Hospital readmissions, mortality and potentially inappropriate prescribing: A retrospective study of older adults discharged from hospital

AIMS: Applying version 2 of the STOPP/START criteria to discharge prescriptions of older adults discharged from a general medical unit, assess potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs)and their association with hospital readmission and mortality.

METHODS: Discharge medications, co-morbidities and patient demographics were recorded over an 8 month period for consecutive emergency admissions aged ≥ 65 years. PIMs and PPOs were identified using version 2 of the STOPP/START criteria. Multivariate analysis for association of PIMs and PPOs with re-admissions and mortality during the follow up period were assessed using binary logistic regression.

RESULTS: Data for 259 patients with a mean age of 77 (65-99, 51% female) were analysed. At discharge the mean number of co-morbidities and medications per patient were 5.4 (SD: 2.1 range: 0-14) and 9.3 (SD: 4.0 range: 1-31) respectively. During the follow-up period (mean 41.5 months, SD: 2.0 range: 38-46 months) 50.2% of patients had died and the median number of readmissions was 2 (IQR: 1-4 range: 0-33). Prescription of more than 5 medications was significantly associated with PIMs and PPOs (OR: 2.75, 95% CI: 1.34-5.62 and OR 3.20, 95% CI: 1.57-6.54 respectively). Presence of a PIM was associated with three or more readmissions (OR: 2.43 95% CI: 1.19-4.98) and PPOs with mortality (OR: 1.88, 95% CI: 1.09-3.27).

CONCLUSIONS: Using version 2 of the STOPP/START criteria, the presence of PIMs and/or PPOs in older adults discharged from hospital is significantly associated with repeated hospital admissions and mortality respectively.