Potentially Inappropriate Medication Usage among Older Emergency Department Patients in a Middle-Income Country
Supa Niruntarai, MD1, Thana Khumyoung, MD2, Jiraporn Sri-on, MD1
Affiliation : 1Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, 2Phra Nang Klao Hospital, Bangkok, Thailand
Objective: To investigate the prevalence of potentially inappropriate medications (PIMs) prescriptions among older patients in the ED based on Beers criteria 2015 and Screening Tool of Older People’s Prescriptions (STOPP) criteria 2015 and to assess the prevalence of patients who return to the ED for treatment due to adverse drug reactions (ADRs), rates of ED revisit, and rates of mortality within 30 days.
Materials and Methods: This retrospective descriptive study was conducted at a single center and included a random sample of patients aged 65 years or older who presented to the ED and received at least one medication in the ED during a 4-month period. Patients were excluded if they received any medications within 1 day before or after the ED visit, experienced cardiac arrest upon ED arrival, intentionally overdosed on drugs, or had incomplete documentation or missing medical records.
Results: Our study comprised 370 patients, 93 (25.1%) of whom were found to have been prescribed PIMs according to the Beers criteria. Among these patients, 19 (20.4%) revisited the ED within 30 days, with 3 (3.2%) cases related to ADRs. Similarly, using the STOPP criteria, 86 patients (23.2%) were identified as having been prescribed inappropriate medications, with 18 (20.9%) of them revisiting the ED within 30 days and 5 (5.8%) cases related to ADRs. In comparing ED revisits between both groups, categorized by the Beers criteria and STOPP criteria, the odds ratios were calculated as 2.37 (95% confidence interval [CI] = 1.25 to 4.51) and 2.42 (95% CI = 1.26 to 4.63), respectively.
Conclusions: One-fourth of the patients who arrived at the ED received PIMs according to the Beers criteria and STOPP criteria. Further studies may be required to evaluate the impact and reduce the incidence of ADRs, thus identifying best practices for prescribing to older patients in the ED.
Received 14 May 2024 | Revised 9 September 2024 | Accepted 5 November 2024
Keywords : Emergency department; Potentially inappropriate medication; Beers 2015; STOPP 2015
