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Potentially Inappropriate Medications, Drug–Drug Interactions, and Anticholinergic Burden in Elderly Hospitalized Patients: Does an Association Exist with Post-Discharge Health Outcomes?

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A Letter to the Editor to this article was published on 19 November 2020

A Letter to the Editor to this article was published on 19 November 2020

Abstract

Background

Polypharmacy is very common in elderly patients and is associated with detrimental outcomes.

Objective

Our objective was to evaluate the associations between a large panel of therapy quality indicators, including explicit lists of potentially inappropriate medications (PIMs; Beers criteria and Screening Tool of Older Persons’ potentially inappropriate Prescriptions [STOPP] criteria), the Anticholinergic Cognitive Burden (ACB) score, and the number of drug–drug interactions (DDIs), with respect to mortality, rehospitalization, and physical function decline within 3 months from hospital discharge in a cohort of hospitalized elderly patients.

Methods

We studied 2631 individuals aged ≥ 65 years (median age 79.6; males 48.6%) enrolled in the REPOSI registry. The relationships with mortality and rehospitalization were evaluated using Cox regressions, and relationships with functional status change (as percentage variation of Barthel Index [BI]) were evaluated using mixed linear models.

Results

None of the studied indicators was associated with mortality and rehospitalization. Conversely, only ACB was associated with physical function decline, even after correction for confounders (adjusted mean BI variation of − 7.55%; 95% confidence interval [CI] − 12.37 to − 2.47). The number of medications at discharge, particularly polypharmacy (more than five drugs daily), were the only therapy-related factors associated with mortality (adjusted hazard ratio [aHR] 1.05 [95% CI 1.01–1.10] and 1.70 [95% CI 1.12–2.58], respectively) and rehospitalization (aHR 1.05 [95% CI 1.01–1.08] and 1.31 [95% CI 1.01–1.71], respectively).

Conclusion

Polypharmacy, a very simple measure, outperformed sophisticated PIM and DDI indicators of quality of therapy as a correlate of primary clinical outcomes, whereas ACB was associated with physical function decline. Thus, innovative approaches to the definition and research of PIMs and DDIs are eagerly awaited from the perspective of averaging the quantitative burden and qualitative interaction of drugs.

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Authors and Affiliations

  1. Unit of Geriatrics, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy

    Antonio De Vincentis, Paolo Gallo, Panaiotis Finamore, Claudio Pedone, Luisa Costanzo & Raffaele Antonelli Incalzi

  2. Unit of Internal Medicine and Hepatology, University Campus Bio-Medico, Rome, Italy

    Paolo Gallo

  3. Dipartimento di Neuroscienze, IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy

    Luca Pasina, Laura Cortesi & Alessandro Nobili

  4. IRCCS Ca’ Granda Maggiore Hospital Foundation and University of Milan, Milan, Italy

    Pier Mannuccio Mannucci

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  1. Antonio De Vincentis
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Corresponding author

Correspondence to Paolo Gallo.

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Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

A. De Vincentis, P. Gallo, P. Finamore, C. Pedone, L. Costanzo, L. Pasina, L. Cortesi, A. Nobili, P.M. Mannucci, and R.A. Incalzi have no conflicts of interest that are directly relevant to the content of this article.

Ethical approval

The study protocol was approved by the ethics committee of the coordinating center and then ratified by the local committee of all participating hospitals.

Informed consent

Written informed consent was obtained for all participants at the time of inclusion in the study.

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De Vincentis, A., Gallo, P., Finamore, P. et al. Potentially Inappropriate Medications, Drug–Drug Interactions, and Anticholinergic Burden in Elderly Hospitalized Patients: Does an Association Exist with Post-Discharge Health Outcomes?. Drugs Aging 37, 585–593 (2020). https://doi.org/10.1007/s40266-020-00767-w

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