Use of potentially inappropriate medications among older outpatients and inpatients in a tertiary care hospital in Malaysia

Hasan SS 1 , Burud IAS 2 , Kow CS 3 , Rasheed MK 4 , Chan KSC 3 , Tay PK 3 Show all authors , Ahmed SI 3

Affiliations 

  • 1 Department of Pharmacy, University of Huddersfield, Huddersfield, UK
  • 2 Department of Surgery, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
  • 3 Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
  • 4 Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah, Al-Qassim, Saudi Arabia
Int J Clin Pract, 2021 Mar;75(3):e13714.
PMID: 32949074 DOI: 10.1111/ijcp.13714

Abstract

BACKGROUND: Older individuals are seemingly having more medical conditions, which predispose them to a greater risk of polypharmacy. Potentially inappropriate medications (PIMs), including those having anticholinergic and sedative properties, are common in their prescriptions, often associated with functional decline and negative health outcomes. Thus, this study reports proportions of inappropriate drugs and drug burden exposures and its correlation with patient-reported outcomes (PROs) among cognitively intact older adults admitted to a ward or visiting the outpatient clinic at a tertiary care hospital in Malaysia.

METHODS: This cross-sectional study included data from 344 older (173 inpatients and 171 outpatients) patients, aged 60 years and above, through validated questionnaires. Medication appropriateness was assessed via Medication Appropriateness Index (MAI) tool, whereas Beers and Screening Tool of Older Person's Potentially Inappropriate Prescribing (STOPP) criteria were used to evaluate PIMs and potentially inappropriate prescribing (PIP), respectively. The Drug Burden Index (DBI) and polypharmacy, as well as PROs, included Groningen Frailty Indicator (GFI), Katz Index of Independence in Activities of Daily Living (Katz ADL) and Older People's Quality of Life (OPQOL) were also evaluated.

RESULTS: Overall, inpatients received significantly higher medications (6.90 ± 2.70 vs 4.49 ± 3.20) than outpatients. A significantly higher proportion of inpatients received at least one PIM (65% vs 57%) or PIP (57.4% vs 17.0%) and higher mean MAI score (1.76 ± 1.08 and 1.10 ± 0.34) and DBI score (2.67 ± 1.28 vs 1.49 ± 1.17) than outpatients. Inpatients had significantly higher total OPQOL (118.53 vs 79.95) and GFI score (5.44 vs 3.78) than outpatients. We only found significant correlations between GFI and DBI and total OPQOL and the number of PIMs.

CONCLUSIONS: Proportions of PIMs and DBI exposure were significantly higher in an inpatient setting. No significant correlations between exposures to inappropriate medications or drug burden and PROs were observed.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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