Prevalence and factors associated with potentially inappropriate medication and medication complexity for older adults in the emergency department of a secondary teaching hospital in Indonesia

• Khusnul Fitri Hamidah ^[3] ; Mahardian Rahmadi ^[1] ; Farah Meutia ^[4] ; Prihatma Kriswidyatomo ^[5] ; Firman Suryadi Rahman ^[1] ; Zamrotul Izzah ^[6] ; Bambang Subakti Zulkarnain ^[1] ; Leopold N. Aminde ^[2] ; Christopher Paul Alderman ^[7] ; Budi Suprapti ^[8]
  1. [1] Airlangga University

     Airlangga University

     Indonesia

     
  2. [2] Griffith University

     Griffith University

     Australia

     
  3. [3] Department of Pharmacy, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
  4. [4] Master of Clinical Pharmacy Program, Faculty of Pharmacy, Universitas Airlangga Surabaya, Indonesia.
  5. [5] Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Emergency Department, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia.
  6. [6] Department of Pharmacy, Universitas Airlangga Teaching Hospital, Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia. Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.
  7. [7] Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.
  8. [8] Department of Pharmacy, Universitas Airlangga Teaching Hospital, Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.

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• Localización: Pharmacy Practice (Granada), ISSN-e 1886-3655, Vol. 20, Nº. 4, 2022 (Ejemplar dedicado a: Oct-Dec)
• Idioma: inglés
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  • Background: Older adults experience progressive decline in various organs and changes in pharmacokinetics and pharmacodynamics of the drugs in the body which lead to an increased risk of medication-related problems. Potentially inappropriate medications (PIMs) and medication complexity are key factors contributing to adverse drug events in the emergency department (ED). Objective: To estimate the prevalence and investigate the risk factors of PIMs and medication complexity among older adults admitted to the ED. Methods: A retrospective observational study was conducted among patients aged > 60 years admitted to the ED of Universitas Airlangga Teaching Hospital in January - June 2020. PIMs and medication complexity were measured using the 2019 American Geriatrics Society Beers Criteria® and Medication Regimen Complexity Index (MRCI), respectively. Results: A total of 1005 patients were included and 55.0% (95% confidence interval [CI]: 52 – 58%) of them received at least one PIM. Whereas, the pharmacological therapy prescribed to older adults had a high complexity index (mean MRCI 17.23 + 11.15). Multivariate analysis showed that those with polypharmacy (OR= 6.954; 95% CI: 4.617 – 10.476), diseases of the circulatory system (OR= 2.126; 95% CI: 1.166 – 3.876), endocrine, nutritional, and metabolic diseases (OR= 1.924; 95% CI: 1.087 – 3.405), and diseases of the digestive system (OR= 1.858; 95% CI: 1.214 – 2.842) had an increased risk of receiving PIM prescriptions. Meanwhile, disease of the respiratory system (OR = 7.621; 95% CI: 2.833 – 15.150), endocrine, nutritional and metabolic diseases (OR = 6.601; 95% CI: 2.935 – 14.847), and polypharmacy (OR = 4.373; 95% CI: 3.540 – 5.401) were associated with higher medication complexity. Conclusion: In our study, over one in every two older adults admitted to the ED had PIMs, and a high medication complexity was observed. Endocrine, nutritional and metabolic disease was the leading risk factors for receiving PIMs and high medication complexity.