Hospitalization and Death Associated With Potentially Inappropriate Medication Prescriptions Among Elderly Nursing Home Residents

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Abstract
Potentially inappropriate prescribing of medications (PIRx) occurs in hospitals,1,2 emergency departments,3 and ambulatory settings.4 Patients 65 years and older are at significant risk of PIRx, owing to polypharmacy for multiple conditions,5 and of resulting adverse drug events ranging from minor symptoms to serious adverse effects, including sedation and life-threatening arrhythmia.6 Although a linkage between PIRx and subsequent major health events, eg, falls with injuries, hospitalization, and death, has been suggested,7 few studies have examined these types of relationships. Perhaps the most cited criteria for PIRx to elderly patients are those developed by Beers and colleagues8 for nursing home (NH) residents in 1991 and updated for community-dwelling elderly patients in 1997.9 One study using the Beers criteria found that elderly patients in an urban academic emergency department with prior PIRx exposure had worse physical functioning and greater pain during a 4-month period after the emergency department visit; however, no association was found between PIRx and death or return visits to the emergency department.3 A study using a different standard for PIRx (a medication appropriateness index) found that patients with PIRx exposure had more subsequent hospitalizations and emergency visits; however, the study was limited by a small sample size.10