Elizabeth Manias1,2, Cheng Hwee Soh3, Md Zunayed Kabir3, Esmee M Reijnierse3,4, Andrea B Maier3,5,6,7. 1. School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, 221 Burwood Highway, Burwood, VIC, 3125, Australia. emanias@deakin.edu.au. 2. Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 300 Grattan Street, Parkville, VIC, 3050, Australia. emanias@deakin.edu.au. 3. Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, 300 Grattan Street, Parkville, VIC, 3050, Australia. 4. Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands. 5. @AgeAmsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. 6. Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 7. Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore, Singapore.
Abstract
BACKGROUND: Inappropriate medication use can affect functional independence in older adults. AIMS: The aim of the study is to examine associations between potentially inappropriate medication use and Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in geriatric rehabilitation inpatients. METHODS: A longitudinal, prospective, observational study was undertaken at a teaching hospital. Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were measured at acute admission, and at admission and discharge from geriatric rehabilitation. Associations between PIM and PPO use and ADL and IADL scores were examined at admission to geriatric rehabilitation, discharge and 3-month post-discharge. RESULTS: A total of 693 inpatients were included. At the 3-month post-discharge, PPOs were associated with lower IADL scores (incident rate ratio = 0.868, 95% CI 0.776-0.972). There were no significant associations between PIMs and PPOs use at admission to geriatric rehabilitation with longitudinal changes of ADLs and IADLs from geriatric rehabilitation admission to 3-month post-discharge Renal PIMs were associated with higher IADL scores at 3-month post-discharge (incidence rate ratio = 1.750, 95% CI 1.238-2.474). At 3-month post-discharge, PPOs involving vaccinations were associated with a lower IADL score (incident risk ratio = 0.844, 95% CI 0.754-0.944). CONCLUSIONS: Inappropriate medication use involving PPOs was associated with lower IADL scores at 3-month post-discharge from geriatric rehabilitation but not with ADL scores. Greater attention is needed in reducing PPOs in geriatric rehabilitation inpatients that can potentially impact IADLs. In the community, health professionals need to be vigilant about assessing how older patients' physical functioning may be affected by inappropriate medication prescribing.
BACKGROUND: Inappropriate medication use can affect functional independence in older adults. AIMS: The aim of the study is to examine associations between potentially inappropriate medication use and Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in geriatric rehabilitation inpatients. METHODS: A longitudinal, prospective, observational study was undertaken at a teaching hospital. Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were measured at acute admission, and at admission and discharge from geriatric rehabilitation. Associations between PIM and PPO use and ADL and IADL scores were examined at admission to geriatric rehabilitation, discharge and 3-month post-discharge. RESULTS: A total of 693 inpatients were included. At the 3-month post-discharge, PPOs were associated with lower IADL scores (incident rate ratio = 0.868, 95% CI 0.776-0.972). There were no significant associations between PIMs and PPOs use at admission to geriatric rehabilitation with longitudinal changes of ADLs and IADLs from geriatric rehabilitation admission to 3-month post-discharge Renal PIMs were associated with higher IADL scores at 3-month post-discharge (incidence rate ratio = 1.750, 95% CI 1.238-2.474). At 3-month post-discharge, PPOs involving vaccinations were associated with a lower IADL score (incident risk ratio = 0.844, 95% CI 0.754-0.944). CONCLUSIONS: Inappropriate medication use involving PPOs was associated with lower IADL scores at 3-month post-discharge from geriatric rehabilitation but not with ADL scores. Greater attention is needed in reducing PPOs in geriatric rehabilitation inpatients that can potentially impact IADLs. In the community, health professionals need to be vigilant about assessing how older patients' physical functioning may be affected by inappropriate medication prescribing.
Authors: Kenneth Rockwood; Xiaowei Song; Chris MacKnight; Howard Bergman; David B Hogan; Ian McDowell; Arnold Mitnitski Journal: CMAJ Date: 2005-08-30 Impact factor: 8.262
Authors: Joella E Storey; Jeffrey T J Rowland; David Basic; David A Conforti; Hugh G Dickson Journal: Int Psychogeriatr Date: 2004-03 Impact factor: 3.878
Authors: Cynthia M Boyd; Michelle Ricks; Linda P Fried; Jack M Guralnik; Qian-Li Xue; Jin Xia; Karen Bandeen-Roche Journal: J Am Geriatr Soc Date: 2009-08-20 Impact factor: 5.562
Authors: Denis O'Mahony; David O'Sullivan; Stephen Byrne; Marie Noelle O'Connor; Cristin Ryan; Paul Gallagher Journal: Age Ageing Date: 2014-10-16 Impact factor: 10.668