Is suboptimal prescribing a risk factor for poor health outcomes in community-dwelling elders? The ICARe Dicomano study

Authors

  • C. Pozzi,

    Corresponding author
    1. Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence, Italy and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
    2. Unit of Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
    • Unit of Gerontology and Geriatric Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy.
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  • F. Lapi,

    1. Tuscan Regional Centre of Pharmacovigilance, Italy
    2. Department of Pharmacology, University of Florence, Italy
    3. Regional Health Authority of Tuscany, Italy
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  • G. Mazzaglia,

    1. Regional Health Authority of Tuscany, Italy
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  • M. Inzitari,

    1. Pere Virgili Hospital, Barcelona, Spain
    2. Institute on Aging of the Autonomous University of Barcelona, Spain
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  • M. Boncinelli,

    1. Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence, Italy and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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  • P. Geppetti,

    1. Tuscan Regional Centre of Pharmacovigilance, Italy
    2. Department of Pharmacology, University of Florence, Italy
    3. Institute on Aging of the Autonomous University of Barcelona, Spain
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  • A. Mugelli,

    1. Tuscan Regional Centre of Pharmacovigilance, Italy
    2. Department of Pharmacology, University of Florence, Italy
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  • N. Marchionni,

    1. Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence, Italy and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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  • M. Di Bari

    1. Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence, Italy and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
    2. Unit of Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
    3. Center of Pharmacoutilization, Pharmacoepidemiology, Pharmacovigilance, and Pharmacoeconomics, Italy
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  • The authors had no financial or any other kind of personal conflicts with this paper.

Abstract

Purpose

Mostly because of comorbidity and drugs consumption, older persons are often exposed to an increased risk of sub-optimal prescribing (SP). At present, few studies investigated the association between SP and long-term health outcomes. We examined the relation between SP and the risk of mortality and hospitalization in Italian older community-dwellers.

Methods

Older (65+ years) community-dwelling residents of a small town in Tuscany were enrolled in a longitudinal study. SP was defined as polypharmacy (use of 5+ drugs), prescription of inappropriate drugs (ID) according to Beers' criteria, and of potentially interacting drugs (PID), evaluated in 1995 and 1999. These three forms of SP were entered as time-dependent exposures into multivariable Cox regression analysis models, whose outcomes were mortality and hospitalizations through 2003.

Results

Of 1022 participants (mean age 73.0 ± 6.8, 57% women), 220 were evaluated in 1995, 234 in 1999 and 568 in both waves. In univariate analysis, mortality was two-fold higher in participants with polypharmacy (73.4/1000 person/years, 95% CI 58.2–92.4 vs. 34.1, 95% CI 29.7–39.2; p < 0.001) or PID (72.7/1000 person/years, 95% CI 46.3–113.9 vs. 38.0, 95% CI 33.5–43.1; p < 0.001), whereas it was unrelated to the presence of ID. Hospitalization rates were independent of any form of SP. In multivariable models, polypharmacy, ID, and PID were no longer associated with an increased risk of death, and ID predicted a slightly increased risk of hospitalizations (HR 1.03, 95% CI 1.0–1.06, p = 0.048).

Conclusions

In this cohort, SP was not associated with an excess risk of poor health outcomes. Copyright © 2010 John Wiley & Sons, Ltd.

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