Improving hospital prescribing practices may reduce the risk of rehospitalization and death in older adults, many of whom are prescribed medications that are not recommended for their patient population, according to a new study led by researchers at McGill University.

The investigators defined potentially inappropriate medications (PIMs) as drugs that should be avoided by seniors because the risk of harm or injury outweighs the expected benefit, particularly when safer or more effective alternatives are available for the same condition. As patients recover, they are particularly vulnerable in the short-term period after discharge, when the associated risks and adverse reactions can result in emergency department visits, rehospitalization, and even death within 30 days, according to the study.

The investigators analyzed data from hospital admission records, provincial health databases, and filled prescriptions in Quebec between October 2014 and November 2016 in order to estimate the number of PIMs prescribed to patients. They found that despite well-established risks, many drugs are inappropriately prescribed for older adults.

“The risks associated with some of these drugs are well-known to clinicians, yet they are still commonly prescribed,” said lead author Daniala Weir, MSc, PhD, in a statement. “Benzodiazepines, for example, are typically used to treat anxiety and insomnia in adults, but are known to increase the risk of falls for seniors.”

The researchers added that clinicians could, however, conclude that the benefits outweigh the risks for their patient in specific situations.

“This could be true in specific situations; however, on the whole, these medications still tend to cause more harm than good for the average older adult,” Weir said.

The investigators said that their findings demonstrate a need not only for further research into the risks associated with continuing PIMs at hospital discharge, but also for better guidance to improve prescribing practices in hospitals for older adults.

“Dr Weir has identified important and preventable risk factors for avoidable harm in hospitalized seniors,” said study author Robyn Tamblyn, MScN, MSc, PhD, CM, in a statement. “With the introduction of computerized discharge prescriptions, there can be an automated review and alerts for potentially inappropriate medications; interventions that have proven to be effective in reducing PIMs in other jurisdictions.”

REFERENCE
Inappropriate prescriptions sending hospitalized seniors back to the ER [news release]. McGill University; August 5, 2020. https://www.mcgill.ca/newsroom/channels/news/inappropriate-prescriptions-sending-hospitalized-seniors-back-er-322806. Accessed August 11, 2020.