Department of Clinical Pharmacology, Flinders Medical Centre and Flinders University, Adelaide, SA, Australia.
Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
BMC Geriatr. 2024 Aug 29;24(1):718. doi: 10.1186/s12877-024-05297-3.
Inappropriate prescribing (IP) is common in hospitalised older adults with frailty. However, it is not known whether the presence of frailty confers an increased risk of mortality and readmissions from IP nor whether rectifying IP reduces this risk. This review was conducted to determine whether IP increases the risk of adverse outcomes in hospitalised middle-aged and older adults with frailty.
A systematic review was conducted on IP in hospitalised middle-aged (45-64 years) and older adults (≥ 65 years) with frailty. This review considered multiple types of IP including potentially inappropriate medicines, prescribing omissions and drug interactions. Both observational and interventional studies were included. The outcomes were mortality and hospital readmissions. The databases searched included MEDLINE, CINAHL, EMBASE, World of Science, SCOPUS and the Cochrane Library. The search was updated to 12 July 2024. Meta-analysis was performed to pool risk estimates using the random effects model.
A total of 569 studies were identified and seven met the inclusion criteria, all focused on the older population. One of the five observational studies found an association between IP and emergency department visits and readmissions at specific time points. Three of the observational studies were amenable to meta-analysis which showed no significant association between IP and hospital readmissions (OR 1.08, 95% CI 0.90-1.31). Meta-analysis of the subgroup assessing Beers criteria medicines demonstrated that there was a 27% increase in the risk of hospital readmissions (OR 1.27, 95% CI 1.03-1.57) with this type of IP. In meta-analysis of the two interventional studies, there was a 37% reduced risk of mortality (OR 0.63, 95% CI 0.40-1.00) with interventions that reduced IP compared to usual care but no difference in hospital readmissions (OR 0.83, 95% CI 0.19-3.67).
Interventions to reduce IP were associated with reduced risk of mortality, but not readmissions, compared to usual care in older adults with frailty. The use of Beers criteria medicines was associated with hospital readmissions in this group. However, there was limited evidence of an association between IP more broadly and mortality or hospital readmissions. Further high-quality studies are needed to confirm these findings.
在虚弱的住院老年患者中，不适当的处方（IP）很常见。然而，目前尚不清楚虚弱是否会增加因 IP 而导致的死亡率和再入院的风险，也不清楚纠正 IP 是否会降低这种风险。进行这项综述是为了确定 IP 是否会增加虚弱的住院中年和老年患者发生不良结局的风险。
对虚弱的住院中年（45-64 岁）和老年（≥65 岁）患者的 IP 进行了系统综述。本综述考虑了多种类型的 IP，包括潜在不适当的药物、处方遗漏和药物相互作用。纳入了观察性和干预性研究。结局是死亡率和住院再入院。检索的数据库包括 MEDLINE、CINAHL、EMBASE、World of Science、SCOPUS 和 Cochrane 图书馆。检索更新至 2024 年 7 月 12 日。使用随机效应模型对风险估计值进行荟萃分析。
共确定了 569 项研究，其中 7 项符合纳入标准，均集中于老年人群。五项观察性研究中的一项发现，IP 与特定时间点的急诊就诊和再入院之间存在关联。三项可进行荟萃分析的观察性研究显示，IP 与住院再入院之间无显著关联（OR 1.08，95%CI 0.90-1.31）。评估 Beers 标准药物的亚组荟萃分析表明，这种类型的 IP 会使住院再入院的风险增加 27%（OR 1.27，95%CI 1.03-1.57）。在两项干预性研究的荟萃分析中，与常规护理相比，减少 IP 的干预措施可使死亡率降低 37%（OR 0.63，95%CI 0.40-1.00），但住院再入院率无差异（OR 0.83，95%CI 0.19-3.67）。
与常规护理相比，减少 IP 的干预措施与虚弱的老年患者的死亡率降低相关，但与住院再入院率无关。在该组中，使用 Beers 标准药物与住院再入院有关。然而，目前尚无充分证据表明更广泛的 IP 与死亡率或住院再入院有关。需要进一步开展高质量研究来证实这些发现。
