Prevalent medication-related harm identified in patients admitted to a geriatric ward: Cross-sectional and survival-based contributors

Abstract

INTROduCTION Medication-related harm (MRH) has been recognized as a global public health issue. ObjECTIvEs This study aimed to assess the prevalence and causes of MRH in geriatric patients. Another objective of the study was to recognize how MRH and drugs prescribed after geriatric interventions affect survival. PATIENTs ANd mEThOds It was a cross-sectional study of 301 geriatric patients admitted to the hos- pital for any cause, combined with a 2-year survival analysis. Altogether, 71 drug items were included. Medication-related harm was defined based on clinical reasoning. Logistic regression models were applied to identify the explanatory variables for each type of MRH. The Cox proportional hazards model was used to determine the association of MRH and postdischarge medications with patient survival. REsuLTs Medication-related harms were identified in 35.2% of the study patients. Those included, among others, hypotension (19.3%), hypoglycemia (13.3%), parkinsonism (4.3%), and benzodiazepine addiction (5.7%). Logistic regression, applied to estimate the impact of drugs before admission on MRH of any type, demonstrated an independent negative effect of typical neuroleptics, antidiabetic medica- tion, benzodiazepines, and supplements, except vitamin D. After geriatric interventions, 4 drug classes showed a positive association with survival: thiazides (hazard ratio [HR], 0.45; 95% CI, 0.22–0.93), selective serotonin reuptake inhibitors (SSRIs; HR, 0.51; 95% CI, 0.34–0.75), paracetamol (HR, 0.54; 95% CI, 0.33–0.88), and angiotensin-converting enzyme inhibitors (ACEIs; HR, 0.59; 95% CI, 0.4–0.89). CONCLusIONs Geriatric-based deprescribing and drug optimization mitigate the negative impacts of MRH on patient survival and may decrease the rehospitalization rate and healthcare costs. Thiazides, ACEIs, SSRIs, and paracetamol, if indicated, were associated with better survival in geriatric patients.