School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 300 Grattan Street, Parkville, VIC, 3050, Australia.
Aging Clin Exp Res. 2022 Feb;34(2):445-454. doi: 10.1007/s40520-021-01946-4. Epub 2021 Aug 9.
Inappropriate medication use can affect functional independence in older adults.
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.
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.
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).
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.
不适当的药物使用会影响老年人的功能独立性。
本研究旨在探讨在老年康复住院患者中，潜在不适当药物使用与日常生活活动（ADL）和工具性日常生活活动（IADL）之间的关系。
在一家教学医院进行了一项纵向、前瞻性、观察性研究。在急性入院时以及在老年康复入院和出院时测量潜在不适当药物（PIM）和潜在处方遗漏（PPO）。在入组老年康复时、出院时和 3 个月后评估 PIM 和 PPO 使用与 ADL 和 IADL 评分之间的关系。
共纳入 693 名住院患者。在 3 个月的随访中，PPO 与较低的 IADL 评分相关（发生率比=0.868，95%CI 0.776-0.972）。在入组老年康复时，PIM 与 PPO 与 ADL 和 IADL 从老年康复入院到 3 个月随访的纵向变化之间没有显著关联。肾脏 PIM 与 3 个月随访时的较高 IADL 评分相关（发生率比=1.750，95%CI 1.238-2.474）。在 3 个月的随访中，涉及疫苗接种的 PPO 与较低的 IADL 评分相关（风险比=0.844，95%CI 0.754-0.944）。
在老年康复出院后 3 个月，涉及 PPO 的不适当药物使用与 IADL 评分较低相关，但与 ADL 评分无关。在老年康复住院患者中，减少潜在的 PPO 以减少其对 IADL 的潜在影响需要引起更多的关注。在社区中，卫生专业人员需要警惕评估不适当的药物处方如何影响老年患者的身体功能。
