Potentially Inappropriate Medication Use Among Healthy Older Adults Impacts Disability, Hospitalization

The use of potentially inappropriate medications (PIMs) among community-dwelling older adults may be associated with an increased risk of disability and hospitalization, according to research published in the Journal of the American Geriatrics Society.  

“Most PIMs research has focused on older people in aged or inpatient care, creating an evidence gap for community-dwelling older adults,” said researchers. “To address this gap, we investigated the impact of PIMs use in the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial cohort.” 

A modified 2019 AGS Beers Criteria was used to define PIMs. Data was analyzed from 19,114 community-dwelling ASPREE participants aged 70 years or older and participants who identified as minorities were aged 65 years or older. To be included, participants could not have major cardiovascular disease, cognitive impairment, or significant physical disability.  

The association between baseline PIMs exposure and disability-free survival, death, incident dementia, disability, and hospitalization, with adjustment for sex, age, country, years of education, frailty, average gait speed, and comorbidities, was estimated using Cox proportional-hazards regression models.  

Initially, 39% (7396 out of the total participants) were prescribed at least one PIM. When compared to those not exposed to PIMs, participants taking PIMs at the beginning of the study had a higher risk of hospitalization (adjusted hazard ratio [HR] 1.26, 95% confidence interaval [CI] 1.20, 1.32) and persistent physical disability (HR 1.47, 95% CI 1.21, 1.80). However, rates of disability-free survival (adjusted HR 1.02, 95% CI 0.93, 1.13) and death (adjusted HR 0.92, 95% CI 0.81, 1.05) were similar to participants not prescribed PIMs. 

The results found were consistent regardless of polypharmacy status. Exposure to PIMs was associated with a higher risk of disability followed by hospitalization (adjusted HR 1.92, 95% CI 1.25, 2.96), as well as the reverse order (adjusted HR 1.54, 95% CI 1.15, 2.05). Specific medications such as proton pump inhibitors (PPIs), anti-psychotics, and benzodiazepines were linked to an increased risk of disability. 

The use of PIMs is linked to a higher risk of developing both disability and hospitalization in the future. Furthermore, the heightened risk of disability before being hospitalized implies that using of PIMs might initiate a progression toward disability in older adults who are otherwise healthy. 

“Our findings emphasize the importance of caution when prescribing PIMs to older adults in otherwise good health,” said researchers. 

Reference  

Lockery JE, Collyer TA, Woods RL, et all. Potentially inappropriate medication use is associated with increased risk of incident disability in healthy older adults. Journal of the American Geriatrics Society. 2023;71(8):2495-2505. doi.org/10.1111/jgs.18353