Potentially inappropriate medications at discharge: Prevalence, predictors, and their association with early readmission and emergency department visits in older adults

Abstract

Background Evidence on the association between potentially inappropriate medications (PIMs) and adverse outcomes after hospital discharge remains limited and contradictory. This study aimed to determine the prevalence, predictors, and impact of PIMs at discharge on early unplanned readmissions and emergency department (ED) visits in older adults. Methods This retrospective cohort study analyzed electronic medical records of older patients discharged from a tertiary-care hospital to home. Patients were followed for 90 days to assess unplanned readmissions and ED visits. Multiple Cox regression and parametric survival analysis determined the association between PIMs and early readmissions/ED visits. Results Among 4,012 older patients, 2,299 (57.3%) were discharged with at least one PIM. Factors independently associated with PIM use included a higher Charlson Comorbidity Index (OR 1.08, 95% CI 1.01–1.15, p=0.02), longer hospital stay (OR 1.01, 95% CI 1.00–1.02, p=0.01), and a greater number of discharge medications (OR 1.26, 95% CI 1.24–1.29, p<0.001). Within 90 days post-discharge, unplanned readmissions or ED visits occurred in 183 of 2,299 patients (7.96%) with PIMs and 89 of 1,713 (5.20%) without PIMs. In multivariable Cox regression, PIM use was associated with a non-significant increase in the risk of unplanned readmission/ED visits (HR 1.15, 95% CI 0.87–1.51, p=0.32), a finding consistent across parametric survival models using Weibull, exponential, lognormal, and log-logistic distributions. Conclusion PIMs were highly prevalent in older patients at discharge, with comorbidity burden, the duration of hospital stay, and polypharmacy as significant predictors. However, PIMs at discharge were not significantly associated with early unplanned readmissions or ED visits.