Deprescribing in geriatric inpatients is associated with a lower readmission risk: a case control study
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SHORT RESEARCH REPORT
Deprescribing in geriatric inpatients is associated with a lower readmission risk: a case control study Laura Hellemans1 · Julie Hias1 · Karolien Walgraeve1 · Johan Flamaing2,3 · Isabel Spriet1,4 · Jos Tournoy2,3 · Lorenz Van der Linden1,4 Received: 27 February 2020 / Accepted: 26 June 2020 © Springer Nature Switzerland AG 2020
Abstract Background Polypharmacy is prevalent in older adults and has been associated with iatrogenic harm. Deprescribing has been promoted to reduce polypharmacy. It remains however unclear whether deprescribing during hospital stay can reduce the readmission risk. Objective We sought to determine whether deprescribing in geriatric inpatients was associated with a lower readmission risk at three months post-discharge. Method A case control study was performed, using data from a prospective, controlled study in geriatric inpatients. Deprescribing was defined as the percentage of discontinued preadmission medications and was assessed upon discharge. A logistic regression analysis was used to determine the odds ratio for deprescribing and the outcome of readmissions. An adjusted odds ratio was then estimated, taking into account age, sex, mortality, the number of preadmission medications and the Charlson Comorbidity Index. Results Data of 166 patients were analysed, of whom 61 had experienced at least one readmission. Adjusting for age, number of preadmission medications and mortality resulted in the most informative regression model, based on the lowest Akaike information criterion (adjusted odds ratio 0.981, 95% confidence interval 0.964 to 0.998). Conclusion Deprescribing in geriatric inpatients was associated with a reduced readmission risk at three months post-discharge. Trial registration S53664. Keywords Clinical pharmacy · Deprescribing · Older adults · Polypharmacy · Readmissions
Impacts on practice • Deprescribing in geriatric inpatients seems to be associ-
ated with a reduction in risk of readmission. As it has been shown in previous reports to be safe, health care professionals should incorporate it when performing a medication review.
* Laura Hellemans [email protected] 1
Hospital Pharmacy Department, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
2
Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
3
Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
4
Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
• Hospital readmissions have been associated with lower
quality of life among older adults and should therefore be considered as a clinically relevant outcome.
Introduction Multimorbidity is common in older adults and is regularly managed by prescribing multiple medications, frequently leading to polypharmacy. Importantly, older adults are at increased risk for medication-related harm, including unplanned hospital admissions. Deprescribing has been promoted to reduce such iatrogenic harm. It entails the systematic
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