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Association Between Potentially Inappropriate Medications Prescription and Health-Related Quality of Life Among US Older Adults
TAKE-HOME MESSAGE
- This large cross-sectional study involving Medicare patients evaluated the association of the prescription of potentially inappropriate medication (PIM, defined according to the Beers Criteria) with health-related quality of life among older adults and found that PIM use in older adults was associated with a significantly lower physical and mental quality of life.
- Although PIMs are often prescribed to older adults under the code of preserving the quality of life, this study reports a negative association between PIM use and physical and mental quality of life.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Potentially inappropriate medications (PIMs) are associated with worse health outcomes among older adults. Our objective was to examine the association between PIM prescription and health-related quality of life (HRQoL) among older adults in the United States using nationally representative data.
METHODS
This was a retrospective study utilizing 2011-2015 Medical Expenditure Panel Survey (MEPS) data. Community dwelling US adults aged 65 years or older were included. A qualified definition operationalized from the 2019 American Geriatrics Society Beers Criteria® was used to define exposure to PIMs during the study period. The Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12) were used to measure HRQoL. Survey-weighted linear regression models were constructed to investigate the association between PIM exposure and participants' PCS and MCS scores. Analyses were stratified across three age cohorts (65-74, 75-85, and ≥85 years).
RESULTS
Unadjusted analysis showed poorer scores in the PIM exposed group for both PCS and MCS (all p < 0.001). PIM exposure was associated with poorer PCS scores across all age groups with those aged 65-74 years (adjusted regression coefficient = -1.60 [95% CI = -2.27, -0.93; p < 0.001]), those 75-84 years (adjusted regression coefficient: -1.49 [95% CI = -2.45, -0.53; p = 0.003]), and those 85 years and older (adjusted regression coefficient = -1.65 [95% CI = -3.03, -0.27; p = 0.02]). PIM exposure was also associated with poorer MCS scores in participants aged 65-74 years (adjusted regression coefficient = -0.69 [95% CI = -1.16, -0.22; p = 0.004]) and 85 years and older (adjusted regression coefficient = -2.01 [95% CI = -3.25, -0.78; p = 0.002]).
CONCLUSIONS
Our results suggest that patients' exposure to PIMs is associated with poorer HRQoL. Further work is needed to assess whether interventions to deprescribe PIMs may help to improve patients' HRQoL.
Additional Info
Disclosure statements are available on the authors' profiles:
Association between potentially inappropriate medications prescription and health-related quality of life among US older adults
J Am Geriatr Soc 2024 May 10;[EPub Ahead of Print], CM Clark, J Guan, AR Patel, J Stoll, RG Wahler, S Feuerstein, R Singh, DM JacobsFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Potentially inappropriate medications, health-related quality of life, and rehospitalization
The American Geriatrics Society (AGS) Beers Criteria was established in 1992 by Dr Mark Beers and is fine-tuned about every 3 years based on evolving evidence.1 It identifies potentially inappropriate medications (PIMs) that should be avoided in older adults.
The authors of the first article (Association Between Potentially Inappropriate Medications Prescription and Health-Related Quality of Life Among US Older Adults) used a questionnaire to identify PIMs verified by data from pharmacies in a US nationally representative sample of the 2011 to 2015 Medical Expenditure Panel Survey.2 A total of 34.4% of patients were prescribed one or more inappropriate medications and 33.1% were prescribed two or more. The survey measured health-related quality of life using the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12), with the results showing worse outcomes for all measures with exposure to PIMs. Poorer outcomes were observed with increasing age in older adults exposed to PIMs, as observed with the PCS scores (adjusted regression coefficient,f –1.65; 95% CI, –3.03 to –0.27; P = .02) and MCS scores in participants aged 85 years and older (adjusted regression coefficient, –2.01; 95% CI, –3.25 to –0.78; P = .002). This occurrence is likely due to the cumulative burden of more medications and comorbidities with increasing age and less organ reserve.
The authors point out that a previous study showed no effect; however, this study did not use the Beers Criteria and used a less robust outcome measure questionnaire.3 In contrast, a study based on the European STOPP criteria found similar adverse effects from the use of inappropriate medications.4 We need randomized controlled trials to establish the cause and effect, but the ethics of such a trial is questionable given the existing evidence from observational studies.
The second article (Emergency Department Visits and Hospital Readmissions After a Deprescribing Intervention Among Hospitalized Older Adults), a secondary analysis of the Shed-MEDS trial randomized 141 patients (age >50 years) to undergo deprescribing during their hospitalization and compared these patients with 142 controls.5 During the 90-day follow-up, the intervention group had fewer emergency department visits (18 vs 20), readmissions (46 vs 51), and deaths (1 vs 4), and, although it did not reach statistical significance, deprescribing did not lead to higher readmissions or increase adverse outcomes. What increased readmissions or emergency department visits were higher drug burden, longer hospital stays, and more comorbidities. A larger trial may have reached statistical significance. It is also not clear how many patients or families did not agree to deprescribing or only agreed to some and not all recommended medications being deprescribed.
I have found the Beers Criteria to be quite accurate and, with deprescribing these medications, I have had great success in improving my patients' quality of life. Moreover, anticholinergic medications and benzodiazepines have lifetime cumulative adverse effects on cognition.6-9 When discussing deprescribing with my patients, I have the greatest success when I explain its correlation with dementia.
References