,12(0,45-2,19) NS
Polypharmacy	1,64(1,56-1,98)
Age over 85 years	1,43 (1,11-3,16)
Severe-moderate pain	1,41(0,86-2,69) NS

Table 2 Association of variables with the appearance of adverse events

In an unadjusted multiple binary regression, the association of different variables with the adverse drug events.

In an unadjusted multiple binary regression, the association of different variables with the perception of quality of life was the one shown in the following table.

Discussion

Inappropriate prescription is similar to the studies published in recent years,¹⁰ according to the Beers criteria 2019, although our study shows lower values. The association of polypharmacy, advanced age, among other factors is also known in the literature, since these factors affect the behavior of drugs, producing effects that would not appear or would be less serious in older adults.

The indices of activities of daily living are related to the appearance of adverse effects, this could have to do with the deterioration of the organism itself that responds to a greater burden of disease due to the toxicity of drugs. Other factors that are associated with the appearance of adverse events are polypharmacy, age over 85 years, and inappropriate prescription according to Beers criteria.

The adverse events found are more frequent than other authors,¹¹ one reason could be that the research in this study was proactive by means of an internationally validated method. Anticoagulants, benzodiazepines, NSAIDs, and antipsychotics were the drugs most commonly found among PIMs. The total number of patients with adverse events were: 21 (7%). The most frequent adverse events were: confusion, respiratory depression, renal failure, electrolyte imbalance, bleeding and others. These events were similar to what was reported in the literature.

There are few studies that have linked these three parameters: inappropriate prescription, adverse events and activities of daily living.